MESS_Score v.1

A simple rating scale that estimates the viability of an extremity, particularly lower limb after a trauma, helping to determine the need for primary amputation versus salvage.

Rashmi Damodaran

models@cambiocds.com

@CambioCDS

To calculate MESS score and identify candidates for successful salvage limb versus future amputation following extremity trauma

Used to provide an early prognosis on an injured limb at the time of admission to the Emergency Department. Applied to all adult patients and utilizes variables, age, limb ischemia, shock, and mechanism of injury, that are readily obtained without any complicated measurements. Formula: MESS Score is calculated by the addition of selected points of all the four variables. If the limb ischemia is present for > 6 hours, the limb ischemia points are doubled. Criteria Values Points Limb ischemia Reduced pulse but normal perfusion 1 Pulseless, Paresthesias, Slow caplillary refill 2 Cool, Paralysis, Numb/insensate 3 Patient Age Range < 30 0 30-50 1 >50 2 Shock Systolic BP >90mmHg consistently 0 Hypotension Transiently 1 Persistent Hypotension 2 Injury Mechanism Low Energy (Stab, gunshot, simple fracture) 1 Medium Energy (Dislocations, open/multiple fractures) 2 High Energy (High-speed MVA or rifle shot) 3 Very High energy (High-speed trauma with gross 4 contamination) Interpretation: MESS Score < 7 - High likelihood of limb/extremity viability (predictive of salvaged limb but cases of amputation in patients with MESS Score <7 found in validation studies) MESS Score >=7 - Low likelihood of limb/extremity viability (100% sensitive in validation studies)

Every effort must be attempted to salvage the limb in upper extremity injuries. Newer surgical techniques increase the probability of limb salvage, hence a higher cut off for MESS score, perhaps 8 or 9 must be considered.

1. Togawa S, Yamami N, Nakayama H, Mano Y, Ikegami K, Ozeki S. The validity of the mangled extremity severity score in the assessment of upper limb injuries. J Bone Joint Surg Br. 2005 Nov;87(11):1516–9. 2. Johansen K, Daines M, Howey T, Helfet D, Hansen ST. Objective criteria accurately predict amputation following lower extremity trauma. J Trauma. 1990 May;30(5):568–72; discussion 572-573.

OBSERVATION.basic_demographic.v1, OBSERVATION.mangled_extremity_severity_score.v0