Objective Criteria Accurately Predict Amputation Following Lower Extremity Trauma

J Trauma. 1990 May;30(5):568-72; discussion 572-3. doi: 10.1097/00005373-199005000-00007.

Abstract

MESS (Mangled Extremity Severity Score) is a simple rating scale for lower extremity trauma, based on skeletal/soft-tissue damage, limb ischemia, shock, and age. Retrospective analysis of severe lower extremity injuries in 25 trauma victims demonstrated a significant difference between MESS values for 17 limbs ultimately salvaged (mean, 4.88 +/- 0.27) and nine requiring amputation (mean, 9.11 +/- 0.51) (p less than 0.01). A prospective trial of MESS in lower extremity injuries managed at two trauma centers again demonstrated a significant difference between MESS values of 14 salvaged (mean, 4.00 +/- 0.28) and 12 doomed (mean, 8.83 +/- 0.53) limbs (p less than 0.01). In both the retrospective survey and the prospective trial, a MESS value greater than or equal to 7 predicted amputation with 100% accuracy. MESS may be useful in selecting trauma victims whose irretrievably injured lower extremities warrant primary amputation.

MeSH terms

  • Adult
  • Amputation*
  • Humans
  • Injury Severity Score
  • Ischemia / complications
  • Ischemia / physiopathology
  • Ischemia / surgery
  • Leg / blood supply
  • Leg Injuries / complications
  • Leg Injuries / physiopathology*
  • Leg Injuries / surgery
  • Middle Aged
  • Prognosis
  • Prospective Studies
  • Retrospective Studies
  • Shock / complications