mAngled eXtremity seVerity Scale

This is the crib sheet they use to decide whether to cut or paste.

Answer: Score: 0 Probably viable limb

Score		Interpretation
0-6		Probably viable limb
over 6		Very high likelihood of amputation (100% predictive in this study)

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Skeletal/Soft Tissue group Low energy (stabs, simple closed fracture, small-caliber gunshot) (1 points) Medium energy (Open or multi-level fracture, dislocation, moderate crush) (2 points) High energy (Close range shotgun, high-velocity gunshot) (3 points) Massive crush (logging, railroad, oil rig accidents) (4 points) Shock Group Normotensive (BP stable in field and in OR) (0 points) Transiently hypotensive (BP unstable in field, but responsive to IV fluids) (1 points) Prolonged hypotension (Systolic BP under 90 mmHg in field and responsive only to fluids in ER) (2 points) Ischemia group None (pulsatile limb w/o ischemia) (0 points) Mild (Diminished pulses w/o signs of ischemia) (1 points) Mild and prolonged (same as mild above, but over 6 hours duration) (2 points) Moderate (No pulse by doppler, sluggish cap refill, paresthesia, weak) (2 points) Advanced (Pulseless, cool, paralyzed, numb, no cap refill) (3 points) Moderate and prolonged (same as moderate above, but over 6 hours duration) (4 points) Advanced and prolonged (same as advanced above, but over 6 hours duration) (6 points) Age Group under 30 years (0 points) 30-49 years (1 points) over 50 years (2 points)

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NOTES:
Mangled Extremity Severity Score (MESS) for adults.

CITATION

Helfet DL et al. in Clinical Orthopaedics and Related Research, 1990, 256:83
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