Mangled Extremity Severity Score (MESS)

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Type Characteristics Injury Points
1 Low Energy Stab wound, simple closed fx, small-caliber GSW 1
2 Medium Energy Open/multilevel fx, dislocation, moderate crush 2
3 High Energy Shotgun, high-velocity GSW 3
4 Massive Crush Logging, railroad, oil rig accidents 4
Shock Group
1 Normotensive Transiently BP Stable 0
2 Hypotensive Prolonged BP unstable in the field but responsive to fluid 1
3 Hypotension SBP <90 mm Hg in the field and responsive to fluid in OR 2
Ischemia Group
1 None Pulsatile, no signs of ischemia 1
2 Mild Diminished pulses without signs of ischemia 2
3 Moderate No dopplerable pulse, sluggish cap refill paresthesia, diminished motor activity  
4 Advanced Pulseless, cool, paralyzed, numb without cap refill 4
Age Group
1 < 30 y/o   0
2 >30  < 50 y/o   1

MESS Score:  six or less consistent with a salvageable limb.  Seven or greater amputation generally the eventual result.

From Helfet DL, Clin Orthop 1990 256:80

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Last reviewed: 09 June 2021