Mangled Extremity Severity Score

The Mangled extremity severity score is used in patients with trauma to a limb, particularly lower extremity trauma. As the name suggests, it determines how badly the injured limb is. The score applied to mangled extremities such as limbs overrun by vehicles.

It was developed to discriminate between salvageable and the limbs which would require amputation in course of the treatment.

Mangled extremity score, therefore, can provide an early prognosis on the injured limb at the initial assessment.

Calculation of Mangled Extremity Severity Score

Following Parameters are recorded

Limb ischemia  [If Limb Ischemia present > 6 hours, Limb Ischemia Points are multiplied by 2]

•  Reduced pulse but normal perfusion
  • +1

• Pulseless, paresthesiae, slow capillary refill
  • +2
• Cool, paralysis, numb/insensate
  • +3

Patient age

• < 30
  • 0
• 30-50
  • +1
• ? 50
  • +2

Shock

• SBP > 90 mmHg consistently
  • 0
• Transient hypotension
  • +1
• Persistent hypotension
  • +2

Injury mechanism

• Low energy (stab, gunshot, simple fracture)
  • +1
• Medium energy (dislocation, open/multiple fractures)
  • +2
• High energy (high-speed motor vehicle accident or rifle shot)
  • +3
• Very high energy (high-speed trauma with gross contamination)
  • +4

Inference

Patients with a MESS > 7 are likely to require amputation secondary to their limb trauma. With modern surgical skills, the limbs are known to perform better even with  7 scores and some authors advocate revising the cutoff.

The original study for mangled extremity severity was published in 1990 by Dr Johansen and colleagues. The score has been subsequently validated in a retrospective study.

It is worthwhile to mention the observation of original creator that no score is an absolute predictor of need for amputation

Mangled extremity severity score can act only as a guide. It is better to use in conjunction with vascular/soft tissue/ bony reconstruction required.

Amputation is a drastic measure which results in loss of limb. The step cannot be modified at any cost. Therefore, all the changes must be given for a limb to survive and clinical observations must be considered instead of absolute reliance on the scoring system.