Outcome and utility of scoring systems in the management of the mangled extremity.

BACKGROUND The role of scoring systems as predictors of amputation and functional outcome in severe blunt extremity trauma was examined. METHODS All severe extremity injuries treated over a 10-year period were scored retrospectively using four scoring systems: Mangled Extremity Syndrome Index (MESI), Mangled Extremity Severity Score (MESS), Predictive Salvage Index (PSI), and Limb Salvage Index (LSI). RESULTS Twenty-three upper (UE) and 51 lower extremity (LE) injuries were evaluated. Sensitivity and specificity, respectively, were MESI 100% and 50%, MESS 79% and 83%, PSI 96% and 50%, and LSI 83% and 83%. For each system, there were no differences between patients with good and poor functional outcomes. CONCLUSION All of the scoring systems were able to identify the majority of patients who required amputation. However, prediction in individual patients was problematic. None of the scoring systems were able to predict functional outcome.

[1]  B. Browner,et al.  The medical and economic impact of severely injured lower extremities. , 1987, The Journal of trauma.

[2]  J. Chibnall,et al.  The Pain Disability Index: factor structure and normative data. , 1994, Archives of physical medicine and rehabilitation.

[3]  M. Merle,et al.  Primary nerve repair in the upper limb. Our preferred methods: theory and practical applications. , 1992, Hand clinics.

[4]  J. Lucke,et al.  The futility of predictive scoring of mangled lower extremities. , 1993, The Journal of trauma.

[5]  R. Burns,et al.  Limb salvage versus traumatic amputation. A decision based on a seven-part predictive index. , 1991, Annals of surgery.

[6]  L. A. Koman,et al.  Salvage of lower extremities following combined orthopedic and vascular trauma. A predictive salvage index. , 1987, The American surgeon.

[7]  R. Gustilo,et al.  Combined orthopedic and vascular injury in the lower extremities: indications for amputation. , 1990, Surgery.

[8]  J R Wheeler,et al.  The mangled extremity syndrome (M.E.S.): a severity grading system for multisystem injury of the extremity. , 1985, The Journal of trauma.

[9]  Raymond C. Tait,et al.  The Pain Disability Index: psychometric properties , 1990, Pain.

[10]  T. Axelrod,et al.  Severe complex injuries to the upper extremity: revascularization and replantation. , 1991, The Journal of hand surgery.

[11]  R H Lange,et al.  Limb reconstruction versus amputation decision making in massive lower extremity trauma. , 1989, Clinical orthopaedics and related research.

[12]  J. Kleinert,et al.  Major limb replantation in children , 1991, Microsurgery.

[13]  T. Tsai,et al.  Comparison of functional results of replantation versus prosthesis in a patient with bilateral arm amputation. , 1987, Clinical orthopaedics and related research.

[14]  Upper limb amputations and prostheses. , 1986, The Orthopedic clinics of North America.

[15]  R. Gustilo,et al.  The management of open fractures. , 1990, The Journal of bone and joint surgery. American volume.

[16]  D. Livingston,et al.  Extent of disability following traumatic extremity amputation. , 1994, The Journal of trauma.

[17]  J H Siegel,et al.  Factors influencing return to work following hospitalization for traumatic injury. , 1987, American journal of public health.

[18]  D. Wisner,et al.  The mangled extremity. When to amputate? , 1991, Archives of surgery.

[19]  K. Johansen,et al.  Objective criteria accurately predict amputation following lower extremity trauma. , 1988, The Journal of trauma.

[20]  R. Beasley,et al.  Present indications and contraindications for replantation as reflected by long-term functional results. , 1981, The Orthopedic clinics of North America.