aka MESS
Johansen et al 1990
No score is an absolute predictor of need for amputation, but only acts as a guide
Better to use in conjunction with sensibility of plantar foot & reconstruction needed
Memory Aid
- “VISA gives you double frequent flyer points after 6 hours”
- Vascularity
- Injury
- Shock
- Age
Scoring
| Component | Finding | Points |
|---|---|---|
| Vascularity / limb ischaemia | Poor pulse | 1 |
| Pulseless & poor CR | 2 | |
| Totally avascular | 3 | |
| Score doubled for ischaemia > 6/24 | ||
| Injury (skeletal / soft tissue) | Low energy | 1 |
| Medium energy | 2 | |
| High energy | 3 | |
| Very high energy | 4 | |
| Shock | Systolic BP > 90mmHg | 0 |
| Hypotensive transiently | 1 | |
| Persistent hypotension | 2 | |
| Age (years) | < 30 | 0 |
| 30-50 | 1 | |
| > 50 | 2 |
Original publication Johansen K, Daines M, Howey T, Helfet D, Hansen St Jr. Objective criteria accurately predict amputation following lower extremity trauma. J Trauma. 1990;30(5):568-72; discussion 572-3.
Helfet Clin Orthop 1990:
- Objective criteria can predict amputation after lower-extremity trauma
- MESS was prospectively evaluated
- In 26 lower-extremity open fractures with vascular injury
- 4.00 for the 14 salvaged limbs
- 8.83 for the 12 amputated limbs
- In 26 lower-extremity open fractures with vascular injury
Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.