LIMB-THREATENING VASCULAR TRAUMA: SEVERITY ASSESSMENT AND OUTCOME ANALYSIS USING MANGLED EXTREMITY SEVERITY SCORE AND LEGAL INJURY CLASSIFICATION

Background: Peripheral vascular injuries (PVIs) are among the most critical trauma presentations in emergency settings, often resulting in limb loss or fatal outcomes. Objective: To evaluate the predictive accuracy of the Mangled Extremity Severity Score (MESS) in determining limb salvage versus amputation, and to analyze its correlation with legal injury classification. Methods: A prospective cohort study of 83 patients with PVIs admitted to Menoufia University Hospitals over one year. Clinical severity was assessed using MESS, and injuries were legally classified as simple, dangerous, or fatal. Outcomes were stratified into limb salvage, amputation, and mortality. Diagnostic accuracy metrics and regression models were applied to identify independent predictors. Results:A MESS threshold of 7 demonstrated strong predictive alignment with limb amputation outcomes, showing complete sensitivity and high specificity. Notably, patients categorized as ‘simple’ injuries consistently presented with lower MESS scores, while fatal outcomes were exclusively associated with scores ≥7 and poorer outcomes. The type of instrument used, the injured vessel, related injuries, and length of hospital stay were the strongest predictors influencing the outcome. Conclusion: MESS is a reliable tool for outcome prediction in PVIs, and its integration with legal classification enhances both clinical decision-making and forensic documentation. The integration of MESS scoring with forensic legal classification offers a multidimensional framework for assessing trauma severity and guiding clinical decision-making. This dual approach not only enhances predictive accuracy but also supports ethically grounded triage in resource-limited settings.