Abstract
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 (Mangled Extremity Severity
Score [MESS]) by measurement of its discrimination in children.
Materials and Methods 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 severe 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 up for 1 year. The discrimination of MESS model in differentiating
of outcome in patients was assessed by calculating the area under the receiver operator
characteristic plot.
Results We evaluated 200 children referred consecutively to our center. The mean MESS in
the amputation group was 7.5 ± 1.59 versus 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 with threshold
of 6.5.
Keywords
Mangled Extremity Severity Score - trauma - children
