Evaluation of Mangled Extremity Severity Score (MESS) as a Predictor of Lower Limb Amputation in Children with Trauma

Background:Management of the severely injured lower limb in children remains a challenge despite advances in surgical techniques. Models that predict the risk of lower-limb trauma patients are designed to provide an estimation of the probability of limb – salvage.In this study we validate Mangled Extremity Syndrome Index (MESS) score by measurement of its discrimination in children.Methods and Materials:From September 2009 to 2010 we collected the hospital records of all children who presented with lower extremity long bone open fractures.The inclusion criteria were I grade, II B, III C open fractures, severe injury to three of four organ systems and sever injury to two of four organ systems with minor injury to two of four systems that require surgical interventions. Severity of limb injury was measured using MESS. Patients were followed for one year. The discrimination of EMSS model in differentiating of outcome in patients was assessed by calculating the area under the receiver operator characteristic (ROC) plot.Results:We evaluated 200 children referred consecutively to our center. The mean MESS in the amputation group was 7.5±1.59 vs. 6.4±2.02 in the limb salvage group (P=0.04). Amputation rate was 7.5% (n=15). Percentages of skeletal/soft tissue injury was different between groups (P = 0.0001). Children in the amputation group showed more tissue injury compared with limb-salvage group. The best clinical discriminator power was calculated as MESS ≥ 6.5 (sensitivity = 73%, specificity = 54%).Conclusion:We assumed that patients with a high risk of amputation can be identified early and specific measures can be implemented immediately by using MESS score with threshold of 6.5.