NCEMI eTools

Mangled extremity severity score
Mangled Extremity Severity Score (MESS) for adults.
Score: 0
Probably viable limb
0-6Probably viable limb
>6Very high likelihood of amputation
(100% predictive in this study)
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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