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The mangled extremity score and amputation: Time for a revision
Melissa N Loja1, Amanda Sammann, Joseph DuBose
1From the Department of Surgery (M.N.L., J.D.), Divisions of Vascular and Trauma Surgery, University of California, Davis, Sacramento, California; Department of Surgery (A.S., M.M.K.), University of California, San Francisco, San Francisco, California; Department of Public Health Sciences, Division of Biostatistics (C-S.L.), University of California, Davis, Sacramento, California, Department of Statistics (Y.L.), University of California, Davis, Sacramento, California; Department of Surgery (S.S.), Indiana University School of Medicine, Indianapolis, Indiana; Department of Surgery (T.S., T.E.R.), R Adams Cowley Shock Trauma Center, University of Maryland, Baltimore, Maryland; Department of Surgery (J.B.H.), Center for Translational Injury Research, University of Texas Health Sciences Center Houston, Houston, Texas.
The Mangled Extremity Severity Score (MESS) does not accurately predict amputation in modern extremity injuries. Advances in treatment have diminished its diagnostic value, highlighting the need for new predictive tools.
Area of Science:
- Trauma Surgery
- Orthopedic Surgery
- Vascular Surgery
Background:
- The Mangled Extremity Severity Score (MESS) was developed to predict amputation after extremity injury.
- Its clinical utility has been debated due to mixed reviews over 25 years.
Purpose of the Study:
- To test the hypothesis that MESS does not correlate with amputation rates in a modern, prospectively collected dataset.
- To evaluate the predictive accuracy of MESS in contemporary trauma care.
Main Methods:
- Applied MESS to patient data from the American Association for the Surgery of Trauma PROspective Vascular Injury Treatment registry.
- Analyzed demographic, injury, treatment, and outcome data from 230 lower extremity arterial injury patients (2013-2015).
Main Results:
- A MESS of 8 or greater correlated with longer hospital and ICU stays.
- Limbs with a MESS of 6-8 were more likely to require amputation (18.7%) compared to those with MESS 3-5 (81.3% salvaged).
- After adjusting for confounding factors, MESS did not significantly differentiate between salvaged and amputated limbs; a MESS of 8 predicted amputation in only 43.2% of cases.
Conclusions:
- Therapeutic advancements have reduced the MESS's accuracy in predicting amputation.
- Additional predictors are needed to improve the assessment of amputation risk following severe extremity injuries.