The Mangled Extremity Syndrome Index (MESI) is a grading system for limbs showing the Mangled Extremity Syndrome (MES). This can help in objectively planning treatment and can aid in the decision to amputate a severely mangled limb. The study was done at the Eastern Virginia Medical School in Norfolk, Virginia.
Parameters:
(1) injury severity score (ISS)
(2) integument
(3) nerve
(4) vascular, artery
(5) vascular, vein
(6) bone
(7) lag time
(8) age
(9) pre-existing disease
(10) shock
|
Parameter |
Single Finding |
Points |
|
injury severity score (ISS) |
0 – 25 |
1 |
|
|
26 - 50 |
2 |
|
|
> 50 |
3 |
|
lag time |
hours from injury to treatment |
(hours – 6) |
|
age |
< 40 years |
0 |
|
|
40 – 50 years |
1 |
|
|
50 – 60 years |
2 |
|
|
60 – 70 years |
3 |
|
shock |
no |
0 |
|
|
yes |
2 |
(from Table II, page 1148)
|
Parameter |
Multiple Potential Findings |
Points |
|
integument |
no injury |
0 |
|
|
guillotine |
1 * (number of injuries) |
|
|
crush and/or burn |
2* (number of injuries) |
|
|
avulsion and/or degloving |
3* (number of injuries) |
|
nerve |
no injury |
0 |
|
|
contusion |
1* (number of injuries) |
|
|
transection |
2* (number of injuries) |
|
|
avulsion |
3* (number of injuries) |
|
vascular, artery |
no injury |
0 |
|
|
transected |
1* (number of injuries) |
|
|
thrombosed |
2* (number of injuries) |
|
|
avulsed |
3* (number of injuries) |
|
vascular, vein |
no injury |
0 |
|
|
injury |
1* (number of injuries) |
|
bone |
no injury |
0 |
|
|
simple fracture |
1* (number of injuries) |
|
|
segmental fracture |
2* (number of injuries) |
|
|
segmental-comminuted fracture |
3* (number of injuries) |
|
|
segmental-comminuted fracture with bone loss <= 6 cm |
4* (number of injuries) |
|
|
segmental-comminuted fracture > 6 cm |
5* (number of injuries) |
|
|
segmental fracture intra-extra articular |
5* (number of injuries) |
|
|
segmental fracture intra-extra articular with bone loss <= 6 cm |
6* (number of injuries) |
|
|
segmental fracture intra-extra articular > 6 cm |
7* (number of injuries) |
|
pre-existing disease |
none |
0 |
|
|
number present |
(number of diseases) |
where:
• Table II shows an overlap in the ISS with ranges 0 – 25 and 25 – 50; I made the second 26 – 50.
• Table II shows the following "** Bone loss greater than 6 cm, add 1". No other "**" is in the table. My guess is that this refers to (a) segmental-comminuted fracture, and (b) segmental fracture intra-extra articular. The latter is listed as "> 6 cm" in the printed table; my guess is that it should be "< 6 cm". I've used these assumptions in the above table.
• The age ranges overlap in the table. Age > 70 is not included in the table.
• The point assignment for patients in Table II show that some of the injuries occurred multiple times, each of which is scored separately.
MESI =
= SUM(points for 4 parameters with single value) + SUM(all points for 6 parameters with multiple potential values)
Interpretation:
• minimum score: 1 (unlikely to have a mangled extremity)
• maximum score: > 62 (varies with lag time).
• A limb with an index < 20 can usually be salvaged; an index > 20 usually indicates that limb salvage is improbable. I am assuming that 20 is indeterminate.
Limitation:
• The score was developed in 1985. Advances in management may have increased the scores where salvage can be achieved.
Specialty: Surgery, orthopedic, Emergency Medicine, Critical Care, Surgery, general
