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Evaluation of Mangled Extremity Severity Score (MESS) as a predictor of lower limb amputation in children with trauma
Saba Behdad1, Mohammad Hadi Rafiei, Hadi Taheri
1Department of Animal sciences, Technology University, Isfahan, Islamic Republic of Iran.
Insights
The Mangled Extremity Severity Score (MESS) can help identify children at high risk for lower limb amputation. A MESS score of 6.5 or higher indicates a greater need for limb salvage interventions.
Area of Science:
- Pediatric Orthopedics
- Trauma Surgery
- Limb Reconstruction
Background:
- Managing severely injured lower limbs in children is challenging.
- Limb salvage prediction models are crucial for trauma patients.
- Validating the Mangled Extremity Severity Score (MESS) in pediatric cases is essential.
Purpose of the Study:
- To validate the discrimination power of the MESS in predicting limb salvage versus amputation in pediatric lower limb trauma.
- To assess the effectiveness of MESS in identifying children at high risk for amputation.
Main Methods:
- Retrospective analysis of hospital records for children with lower extremity open fractures (September 2009-2010).
- Inclusion criteria: specific open fracture grades and multi-organ system injuries.
- MESS calculated for limb injury severity; patients followed for 1 year; discrimination assessed using ROC curve analysis.
Main Results:
- Evaluated 200 children; amputation rate was 7.5%.
- Mean MESS was higher in the amputation group (7.5) vs. limb salvage group (6.4) (p=0.04).
- Optimal discriminator power achieved with MESS ≥ 6.5 (sensitivity 73%, specificity 54%).
Conclusions:
- MESS can identify pediatric patients at high risk for amputation.
- A MESS threshold of 6.5 allows for early intervention planning.
- Facilitates timely implementation of specific measures for limb salvage in pediatric trauma.
Background:
Management of the severely injured lower limb in children remains a challenge despite advances in surgical techniques. Models that predict the risk of lower limb trauma patients are designed to provide an estimation of the probability of limb salvage. In this study, we validate Mangled Extremity Syndrome Index (Mangled Extremity Severity Score [MESS]) by measurement of its discrimination in children.
Materials And Methods:
From September 2009 to 2010, we collected the hospital records of all children who presented with lower extremity long bone open fractures. The inclusion criteria were I grade, II B, III C open fractures, severe injury to three of four organ systems, and severe injury to two of four organ systems with minor injury to two of four systems that require surgical interventions. Severity of limb injury was measured using MESS. Patients were followed up for 1 year. The discrimination of MESS model in differentiating of outcome in patients was assessed by calculating the area under the receiver operator characteristic plot.
Results:
We evaluated 200 children referred consecutively to our center. The mean MESS in the amputation group was 7.5 ± 1.59 versus 6.4 ± 2.02 in the limb salvage group (p = 0.04). Amputation rate was 7.5% (n = 15). Percentages of skeletal/soft-tissue injury was different between groups (p = 0.0001). Children in the amputation group showed more tissue injury compared with limb salvage group. The best clinical discriminator power was calculated as MESS ≥ 6.5 (sensitivity = 73%, specificity = 54%).
Conclusion:
We assumed that patients with a high risk of amputation can be identified early, and specific measures can be implemented immediately by using MESS with threshold of 6.5.
