Mangled Extremity Score Not a Reliable Predictor of Amputation

In a study with results published in the Journal of Trauma and Acute Care Surgery (Vol. 82, No. 3), the PROspective Observational Vascular Injury Treatment (PROOVIT) group found that “Blunt injuries, vessel transection, popliteal injuries, and concomitant nerve and orthopedic injuries were associated with the need for amputation, and were more predictive than an isolated [Mangled Extremity Severity Score] MESS.”

The group employed the PROOVIT database to re-evaluate the MESS after other tests of the scoring system, originally developed in 1990, questioned its validity. Since the introduction of the MESS, researchers have developed alternative scoring systems including the Limb Salvage Index; the Predictive Salvage Index; the Nerve, Injury, Ischemia, Soft-tissue Injury, Skeletal Injury, Shock and Age of Patient Score (NISSA); and the Hannover Fracture Scale. And military surgeons have concluded that the MESS is not useful in battlefield-related injury classification.

“Prehospital use of a tourniquet, damage control, balanced resuscitation, use of vascular shunts to reduce ischemia time, early fasciotomy, aggressive wound care, mircrosurgical abilities, and advanced tissue coverage techniques have all contributed to our increased ability to care for patients with mangled extremities,” they concluded. “We advocate for the use of a team approach to decision making regarding limb salvage rather than the use of a score.”

PROOVIT investigators, funded by the Department of Defense through the National Trauma Institute, continue to evaluate a growing pool of data in order to inform practice decisions and assure the best outcomes for patients with limb-threatening mangled extremities.

“The optimal management of peripheral vascular injury remains a complex issue,” said Joe DuBose, MD, the study primary investigator. “Our effort was designed to re-examine the validity of standardized grading systems in predicting outcome for these injuries. I think the work proved useful in determining that we need additional research on the topic. It is our hope that the further maturation of the PROOVIT registry will provide some much needed answers in this important area of trauma care.”

Read the article in JOT.

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