Clinical application of mangled extremity severity score [MESS] among injured patiens attending emergency department at the main Alexandria University Hospital

ABSTRACT

Management of mangled lower extremity is one of the most challenging problems for a trauma surgeon. The decision of whether to amputate or not and when to amputate is a critical decision. It has surgical, medicolegal, social and psychological importance. Many scoring systems have been devised to facilitate the decision of amputation of an injured extremity. Mangled Extremity Severity Score [MESS] is one of the used scores and it is needed to be evaluated in our country. Of this study was to evaluate the validity of clinical application of MESS for mangled lower limbs and its predictive value in the decision making for injured cases. Fifty patients admitted to the emergency department of the Main Alexandria University Hospital were studied. They were assessed by MESS to have a provisional decision for amputation or conservative treatment. The final decision of conservative treatment or amputation was decided after complete investigations and proper evaluation. In five patients, trials of conservative treatment were done first. The utility of MESS for decision of amputation was assessed. The studied patients were 38 males and 12 females. Their ages ranged between 2.5 and 42 years with a median of 23. 7 +/- 18.]. MESS had a score 7or more than 7for 3lpatients with probability of amputation; and score less than 7 for 19 patients with probability of saving the limb. After complete investigations, trials of revascularization and proper evaluation; amputation was performed for 18 patients. Secondary amputation was done for five of them. The sensitivity of MESS on decision making for amputation was 58% and specificity of the scoring was 63%. Positive predictive value of MESS for amputation was 72% and negative predictive value was 68%. This study showed that MESS has limits for its usefulness and cannot be used as the sole criterion by which amputation decision can be made. With a cooperative multidisciplinary effort with close communication between the trauma, orthopaedic and plastic surgeons, the outcome of mangled lower extremity injuries can be optimized. More limbs could be salvaged by complete evaluation after necessary investigations, continuous surveillance and even operative exploration