Comparative evaluation of diagnostic accuracy of MESS and PSI in lower limb amputation following trauma presenting at the National Orthopaedic Hospital, Dala Kano

Abstract

Background: Mangled Extremity Severity Score (MESS) and Predictive Salvage Index (PSI) are two common diagnostic tools used to assess traumatic limb for amputation or salvage. However, there is paucity of local data with regards to accuracy of the tools. Objective: This study is therefore aimed at comparing the accuracy and predictive value of MESS and PSI in lower limb salvage and amputation following trauma in National Orthopaedic Hospital Dala (NOHD), Kano. Methodology: Twenty-three individuals with mangled extremity participated in this hospital-based one-year prospective, interventional study. Socio-demographic data of participants were collected and recorded as well as the severity of the injury at the time of initial presentation using both MESS and PSI by the researcher while the Consulting surgeons went ahead to make their decision as per their clinical routine without any influence from the researcher. Results: Findings of the study showed that MESS has a high sensitivity score of 89% and a low to medium specificity score of 43.8% with a positive predictive value (PPV) of 47.1% while PSI had a high specificity with low to medium sensitivity scores of 81.25% and 55% respectively with a PPV of 62.50%. Conclusion: The result of this study showed that MESS had high sensitivity and low specificity than PSI which had higher specificity and lower sensitivity than MESS in predicting amputation and limb salvage in patients with mangled lower extremity injuries. It is, therefore, recommended that surgeons should use both tools in decision making of limb salvage and amputation for optimal outcomes.