An evaluation of the clinical utility of mangled extremity severity score in severely injured lower limbs (original) (raw)
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Indian Journal of Orthopaedics, 2007
Introduction: Massive lower extremity trauma,in particular open tibial fractures with associated vascular injuries, present an immediate and complex decision-making challenge between a limb salvage attempt and primary amputation. Medical and surgical advances of the past two decades have improved the ability to reconstruct severely injured limb. Limbs that once would have been amputated are now routinely managed with complex reconstruction protocol.Mangled extremity severity score is one of the scoring systems to predict the fate of limbs after severe limb injuries. Methods: Patients fulfilling the inclusion criteria were evaluated with MESS, at the same time treatment protocol for management of injuries of lower limb were followed independently by attending orthopedic surgeon. Mean MESS for salvaged and amputated limbs were calculated and its reliability for prediction of fate of injured limb was assessed using software SPSS v16. Result: The age of patient ranges from 10 to 65 yrs with mean age 35.83. The most common mechanism of injury was Road Traffic Accident followed by fall from height. The mean MESS score for salvaged limbs was 4.18 and for amputated limbs was 8.12 suggesting significant difference in mean scores. The sensitivity (the probability that limbs requiring amputation will have MESS at or above 7) was found to be 75%. The specificity of MESS (the probability that salvage limbs will have MESS < 7) was 95.45%. Conclusion: MESS is a reliable indicator in decision making process whether a limb can be salvaged or needs amputation. The mangled lower extremity with the score of less than 7 may be salvaged and 7 or more may need amputation.
World Journal of Surgery, 2019
Background The Mangled Extremity Severity Score (MESS) was constructed as an objective quantification criterion for limb trauma. A MESS of or greater than 7 was proposed as a cutoff point for primary limb amputation. Opinions concerning the predictive value of the MESS vary broadly in the literature. The aim of this study was to evaluate the applicability of the MESS in a contemporary civilian Central European cohort. Methods All patients treated for extremity injuries with arterial reconstruction at two centres between January 2005 and December 2014 were assessed. The MESS and the amputation rate were determined. Results Seventy-one patients met the inclusion criteria and could be evaluated for trauma mechanism and injury patterns. The mean MESS was 4.97 (CI 4.4-5.6). Seventy-three per cent of all patients (52/71) had a MESS \ 7 and 27% (19/71) of C7. Eight patients (11%) underwent secondary amputation. Patients with a MESS C 7 showed a higher, but statistically not significant secondary amputation rate (21.1%; 4/19) than those with a MESS \ 7 (7.7%; 4/52; p = 0.20). The area under the ROC curve was 0.57 (95% CI 0.41; 0.73). Conclusions Based on these results, the MESS appears to be an inappropriate predictor for amputation in civilian settings in Central Europe possibly due to therapeutic advances in the treatment of orthopaedic, vascular, neurologic and soft-tissue traumas.
Revalidation of Mangled Extremity Severity Score in lower limb traumatic vascular injury
Benha Journal of Applied Sciences, 2021
Extreme horrendous lower appendages wounds have been related with high rate of different frameworks included. That is settle on trouble and weight on specialist's dynamic either to sever or protect the harmed appendages. the evaluation of seriousness of injury to the appendage is generally done dependent on abstract rules as opposed to target rules. The error of this strategy drove a few creators to endeavor to measure the seriousness of injury and to propose scores in order to build up mathematical rules .The Mangled Extremity Severity Score (MESS) is presumably the most widely recognized scoring framework utilized. Point revalidation of Mangled Extremity Severity Score (MESS) in lower appendage awful vascular injury. Techniques This is an imminent non randomized investigation, led on 33 patients with serious furthest points wounds that met the measures of the Mangled Extremity Severity Scoring (MESS score at or close to edge (score 7 and score 8) taking care of the Emergency Department (ED) at Benha University Hospital. Result this investigation showed that the most regular influenced vessel was popliteal supply route (54.5%) trailed by PTA (24.2%) at that point ATA and SFA (18.2% for each) and CFA (3.0%) This examination showed that 54.5% showed breaks, 21.2% showed disengagement, 18.2% showed nerve injury and 42.4% showed muscle injury, Mean length of emergency clinic stay was 10 days with standard deviation of 3 days, just 27.3% of study populace went through 2ry removal. Ends the MESS was not prescient of removal Overall with the need of additional revalidation and the chance of appendage rescue for MESS score over the edge in the present of new period in remaking methods.
Application of the Mangled Extremity Severity Score in a combat setting
Military medicine, 2007
The aim of this study was to examine the Mangled Extremity Severity Score (MESS) in a combat setting. Data on extremity injuries were collected from a forward surgical team. MESS and Revised Trauma Score values were retrospectively calculated for each patient. Student's t test was used to compare amputated and salvaged limbs. A total of 60 extremities was identified in 49 patients. There were 10 major vascular repairs (20%). MESS values differed significantly for the eight amputations performed (mean MESS, 7.87 +/- 1.91) and 50 salvaged extremities (mean MESS, 2.44 +/-_ 0.438; p = 0.001). A MESS of >7 correlated with amputation, thus validating the MESS in a combat setting. A young average patient age and high-energy injury mechanism on the battlefield leave ischemic time and shock as the most important factors in dictating whether a MESS is >7 or <7.
Mangled lower extremity: can we trust the amputation scores?
