Significance of the Mangled Extremity Severity Score in Traumatic Popliteal Artery Injury

OBJECTIVES: The Mangled Extremity Severity Score (MESS) is not routinely utilized; however, failed revascularization remains a vexing problem for clinicians. The objective of this study is to evaluate the significance of MESS in patients with traumatic popliteal artery injury at a civilian Level I Trauma Center.
METHODS: From January 2002 to June 2009, 68 patients with popliteal artery injuries were identified in the Trauma Registry. We conducted a retrospective chart review documenting age, mechanism of injury, orthopedic injury, venous injury, fasciotomy, mangled extremity severity score (MESS), and injury severity score (ISS). Univariate and Multivariate analysis was performed to determine risk factors for amputation.
RESULTS: 70 popliteal artery injuries were identified in 68 patients. Median age was 33 years (range=5,88). 57 (81%) patients were male. 51 (73%) injuries resulted from blunt trauma. Median MESS was 5 (range= 2, 9). 62 (89%) patients had revascularization. 23% of patients had compartment syndrome and 56% of patients had fasciotomy. 15 (21%) patients required amputation: 8 (11%) primary, 7 (10%) secondary.
Four variables were significantly associated with amputation: MESS (OR=2.44, p10 compared to ISS<9 (OR=7.41, p<0.0429); blunt injury (OR=10.69, p=0.0088), and fractures (OR=0.13, p<0.0437). After adjusting for the other 3 predictors, only MESS was significant (P 0.05). Odds of amputation more than doubled for every unit increase in MESS (OR = 2.15, p=0.0021). Odds were similar for primary (OR=2.60, p=0.001) and secondary (OR-2.39, p=0.002) amputation. Odds of amputation increased nearly 50 times (OR=46.64, p=0.0001) for patients with MESS ≥7 compared to patients with a MESS score ≤4.
CONCLUSION: The Mangled Extremity Severity Score should be considered to avoid futile attempts at limb salvage in critically injured patients.