Mangled Extremity Severity Score (MESS)
Predicts amputation after severe lower-extremity trauma.
Inputs
3 of 4Skeletal or soft tissue injury
Limb ischemia
Ischemia longer than 6 hoursDoubles the ischemia points.
Shock
Age
When to use
- Severe lower-extremity trauma with vascular injury.
Pearls and pitfalls
- 7 or higher was associated with amputation; do not use as the sole basis for amputation.
Why use
Structures a difficult decision.
| Criterion | Points |
|---|---|
| Skeletal or soft tissue injury: Low energy (stab, simple fracture) | +1 |
| Medium energy (open or multiple fractures) | +2 |
| High energy (high-speed crash, rifle wound) | +3 |
| Very high energy (plus gross contamination) | +4 |
| Limb ischemia: None | 0 |
| Reduced or absent pulse, normal perfusion | +1 |
| Pulseless, paresthesias, slow capillary refill | +2 |
| Cool, paralyzed, numb | +3 |
| Shock: SBP always above 90 | 0 |
| Transient hypotension | +1 |
| Persistent hypotension | +2 |
| Age: Under 30 | 0 |
| 30–50 | +1 |
| Over 50 | +2 |