The futility of predictive scoring of mangled lower extremities

Fifty-eight lower limb salvage attempts over a 10-year period were retrospectively scored using the Mangled Extremity Syndrome Index (MESI), Mangled Extremity Severity Score (MESS), Predictive Salvage Index (PSI), and the Limb Salvage Index (LSI). Primary amputations were excluded. Limb salvage fail...

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Bibliographic Details
Published inThe journal of trauma Vol. 34; no. 1; p. 99
Main Authors Bonanni, F, Rhodes, M, Lucke, J F
Format Journal Article
LanguageEnglish
Published United States 01.01.1993
Subjects
Adolescent
Adult
Amputation
Child
Female
Humans
Injury Severity Score
Leg Injuries - classification
Leg Injuries - pathology
Leg Injuries - surgery
Male
Middle Aged
Sensitivity and Specificity
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Summary:Fifty-eight lower limb salvage attempts over a 10-year period were retrospectively scored using the Mangled Extremity Syndrome Index (MESI), Mangled Extremity Severity Score (MESS), Predictive Salvage Index (PSI), and the Limb Salvage Index (LSI). Primary amputations were excluded. Limb salvage failure was defined at four levels, including functional failure 2 years postinjury. Cross-validational sensitivity and specificity analyses revealed no predictive utility in any of the four indices. Although most failed limb salvage attempts could be identified early in the course of management, a significant percentage of our patients suffered prolonged reconstructive efforts. We conclude that efforts must be directed at more precisely determining the factors that aid in the decisions to terminate futile salvage efforts.
ISSN:0022-5282
DOI:10.1097/00005373-199301000-00019