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Duke Orthopaedics
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Wheeless' Textbook of Orthopaedics

Mangled Extremity Severity Score (MESS)



                                                                           - from Johansen, et al. (1990)
Skeletal / soft-tissue injury
     Low energy (stab; simple fracture; pistol gunshot wound): 1
     Medium energy (open or multiple fractures, dislocation): 2
     High energy (high speed MVA or rifle GSW): 3
     Very high energy (high speed trauma + gross contamination): 4
Limb ischemia
     Pulse reduced or absent but perfusion normal: 1*
     Pulseless; paresthesias, diminished capillary refill: 2
     Cool, paralyzed, insensate, numb: 3*
Shock
     Systolic BP always > 90 mm Hg: 0
     Hypotensive transiently: 1
     Persistent hypotension: 2
Age (years)
     < 30: 0
     30-50: 1
     > 50: 2

* Score doubled for ischemia > 6 hours
Limb salvage versus amputation. Preliminary results of the Mangled Extremity Severity Score.


- Discussion:
    - in the report by Bosse, et al (2001), the authors studied the clinical utility of five lower extremity injury-severity scoring systems;
           - 546 high-energy lower-extremity injuries were prospectively evaluated with use of five injury-severity scoring systems for lower-extremity trauma designed to assist in the decision-making process for the care of patients with such injuries;
           - 407 limbs remained in the salvage pathway six months after the injury;
           - the analysis did not validate the clinical utility of any of the lower-extremity injury-severity scores;
           - high specificity of the scores in all of the patient subgroups did confirm that low scores could be used to predict limb-salvage potential;
           - the converse was not true - low sensitivity of the indices failed to support the validity of the scores as predictors of amputation.
           - see tibial defect reconstruction and amputation following tibia fractures
           - A Prospective Evaluation of the Clinical Utility of the Lower-Extremity Injury-Severity Scores



Limb salvage versus amputation. Preliminary results of the Mangled Extremity Severity Score.

Amputations and Artificial Limbs--Symposium: Limb Salvage Versus Amputation: Preliminary Results of the Mangled Extremity Severity Score.

A Prospective Evaluation of the Clinical Utility of the Lower-Extremity Injury-Severity Scores  

To Reconstruct or Not to Reconstruct?

An Analysis of Outcomes of Reconstruction or Amputation after Leg-Threatening Injuries.

Ability of Lower-Extremity Injury Severity Scores to Predict Functional Outcome After Limb Salvage



Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Tuesday, August 7, 2012 3:04 pm