MESS Mangled Extremity Severity Score Calculator
- Interpretation guidance
The Mangled Extremity Severity Score is the sum of four component scores skeletal and soft tissue injury limb ischemia shock and patient age. A multiply of the limb ischemia component is applied when warm ischemia time exceeds six hours leading to a higher effective ischemia contribution in the total. Historically total scores of seven or greater have been associated with a high likelihood of primary amputation while lower totals have been associated with likely limb salvage. Use this score as one element of clinical decision making and not as the sole determinant of definitive management. Clinical judgement patient comorbidity and institutional capability must be integrated in any limb salvage decision.
Practical note
When ischemia time is greater than six hours consider the ischemia score doubled for the purpose of the total MESS calculation. Remember that this score was developed as an aid to prediction and should not replace careful multidisciplinary evaluation of the injured limb.
MESS Mangled Extremity Severity Score Explanation and Clinical Context
The Mangled Extremity Severity Score is a prediction aid originally developed to assist clinicians in early decision making about limb salvage versus primary amputation for severe lower extremity trauma. The score uses four domains skeletal and soft tissue injury limb ischemia shock and patient age to generate a numeric total. When warm ischemia exceeds six hours the limb ischemia component is doubled before summation to reflect the higher risk of irreversible tissue injury. Historically a total of seven or greater has been associated with a high probability that amputation will be required but this threshold is a guide not an absolute rule and must be interpreted in the context of clinical findings and available resources.
Reference
Johansen K et al Mangled extremity severity score original description and utility and subsequent validation literature.
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