Outcome and utility of scoring systems in the management of the mangled extremity.
BACKGROUND
The role of scoring systems as predictors of amputation and functional outcome in severe blunt extremity trauma was examined.


METHODS
All severe extremity injuries treated over a 10-year period were scored retrospectively using four scoring systems: Mangled Extremity Syndrome Index (MESI), Mangled Extremity Severity Score (MESS), Predictive Salvage Index (PSI), and Limb Salvage Index (LSI).


RESULTS
Twenty-three upper (UE) and 51 lower extremity (LE) injuries were evaluated. Sensitivity and specificity, respectively, were MESI 100% and 50%, MESS 79% and 83%, PSI 96% and 50%, and LSI 83% and 83%. For each system, there were no differences between patients with good and poor functional outcomes.


CONCLUSIONS
All of the scoring systems were able to identify the majority of patients who required amputation. However, prediction in individual patients was problematic. None of the scoring systems were able to predict functional outcome.
Durham
R M
RM
Department of Surgery, St. Louis University Medical Center, Missouri 63110-0250, USA.
Mistry
B M
BM
Mazuski
J E
JE
Shapiro
M
M
Jacobs
D
D
D000328:Adult; D000671:Amputation, Surgical; D001134:Arm Injuries / Q000601:surgery*; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D007869:Leg Injuries / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D016896:Treatment Outcome; D014949:Wounds, Nonpenetrating / Q000601:surgery*