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Mangled extremity severity score in children.

Mitchell F Fagelman1, Howard R Epps, Mercer Rang

  • 1Department of Orthopaedic Surgery, Loyola University, Chicago, Illinois, USA.

Journal of Pediatric Orthopedics
|February 22, 2002
PubMed
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The Mangled Extremity Severity Score (MESS) accurately predicted outcomes for severe pediatric lower extremity trauma in 93% of limb salvage cases. However, it agreed with surgical decisions in only 63% of amputation cases.

Area of Science:

  • Pediatric Orthopedics
  • Trauma Surgery
  • Limb Reconstruction

Background:

  • Severe lower extremity trauma in children presents complex treatment challenges.
  • The Mangled Extremity Severity Score (MESS) aids in acute management decisions but has limited data in pediatric populations.
  • Existing research on MESS predominantly involves adult or mixed-age cohorts.

Purpose of the Study:

  • To exclusively investigate the efficacy and predictive value of the MESS in pediatric patients with severe lower extremity trauma.
  • To compare MESS predictions with actual clinical outcomes and surgical decisions in children.
  • To determine the utility of the MESS in guiding limb salvage versus amputation in pediatric trauma.

Main Methods:

  • Retrospective analysis of 36 pediatric patients with open lower extremity fractures (grades IIIB and IIIC).

Related Experiment Videos

  • Data collected from two Level 1 pediatric trauma centers.
  • Patients categorized into limb salvage and primary amputation groups based on surgeon decisions; MESS applied retrospectively.

    • Main Results:

    • The MESS demonstrated high accuracy (93%) in predicting outcomes for limbs undergoing salvage procedures.
    • In cases resulting in primary amputation, the MESS agreed with the treating surgeon's decision in 63% of instances.
    • Analysis included 18 grade IIIB and 10 grade IIIC fractures in the salvage group, and 8 limbs in the amputation group.

    Conclusions:

    • The MESS shows significant predictive value for limb salvage in pediatric lower extremity trauma.
    • While useful, the MESS demonstrated less concordance with surgical amputation decisions in this pediatric cohort.
    • The findings support considering the MESS as a valuable tool in the management of severe pediatric lower extremity trauma.