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Updated: Jul 13, 2026

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Application of the Mangled Extremity Severity Score in a combat setting.

Robert M Rush1, Randy Kjorstad, Benjamin W Starnes

  • 1Department of Surgery, Madigan Army Medical Center, Tacoma, WA 98431, USA.

Military Medicine
|August 19, 2007
PubMed
Summary

The Mangled Extremity Severity Score (MESS) effectively predicts amputation in combat casualties. A MESS score over 7 indicates a high likelihood of limb amputation on the battlefield.

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Area of Science:

  • Orthopedic Surgery
  • Trauma Surgery
  • Military Medicine

Background:

  • The Mangled Extremity Severity Score (MESS) is a tool used to assess the severity of extremity injuries.
  • Its utility in combat settings, characterized by high-energy trauma, requires specific validation.

Purpose of the Study:

  • To evaluate the effectiveness of the MESS in predicting limb amputation in a combat environment.
  • To identify key factors influencing MESS scores in battlefield extremity injuries.

Main Methods:

  • Retrospective analysis of extremity injury data from a forward surgical team.
  • Calculation of MESS and Revised Trauma Score for 60 extremities across 49 patients.
  • Statistical comparison of MESS between amputated and salvaged limbs using Student's t test.

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Main Results:

  • A total of 60 extremities from 49 patients were analyzed.
  • MESS values were significantly higher in the 8 amputated extremities (mean 7.87) compared to the 50 salvaged extremities (mean 2.44; p=0.001).
  • 10 major vascular repairs were performed, representing 20% of cases.

Conclusions:

  • A MESS score greater than 7 strongly correlates with amputation, validating its use in combat settings.
  • Ischemic time and shock are critical determinants of limb salvage in young combat casualties with high-energy injuries.