The Mangled Extremity Severity Score can be used to evaluate patients with lower extremity trauma with vascular compromise. It can help to decide whether to attempt limb salvage or to perform amputation.
Parameters:
(1) extent of skeletal and soft tissue injury
(2) patient's blood pressure
(3) duration and extent of limb hypoperfusion
(4) age of patient
Group |
Finding |
Points |
---|---|---|
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 |
where:
• Scores for ischemia > 6 hours are twice those of <= 6 hours.
mangled extremity severity score =
= (points for skeletal and soft tissue injury) + (points for blood pressure) + (points for ischemia, depending on duration of ischemia) + (points for age)
Interpretation:
• minimum score 1
• maximum score 14
• A score >= 7 is 100% predictive for amputation in the study population.
• A score < 7 can usually be salvaged.
Purpose: To use the Mangled Extremity Severity Score to grade the injury and guide decision making.
Specialty: Surgery, orthopedic, Emergency Medicine, Critical Care, Surgery, general
Objective: severity, prognosis, stage, complications, disability and performance, prevention, surgery
ICD-10: S75, S76, S79, S85, S86, S87, S88,