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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.
Insights
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).
- 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.
Abstract:
Treatment of the severely traumatized or mangled lower extremity poses significant challenges. The Mangled Extremity Severity Score (MESS) is a scale that uses objective criteria to assist with acute management decisions. Most research on the MESS has been in adults or combined series with few children. The study was performed to investigate the MESS in children exclusively. The MESS was applied retrospectively to 36 patients with grades IIIB and IIIC open lower extremity fractures collected from two level 1 pediatric trauma centers. Patients were divided into limb salvage and primary amputation groups based on the decision of the treating surgeon. In the salvage group there were 18 grade IIIB fractures and 10 grade IIIC fractures. The MESS prediction was accurate in 93% of the injured limbs. In the amputation group eight limbs met the inclusion criteria; the MESS agreed with the treating surgeon in 63% of cases. These findings suggest the MESS should be considered when managing a child with severe lower extremity trauma.