PUBLIC LIBRARY / CALCULATOR

MESS (Mangled Extremity Severity Score)

Grades complex lower limb trauma severity (bone, soft tissue and vascular injury) and helps discuss salvage versus primary amputation.

Calculate with transparency

Check the population, units and version. The result shows the formula or classification; it does not make an automatic treatment decision.

Preparing the form…

Check the method
Enter the data
Check the result

Method · Limits of application

MESS/Johansen 1990: 4 domains, ischemia doubled >6 h; no automatic amputation order

The original MESS was derived in small groups with severe lower-limb trauma. The association of the ≥7 cutoff with amputation in those groups does not establish a universal rule or automatic indication. Limb salvage depends on multidisciplinary assessment and clinical conditions not summarized by the score.

Conditions of use

Check the population, units, inclusion and exclusion criteria, and version in the original source. A result alone does not establish a diagnosis, discharge decision or prescription.

Documented parameters

Skeletal and soft-tissue injury
Limb ischemia
Ischemia for more than 6 hours?
Shock
Age

3/3 reference cases checked. Numerical tests are not clinical validation.

Sources and documentation

Documented formula

Transcribed from the source or a recorded revision; this is not a clinical recommendation.

MESS = skeletal/soft tissue injury (1 to 4) + ischemia (0 to 3, doubled if lasting more than 6 h) + shock (0 to 2) + age (0 to 2).

References

Johansen K et al. Objective criteria accurately predict amputation following lower extremity trauma. J Trauma, 1990.

Identifier: escore-mess

Original clinical content: Brazilian Portuguese.

Method version

MESS/Johansen 1990: 4 domains, ischemia doubled >6 h; no automatic amputation order

escore-mess@native-2026-10-05+7ccb0212004a

Source for the active edition

The bibliographic edition identifies the source. By itself, it proves neither full conformity of the formula nor clinical approval.

Synthetic cases checked (3)

Synthetic cases for checking the implementation, with no patient data.

Case 1

reference-001

Inputs

Skeletal and soft-tissue injury: Medium energy (open or multiple fracture, dislocation)
Limb ischemia: Reduced or absent pulse, normal perfusion
Ischemia for more than 6 hours?: No
Shock: Systolic blood pressure always > 90 mmHg
Age: 30 to 50 years

{
  "energia": "2",
  "isquemia": "1",
  "tempo": "0",
  "choque": "0",
  "idade": "1"
}

Expected result

{
  "score": 4,
  "level": "low"
}

Actual result

{
  "score": 4
}

Case 2

reference-002

Inputs

Skeletal and soft-tissue injury: High energy (high-speed accident, rifle projectile)
Limb ischemia: Absent pulse, paresthesia, slow capillary refill
Ischemia for more than 6 hours?: Yes
Shock: Transient hypotension
Age: < 30 years

{
  "energia": "3",
  "isquemia": "2",
  "tempo": "1",
  "choque": "1",
  "idade": "0"
}

Expected result

{
  "score": 8,
  "level": "high"
}

Actual result

{
  "score": 8
}

Case 3

reference-003

Inputs

Skeletal and soft-tissue injury: High energy (high-speed accident, rifle projectile)
Limb ischemia: Absent pulse, paresthesia, slow capillary refill
Ischemia for more than 6 hours?: No
Shock: Transient hypotension
Age: 30 to 50 years

{
  "energia": "3",
  "isquemia": "2",
  "tempo": "0",
  "choque": "1",
  "idade": "1"
}

Expected result

{
  "score": 7,
  "level": "high"
}

Actual result

{
  "score": 7
}

Code and reproducibility

This tool’s code on GitHub

Download code and tests

Sources, version and reproduction instructions

README

Local installation

Code license: Apache-2.0

Guidelines and conditions

This repository’s license applies to the code. Third-party instruments, questionnaires, data and models remain subject to their owners’ conditions.

The code tests are technical checks. Clinical approval and professional translation review are recorded separately.

Relationship with cancer research

General context — relationship to be defined

A resource for general clinical contexts. This edition does not assign a specific oncological relationship; selecting it for a study requires a justified question, population and purpose.