Utility of severity scoring systems for mangled upper limb salvage: A systematic review and meta-analysis
Hidemasa Yoneda1, Shinsuke Takeda2, Masaomi Saeki1
1Department of Human Enhancement and Hand surgery, Nagoya University, Nagoya, Aichi, Japan.
Injury
|February 28, 2024
Summary
Current scoring systems, like the Mangled Extremity Scoring System (MESS), are unreliable for predicting upper limb salvage after severe trauma. These tools should not be used to justify amputation due to poor accuracy in determining limb viability.
Area of Science:
- Orthopedic surgery
- Trauma care
- Decision-making in limb salvage
Background:
- Scoring systems aim to guide decisions on salvaging or amputating mangled extremities.
- The efficacy of these systems for upper limb injuries remains uncertain.
- This study evaluates the predictive accuracy of scoring systems for upper limb salvage.
Approach:
- Systematic literature search of 3 major databases (1985-2022).
- Inclusion criteria: studies on upper extremity limb salvage/amputation outcomes, identified scoring system, and individual treatment results.
- Meta-analysis focused on the Mangled Extremity Scoring System (MESS).
Key Points:
- Ten studies (N=338) involving the Mangled Extremity Scoring System (MESS) were included.
- Pooled sensitivity: 0.95 (0.69-0.99), Specificity: 0.81 (0.65-0.91).
- Area under ROC curve: 0.95 (0.93-0.97); lower specificity noted for isolated vascular injuries.
Conclusions:
- MESS performance for upper limbs is comparable to lower limbs.
- Specificity indicates limb salvage occurred in ~20% of cases with high MESS scores.
- Current scoring systems inadequately predict upper limb salvageability and should not guide amputation decisions.