International journal of burns and trauma, 2012
Limb injuries represent a constant and severe problem. Several lower limb injuries are more frequent than upper limb injuries. Over time, in an attempt to quantify the severity of traumas and to establish guidelines for the decision whether to save or amputate a mangled extremity, several scoring systems have been reported. Most refer to bone fractures, soft tissue damage, vascular, nerves and tendon lesions. Articles dealing with mangled lower extremities published in the last 15 years were analyzed. Other inclusion criteriaincluded:articles reporting MESS, PSI, LSI, and Gustillo-Anderson scores, studies based on groups of more than 25 patients, and English language articles. We tried to determine if there was good correlation between amputation recommendations and various scores of injury, with regard to combat wounds and civilian injuries, in adult and pediatric groups. Thirty-two papers fulfilled our criteria; in 17 of these, correlation between mangled extremity scores and the ...
A Prospective Evaluation of the Clinical Utility of the Lower-Extremity Injury-Severity Scores
The Journal of Bone and Joint Surgery American Volume, 2001
Permissions] link. and click on the [Reprints and jbjs.org article, or locate the article citation on to use material from this order reprints or request permission Click here to Background: High-energy trauma to the lower extremity presents challenges with regard to reconstruction and rehabilitation. Failed efforts at limb salvage are associated with increased patient mortality and high hospital costs. Lower-extremity injury-severity scoring systems were developed to assist the surgical team with the initial decision to amputate or salvage a limb. The purpose of the present study was to prospectively evaluate the clinical utility of five lower-extremity injury-severity scoring systems. Methods: Five hundred and fifty-six 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. Four hundred and seven limbs remained in the salvage pathway six months after the injury. The sensitivity, specificity, and area under the receiver operating characteristic curve were calculated for the Mangled Extremity Severity Score (MESS); the Limb Salvage Index (LSI); the Predictive Salvage Index (PSI); the Nerve Injury, Ischemia, Soft-Tissue Injury, Skeletal Injury, Shock, and Age of Patient Score (NISSSA); and the Hannover Fracture Scale-97 (HFS-97) for ischemic and nonischemic limbs. The scores were analyzed in two ways: including and excluding limbs that required immediate amputation. Results: The analysis did not validate the clinical utility of any of the lower-extremity injury-severity scores. The 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, however, was not true. The low sensitivity of the indices failed to support the validity of the scores as predictors of amputation. Conclusions: Lower-extremity injury-severity scores at or above the amputation threshold should be cautiously used by a surgeon who must decide the fate of a lower extremity with a high-energy injury.
BORNO MEDICAL JOURNAL, 2019
Background: Mangled Extremity Severity Score (MESS) and Predictive Salvage Index (PSI) are two common diagnostic tools used to assess traumatic limb for amputation or salvage. However, there is paucity of local data with regards to accuracy of the tools. Objective: This study is therefore aimed at comparing the accuracy and predictive value of MESS and PSI in lower limb salvage and amputation following trauma in National Orthopaedic Hospital Dala (NOHD), Kano. Methodology: Twenty-three individuals with mangled extremity participated in this hospital-based one-year prospective, interventional study. Socio-demographic data of participants were collected and recorded as well as the severity of the injury at the time of initial presentation using both MESS and PSI by the researcher while the Consulting surgeons went ahead to make their decision as per their clinical routine without any influence from the researcher. Results: Findings of the study showed that MESS has a high sensitivity score of 89% and a low to medium specificity score of 43.8% with a positive predictive value (PPV) of 47.1% while PSI had a high specificity with low to medium sensitivity scores of 81.25% and 55% respectively with a PPV of 62.50%. Conclusion: The result of this study showed that MESS had high sensitivity and low specificity than PSI which had higher specificity and lower sensitivity than MESS in predicting amputation and limb salvage in patients with mangled lower extremity injuries. It is, therefore, recommended that surgeons should use both tools in decision making of limb salvage and amputation for optimal outcomes.
Factors Influencing the Decision to Amputate or Reconstruct after High-Energy Lower Extremity Trauma
The Journal of Trauma: Injury, Infection, and Critical Care, 2002
for the LEAP Study Group Background: Factors thought to influence the decision for limb salvage include injury severity, physiologic reserve of the patient, and characteristics of the patient and their support system. Methods: Eligible patients were between the ages of 16 and 69 with Gustilo type IIIB and IIIC tibial fractures, dysvascular limbs resulting from trauma, type IIIB ankle fractures, or severe open midfoot or hindfoot injuries. Data collected at enrollment relevant to the decision-making process included injury characteristics and its treatment, and the nature and severity of other injuries. Logistic regression and stepwise modeling were used to determine the effect of each covariate on the variable salvage/ amputation. Results: Of 527 patients included in the analysis, 408 left the hospital with a salvaged limb. Of the 119 amputations performed, 55 were immediate and 64 were delayed. The multivariate analysis confirmed the bivariate analysis: all injury characteristics remained significant predictors of limb status with the exception of bone loss; and soft tissue injury and absence of plantar sensation were the most important factors in accounting for model validity. Conclusion: Soft tissue injury severity has the greatest impact on decision making regarding limb salvage versus amputation.
Mangled Extremity: Amputation Versus Salvage
Current Trauma Reports, 2015
The mangled extremity is defined as massive anatomic disruption of the bone, muscle, tendon, nerve, vasculature, and/or soft tissue that threatens limb viability and functionality. The clinical team is left with the decision whether to amputate or salvage and reconstruct. The decision should integrate baseline factors (e.g., pre-injury comorbidities, functional status), injury factors (e.g., location and severity of mangled extremity, wound contamination, total burden of traumatic injuries, physiologic severity of illness), patient preference, and available personnel and resources. From the primary survey through the recovery phases, the management is best summarized as "life before limb". Extremity tourniquets are key adjuncts in managing uncontrolled hemorrhage. Amputation or limb salvage, both are associated with risks of long-term disability and unemployment. Management decisions should be patient-centered and multidisciplinary with extensive communication among providers, patients, and families, and should be appropriately documented.