The mangled extremity score and amputation

Abstract

Background The Mangled Extremity Severity Score (MESS) was developed 25 years ago in an attempt to utilize the extent of skeletal and soft tissue injury, limb ischemia, shock, and age to predict the need for amputation after extremity injury. Subsequently, there have been mixed reviews as to the utility of this score. We hypothesized that the MESS, when applied to a data set collected prospectively in modern times, would not correlate with the need for amputation. Methods We applied the MESS to patient data collected in the American Association for the Surgery of Trauma PROspective Vascular Injury Treatment (PROOVIT) registry. This registry contains prospectively collected demographic, diagnostic, treatment, and outcome data. Results Between 2013 and 2015, 230 patients with lower extremity arterial injuries were entered into the PROOVIT registry. The majority were male with a mean age of 34 years (range 4–92) and a blunt mechanism of injury at a rate of 47.4%. A MESS of 8 or greater was associated with a longer stay in the hospital (median 22.5 (15, 29) vs 12 (6, 21), p=0.006) and ICU (median 6 (2, 13) vs 3 (1, 6), p=0.03). 81.3% of limbs were ultimately salvaged (median MESS 4 (3, 5)) and 18.7% required primary or secondary amputation (median MESS 6 (4, 8), p < 0.001). However, after controlling for confounding variables including mechanism of injury, degree of arterial injury, injury severity score, arterial location, and concomitant injuries, the MESS between salvaged and amputated limbs was no longer significantly different. Importantly, a MESS of 8 predicted in-hospital amputation in only 43.2% of patients. Conclusion Therapeutic advances in the treatment of vascular, orthopedic, neurologic and soft tissue injuries have reduced the diagnostic accuracy of the MESS in predicting the need for amputation. There remains a significant need to examine additional predictors of amputation following severe extremity injury. Level of Evidence Level III evidence, prospective study, prognostic.

Major venous injury and large volume crystalloid resuscitation: A limb threatening combination

“…Additionally, we did not consider the extent of soft tissue and bony injury or the Mangled Extremity Severity Score (MESS) that may have been a significant contributor to the need for amputation, but recent literature suggests that advances in therapeutic treatments have put the validity of the MESS for predicting amputation into question. 29 Lastly, resuscitation strategy and use of crystalloid versus blood products was at the discretion of the treating providers and not dictated by any study protocols which could lead to potential study bias not accounted for in our dataset and analyses.…”

Primary vs delayed primary closure in patients undergoing lower limb amputation following trauma: A randomised control study

“…However, in recent studies authors have not been able to achieve great accuracy and have developed alternative scoring systems. As per Loja et al, MESS of eight predicted in‐hospital amputation in only 43.2% of patients. During 2013 and 2015, 230 patients with lower extremity arterial injuries were recruited in the PROOVIT registry.…”

Reporte de un caso: Fractura expuesta del mediopie por accidente de tránsito en paciente VIH/SIDA

“…El puntaje MESS (Mangled Extremity Severity Score) estima la viabilidad de una extremidad después del trauma, para determinar la necesidad de rescate frente a la amputación. Este puntaje se obtiene a partir de la suma de puntos obtenidos en 4 parámetros que son: lesión de huesos y tejidos blandos, isquemia de extremidad, estado hemodinámico y edad (14) . En este caso, se trata de un paciente de 18 años de edad, una presión sistólica sobre 90 mmHg, sin pulso pedio, con sensibilidad en la zona de lesión, y trauma de alta energía por lo que su puntaje total fue de 6 puntos.…”