Mangled Extremity Severity Score (MESS)

skeletal and soft tissue injury

low energy (stab wounds, simple closed fractures, small caliber gunshot wounds)

1

medium energy (open or multiple level fractures, dislocations, moderate crush injuries)

2

high energy (shotgun blast at close range, high velocity gunshot wound)

3

massive crush injury (logging, railroad or oil rig accidents)

4

shock

normotensive (blood pressure stable in field and in OR)

0

transiently hypotensive (blood pressure unstable in field but responsive to intravenous fluids)

1

prolonged hypotension (systolic blood pressure < 90 mm Hg in field and responsive to intravenous fluid only in the OR)

2

ischemia (<= 6 hours)

none (pulsatile limb without signs of ischemia)

0

mild (diminished pulses without signs of ischemia)

1

moderate (no pulse by Doppler, sluggish capillary refill, paresthesia, diminished motor activity)

2

severe (pulseless, cool, paralyzed, numb, without capillary refill)

3

ischemia (> 6 hours)

none (as above)

0

mild (as above)

2

moderate (as above)

4

severe (as above)

6

age

< 30 years of age

0

>= 30 and < 50 years of age

1

>= 50 years of age

2