Comparison of three grading systems for mangled extremity syndrome: amputation versus salvage

Abstract

Objective To compare the values of the mangled extremity syndrome index （MESI）, the mangled extremity severity score （MESS） and the limb salvage index （LSI） in deciding amputation or salvage in the management of the mangled extremity syndrome （MES）. Methods Clinical data of 353 MES patients including 95 with amputation and 258 with salvage admitted in recent eight years were retrospectively evaluated by using MESI, MESS and LSI, the value of which in deciding amputation or salvage was assessed with receiver operating characteristic （ ROC ）. Results There was statistical difference in aspect of mean scores of three grading systems between patients with amputation or salvage （P〈0. 01）. For MESI, MESS and LSI, the sensitivities was 89.47%, 85.26% and 83.15% respectively, the specificities was 100%, 96.89% and 96.12% respectively, the coincidence was 97.16%,93.76% and 92.63% respectively, the areas under ROC curves was 0. 924, 0905 and 0. 861 respectively and the cut-off points were equal or over 20, 7 and 6 respectively. Conclusions Three scoring systems are all highly capable of predicting early amputation or not in MES management. The MESI is recommended as a quantitative criterion for determining amputation or salvage. Key words: Amputation, traumatic ; Extremities ; Wounds and injuries