Comparative Evaluation of Diagnostic Accuracy of MESS and PSI in Lower Limb Amputation Following Trauma Presenting at the National Orthopaedic Hospital, Dala Kano (original) (raw)

Salvage versus amputation: Utility of mangled extremity severity score in severely injured lower limbs

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.

An evaluation of the clinical utility of mangled extremity severity score in severely injured lower limbs

International Journal of Research in Medical Sciences, 2016

Background: The management of severe lower limb injury is one of the most controversial subjects in the field of Orthopedic surgery. While the advancement of sophisticated microsurgical reconstruction technique has created the possibility of successful limb salvage in even the most extreme cases, it has become painfully obvious that the technical possibilities are double-edged swords. The aim of study was to analyze and ascertain the clinical utility of mangled extremity severity score (MESS) in severely injured lower limbs. Methods: The current study was undertaken in the Department of Orthopedics among 50 patients who sustained high-energy injuries and approached a tertiary care center to seek care. The study design included both retrospective and prospective evaluation. Retrospectively 25 and prospectively 25 lower limbs in 54 patients with high-energy injuries were evaluated using mangled extremity severity score to assist in the decision-making process for the care of patients with such injuries. MESS served as study tool. Differences between the mean MESS scores for amputated and salvaged limbs were explored. Results: Crush injury of leg with fracture of tibia and fibula was observed in 78% of injured limbs. The most common mechanism of injury was high-energy trauma. Road traffic accidents accounted for 72% of patients. Mean hospitalization for primary amputation was 19.3 (8-26) days and for delayed amputation limbs was 36.6 (15-62) days and for salvaged limbs was 45.5 (14-128) days. In the prospective study, out of 7 injured limbs with a MESS score of equal or more than 7, 6 limbs were amputated and 1 limb was salvaged. Out of the remaining 18 injured limbs with a MESS score of less than 7, 17 limbs were successfully salvaged and one limb was amputated. In the retrospective study, 10 injured limbs with a MESS score of equal or more than 7 were amputated (mean score 8.4 with range of 10-8) and the remaining 15 injured limbs with a MESS score of less than 7 were salvaged (mean score 4.57 with range of (4-6)); suggesting a significant difference in the mean scores. Conclusions: MESS is a cost-effective, relatively simple and readily available scoring system, which assists the surgeon to identify variables that may ultimately influence the outcome of a severely traumatized extremity with arterial compromise due to high-energy injury.

The Mangled Extremity Severity Score Fails to be a Good Predictor for Secondary Limb Amputation After Trauma with Vascular Injury in Central Europe

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.

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 ...

Preliminary Results of a Prospective Study on Severe Lower Limb Trauma: Analysis of Laboratory Tests as Predictors of Amputation

Panamerican Journal of Trauma, Critical Care & Emergency Surgery, 2013

The decision of either preserving a member or primary amputation (PA) in severe extremity trauma, especially in the presence of fractures, vascular injuries or serious injuries of soft tissues has always been a challenge for the trauma surgeon. The initial assessment with objective criteria like indexes, such as the Mangled Extremity Severity Score (MESS) or the PSI, can aid in the differentiation of members that can be saved or should be amputated primarily. We report on the design and preliminary results of our ongoing prospective study analyzing laboratory test as predictors of amputation in severe lower limb trauma. Materials and methods: All patients treated in our emergency department with severe lower limb trauma and open fractures (classified as Gustilo III) were included in this study. We collected blood for laboratory test of all patients at admission. All injured limb were photographed for posterior analysis and MESS classification. Results: From March 15, 2012, to June 10, 2012, n = 20 patients were included in our study. PA was performed in eight (40%) and preserving procedures (PP) in 12 (60%). Mean age was 30 in PP group and 40.5 in PA. Mean systolic pressure at the emergency room was 130 mm Hg in PP and 107 mm Hg in PA. MESS index was calculated for all patients and the means were 5 for the PP group and 8 for the PA group. Laboratory test of the two groups were compared and statistically analyzed. Acidosis, arterial lactate levels and hemoglobin levels at admission had a statistical difference between the two groups: pH = 7.36 PP vs 7.18 PA (p = 0.001); lactate: PP = 25 vs PA = 63 (p < 0.001); hemoglobin: PP = 13.6 vs PA = 7.85 (p = 0.03). Conclusion: Laboratory results of tests collected during initial assessment of patients with severe lower limb trauma are different between those submitted to PA or a PP.

Predictive factors for primary amputation in trauma patients in a Nigerian university teaching hospital

East African Medical Journal, 2007

The decision to attempt salvage or to amputate a severely injured limb is among the most difficult decision that the orthopaedist must face. Objective: To determine possible predictive factors that could become guides in taking decision for primary amputation as a first line treatment for trauma patients. Design: A prospective study of post-traumatic primary limb amputations. Results: Sixty six traumatised patient limbs were primarily amputated during the study period.

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.

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

The Journal of Bone and Joint Surgery (American), 2008

Background: Lower-extremity injury severity scoring systems were developed to assist surgeons in decision-making regarding whether to amputate or perform limb salvage after high-energy trauma to the lower extremity. These scoring systems have been shown to not be good predictors of limb amputation or salvage. This study was performed to evaluate the clinical utility of the five commonly used lower-extremity injury severity scoring systems as predictors of final functional outcome.