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