Keywords
amputation
MESS
HFS-98
How to Cite
Abstract
Summary. Assessing the severity of ballistic limb injury remains a relevant clinical problem, as it determines the treatment strategy—reconstruction or amputation.
Objective. To determine the diagnostic value of the Mangled Extremity Severity Score (MESS) and Hannover Fracture Scale-98 (HFS-98) as tools for establishing indications for amputation in patients with ballistic injuries of the lower extremity.
Materials and Methods. The study included 177 patients with ballistic injuries of the lower extremity (183 cases) aged 37.0 ± 0.7 years (range 20–63 years). The cohort comprised 174 males and 3 females; the mean time from injury was 284.9 ± 18.7 days. Types of combat trauma included mine-blast injuries (88 cases), shrapnel wounds (86 cases), and bullet wounds (9 cases). Two groups were formed: patients with a reconstructed limb (group I, 89 cases) and those who underwent major amputation (group II, 94 cases). The Gustilo-Anderson classification of open injuries, MESS, and HFS-98 were applied. Convergent validity, discriminative ability, sensitivity, specificity, and diagnostic accuracy of MESS and HFS-98 were studied.
Results. The mean scores of numerical indicators for groups I and II were, respectively, 5.8 and 8.4 for MESS, and 13.2 and 23.1 for HFS-98. The convergent validity between MESS and HFS-98 was 0.85. The discriminative ability (ROC-analysis) was 0.9 for both scoring systems. Sensitivity, specificity, and diagnostic accuracy, according to logistic regression and ROC-analysis, were 0.74, 0.89, and 0.79 at a threshold of ≥ 7 for MESS and 0.82, 0.74, and 0.79 at a threshold of > 17 for HFS-98.
Conclusions. The high diagnostic accuracy and discriminative ability of MESS and HFS-98 support their use for determining indications for amputation in patients with ballistic injuries of the lower extremity. Exceeding the threshold value of ≥ 11 proposed by the developers of HFS-98 requires further investigation.
References
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