The Predictive Salvage Index (PSI) can be used to evaluate a lower extremity that has undergone trauma with orthopedic and vascular injuries. This can help separate those limbs with a reasonable chance for salvage from those that have a poor outcome. The authors are form Wake Forest University in Winston-Salem, North Carolina.
Parameters:
(1) level of arterial injury
(2) degree of bone injury
(3) degree of muscle injury
(4) interval from injury until arrival in the operating room
|
Tissue Injury |
Findings |
Degree |
|
bone |
transverse fracture with possible butterfly component; simple oblique fracture; fracture dislocation of joint |
mild |
|
|
comminuted fracture over 2-5 cm |
moderate |
|
|
comminuted fracture > 5 cm; or segmental loss |
severe |
|
muscle |
laceration of one or more muscles in a single compartment; no significant crush component |
mild |
|
|
laceration of one or more muscles in 2 compartments; crush-revulsion component |
moderate |
|
|
laceration of one or more muscles in 3 or 4 compartments |
severe |
|
Parameter |
Findings |
Points |
|
level of arterial injury |
suprapopliteal |
1 |
|
|
popliteal |
2 |
|
|
infrapopliteal |
3 |
|
degree of bone injury |
mild |
1 |
|
|
moderate |
2 |
|
|
severe |
3 |
|
degree of muscle injury |
mild |
1 |
|
|
moderate |
2 |
|
|
severe |
3 |
|
interval before surgery |
< 6 hours |
0 |
|
|
6 – 12 hours |
2 |
|
|
> 12 hours |
4 |
predictive salvage index =
= SUM(points for all 4 parameters)
Interpretation:
• minimum score: 3 (based on the point assignments; if no vascular, bone or muscle injury then the score could reach 1, but then it would not be a seriously injured limb)
• maximum score: 13
• The higher the score the worse the chances for a successful limb salvage.
|
PSI |
Outcome |
|
<= 7 |
good (12 of 14 limbs salvaged |
|
>= 8 |
poor (7 of 7 amputated) |
Performance:
• Sensitivity 78% with specificity 100%.
Specialty: Surgery, orthopedic, Emergency Medicine, Critical Care, Surgery, general
ICD-10: ,
