This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Letters to the Editor: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when Letters to the Editor are posted
Right arrow Alert me if a correction is posted
Services
Right arrow E-mail this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrowReprints and Permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Bosse, M. J.
Right arrow Articles by Cyril, J. K.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Bosse, M. J.
Right arrow Articles by Cyril, J. K.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us   Add to Technorati  
What's this?
The Journal of Bone and Joint Surgery 83:3 (2001)
© 2001 The Journal of Bone and Joint Surgery, Inc.

A Prospective Evaluation of the Clinical Utility of the Lower-Extremity Injury-Severity Scores

Michael J. Bosse, MD, Ellen J. MacKenzie, PhD, James F. Kellam, MD, Andrew R. Burgess, MD, Lawrence X. Webb, MD, Marc F. Swiontkowski, MD, Roy W. Sanders, MD, Alan L. Jones, MD, Mark P. McAndrew, MD, Brendan M. Patterson, MD, Melissa L. McCarthy, ScD and Juliana K. Cyril, MPH

Investigation performed as part of a larger study (the Lower Extremity Assessment Project) at eight level-I trauma centers in the United States
Michael J. Bosse, MD
James F. Kellam, MD
Department of Orthopaedic Surgery, Carolinas Medical Center, P.O. Box 32861, Charlotte, NC 28232-2861
Ellen J. MacKenzie, PhD
Melissa L. McCarthy, ScD
Juliana K. Cyril, MPH
Center for Injury Research and Policy, Johns Hopkins University School of Hygiene and Public Health, 624 North Broadway, Baltimore, MD 21205
Andrew R. Burgess, MD
Alan L. Jones, MD
The R Adams Cowley Shock Trauma Center, University of Maryland at Baltimore, 22 South Green Street, T3R59, Baltimore, MD 21201-1595
Lawrence X. Webb, MD
Department of Orthopaedic Surgery, Wake Forest University Baptist Medical Center, Medical Center Boulevard, Winston-Salem, NC 27157
Marc F. Swiontkowski, MD
Department of Orthopaedic Surgery, University of Minnesota Medical School, 420 Delaware Street S.E., Box 492, Minneapolis, MN 55455
Roy W. Sanders, MD
Orthopaedic Trauma Service, 4 Columbia Drive, Suite 710, Tampa, FL 33606
Mark P. McAndrew, MD
Department of Orthopaedics and Rehabilitation, Vanderbilt University School of Medicine, 1161 21st Avenue South, Medical Center North, T-4311, Nashville, TN 37232
Brendan M. Patterson, MD
Department of Orthopaedic Surgery, Cleveland MetroHealth Medical Center, 2500 MetroHealth Drive, Cleveland, OH 44109
No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article. Funds were received in total or partial support of the research or clinical study presented in this article. The funding source was Grant RO1-AR42659 from the National Institutes of Arthritis and Musculoskeletal and Skin Diseases, the National Institutes of Health.

Background: High-energy trauma to the lower extremity presents challenges with regard to reconstruction and rehabilitation. Failed efforts at limb salvage are associated with increased patient mortality and high hospital costs. Lower-extremity injury-severity scoring systems were developed to assist the surgical team with the initial decision to amputate or salvage a limb. The purpose of the present study was to prospectively evaluate the clinical utility of five lower-extremity injury-severity scoring systems.

Methods: Five hundred and fifty-six high-energy lower-extremity injuries were prospectively evaluated with use of five injury-severity scoring systems for lower-extremity trauma designed to assist in the decision-making process for the care of patients with such injuries. Four hundred and seven limbs remained in the salvage pathway six months after the injury. The sensitivity, specificity, and area under the receiver operating characteristic curve were calculated for the Mangled Extremity Severity Score (MESS); the Limb Salvage Index (LSI); the Predictive Salvage Index (PSI); the Nerve Injury, Ischemia, Soft-Tissue Injury, Skeletal Injury, Shock, and Age of Patient Score (NISSSA); and the Hannover Fracture Scale-97 (HFS-97) for ischemic and nonischemic limbs. The scores were analyzed in two ways: including and excluding limbs that required immediate amputation.

Results: The analysis did not validate the clinical utility of any of the lower-extremity injury-severity scores. The high specificity of the scores in all of the patient subgroups did confirm that low scores could be used to predict limb-salvage potential. The converse, however, was not true. The low sensitivity of the indices failed to support the validity of the scores as predictors of amputation.

Conclusions: Lower-extremity injury-severity scores at or above the amputation threshold should be cautiously used by a surgeon who must decide the fate of a lower extremity with a high-energy injury.


Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Technorati Technorati    What's this?


This article has been cited by other articles:


Home page
 JBJSHome page
T. V. Ly, T. G. Travison, R. C. Castillo, M. J. Bosse, E. J. MacKenzie, and the LEAP Study Group
Ability of Lower-Extremity Injury Severity Scores to Predict Functional Outcome After Limb Salvage
J. Bone Joint Surg. Am., August 1, 2008; 90(8): 1738 - 1743.
[Abstract] [Full Text] [PDF]

Home page
 JBJSHome page
R. V. O'Toole, R. C. Castillo, A. N. Pollak, E. J. MacKenzie, M. J. Bosse, and the LEAP Study Group
Determinants of Patient Satisfaction After Severe Lower-Extremity Injuries
J. Bone Joint Surg. Am., June 1, 2008; 90(6): 1206 - 1211.
[Abstract] [Full Text] [PDF]

Home page
 INT J LOW EXTREM WOUNDSHome page
S. Matousek, A.K. Deva, and R. Mani
Outcome Measurements in Wound Healing Are Not Inclusive: A Way Forward
International Journal of Lower Extremity Wounds, December 1, 2007; 6(4): 284 - 290.
[Abstract] [PDF]

Home page
 J Am Acad Orthop SurgHome page
E. J. MacKenzie and M. J. Bosse
Factors Influencing Outcome Following Limb-Threatening Lower Limb Trauma: Lessons Learned From the Lower Extremity Assessment Project (LEAP)
J. Am. Acad. Ortho. Surg., September 1, 2006; 14(10): S205 - S210.
[Abstract] [Full Text] [PDF]

Home page
 JBJSHome page
M. J. Bosse, M. L. McCarthy, A. L. Jones, L. X. Webb, S. H. Sims, R. W. Sanders, E. J. MacKenzie, and the Lower Extremity Assessment Project (Leap) Stud
The Insensate Foot Following Severe Lower Extremity Trauma: An Indication for Amputation?
J. Bone Joint Surg. Am., December 1, 2005; 87(12): 2601 - 2608.
[Abstract] [Full Text] [PDF]

Home page
 J Bone Joint Surg BrHome page
V. Z. John, M. Alagappan, S. Devadoss, and A. Devadoss
A completely shattered tibia
J Bone Joint Surg Br, November 1, 2005; 87-B(11): 1556 - 1559.
[Abstract] [Full Text] [PDF]

Home page
 J Bone Joint Surg BrHome page
J. F. Keating, A. H. R. W. Simpson, and C. M. Robinson
The management of fractures with bone loss
J Bone Joint Surg Br, February 1, 2005; 87-B(2): 142 - 150.
[Full Text] [PDF]