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Severity Score for Limb Injury (MESS)
Local limb ischemia > 6 hours
Local limb ischemia
Pulse decreased but blood flow is normal
No pulse, sensory abnormalities, slow capillary refill
Cold, paralyzed, numb/no sensation
Patient Age
< 30 years
30-50 years
> 50 years
Shock
Systolic pressure > 90 mmHg consistently
Transient hypotension
Persistent hypotension
Musculoskeletal Soft Tissue Injury
Low energy (stab wounds, gunshot wounds, simple fractures)
Medium energy (dislocation, open/multiple fractures)
High energy (close-range gunshot wounds or military firearm injuries, crush injuries)
Very high energy (above injuries with severe contamination, soft tissue avulsion)
MESS Score:
Result Interpretation
MESS score > 7 indicates low limb mobility
References
Objective criteria accurately predict amputation following lower extremity trauma. Johansen, K. Journal of Trauma, 1990.
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