Behdad Saba, Rafiei Mohammad Hadi, Taheri Hadi, Behdad Samin, Mohammadzadeh Mahdi, Kiani Gelare, Hosseinpour Mehrdad
Department of Animal sciences, Technology University, Isfahan, Islamic Republic of Iran.
Eur J Pediatr Surg. 2012 Dec;22(6):465-9. doi: 10.1055/s-0032-1322541. Epub 2012 Aug 17.
Management of the severely injured lower limb in children remains a challenge despite advances in surgical techniques. Models that predict the risk of lower limb trauma patients are designed to provide an estimation of the probability of limb salvage. In this study, we validate Mangled Extremity Syndrome Index (Mangled Extremity Severity Score [MESS]) by measurement of its discrimination in children.
From September 2009 to 2010, we collected the hospital records of all children who presented with lower extremity long bone open fractures. The inclusion criteria were I grade, II B, III C open fractures, severe injury to three of four organ systems, and severe injury to two of four organ systems with minor injury to two of four systems that require surgical interventions. Severity of limb injury was measured using MESS. Patients were followed up for 1 year. The discrimination of MESS model in differentiating of outcome in patients was assessed by calculating the area under the receiver operator characteristic plot.
We evaluated 200 children referred consecutively to our center. The mean MESS in the amputation group was 7.5 ± 1.59 versus 6.4 ± 2.02 in the limb salvage group (p = 0.04). Amputation rate was 7.5% (n = 15). Percentages of skeletal/soft-tissue injury was different between groups (p = 0.0001). Children in the amputation group showed more tissue injury compared with limb salvage group. The best clinical discriminator power was calculated as MESS ≥ 6.5 (sensitivity = 73%, specificity = 54%).
We assumed that patients with a high risk of amputation can be identified early, and specific measures can be implemented immediately by using MESS with threshold of 6.5.
尽管外科技术有所进步，但儿童严重受伤下肢的管理仍然是一项挑战。预测下肢创伤患者风险的模型旨在估计肢体挽救的概率。在本研究中，我们通过测量其在儿童中的辨别力来验证肢体毁损综合征指数（肢体毁损严重程度评分[MESS]）。
2009年9月至2010年，我们收集了所有出现下肢长骨开放性骨折儿童的医院记录。纳入标准为Ⅰ级、ⅡB级、ⅢC级开放性骨折，四个器官系统中的三个严重损伤，以及四个器官系统中的两个严重损伤且四个系统中的两个有轻微损伤需要手术干预。使用MESS测量肢体损伤的严重程度。对患者进行了1年的随访。通过计算受试者操作特征曲线下面积来评估MESS模型在区分患者结局方面的辨别力。
我们评估了连续转诊至我们中心的200名儿童。截肢组的平均MESS为7.5±1.59，而保肢组为6.4±2.02（p = 0.04）。截肢率为7.5%（n = 15）。两组间骨骼/软组织损伤的百分比不同（p = 0.0001）。与保肢组相比，截肢组的儿童显示出更多的组织损伤。最佳临床辨别力计算为MESS≥6.5（敏感性 = 73%，特异性 = 54%）。
我们认为，通过使用阈值为6.5的MESS，可以早期识别截肢高风险患者，并立即实施具体措施。
