Objective criteria accurately predict amputation following lower extremity trauma.
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.
Johansen
K
K
Department of Surgery, Harborview Medical Center, University of Washington School of Medicine, Seattle 98104.
Daines
M
M
Howey
T
T
Helfet
D
D
Hansen
S T
ST
D000328:Adult; D000671:Amputation, Surgical; D006801:Humans; D015601:Injury Severity Score; D007511:Ischemia / Q000150:complications / Q000503:physiopathology / Q000601:surgery; D007866:Leg / Q000098:blood supply; D007869:Leg Injuries / Q000150:complications / Q000503:physiopathology* / Q000601:surgery; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012189:Retrospective Studies; D012769:Shock / Q000150:complications