Session I - Polytrauma

Thurs., 10/5/06 Polytrauma, Paper #4, 2:39 pm

Evaluation of the Clinical Utility of Lower Extremity Injury-Severity Scores and Their Association with Functional Outcomes

Thuan V. Ly, MD1 (n); Thomas G. Travison, PhD2 (n);
Renan C. Castillo, MS3 (n); Michael J. Bosse, MD1 (n);
Ellen J. MacKenzie, PhD3 (n); LEAP Study Group;
1Carolinas Medical Center, Charlotte, North Carolina, USA;
2New England Research Institutes, Watertown, Massachusetts, USA;
3Center for Injury Research & Policy, Johns Hopkins Bloomberg School of
Public Health, Baltimore, Maryland, USA

Purpose: Lower extremity injury-severity scoring systems exist to assist surgeons in decision-making regarding whether to amputate or perform limb salvage after high-energy trauma to the lower extremity. These scoring systems have been shown to not be a good predictor of limb amputation or salvage. However, these scoring systems may be predictive of functional outcomes. This study will evaluate the clinical utility of the five lower extremity injury scoring systems and their association with functional outcomes.

Methods: We analyzed data from a cohort of patients that participated in a multicenter prospective study of clinical and functional outcomes after high-energy lower-extremity trauma. Injury severity was assessed using the Mangled Extremity Severity Score (MESS); the Limb Salvage Index (LSI); the Predictive Salvage Index (PSI); the Nerve Injury, Ischemia, Soft-Tissue Injury, Skeletal Injury, Shock, and Age of Patient Score (NISSSA); and the Hannover Fracture Scale-97 (HFS-97). Functional outcomes were measured using the physical and psychosocial domains of the Sickness Impact Profile (SIP), at both 6 months and 2 years following hospital discharge. 407 subjects whose reconstruction regimens were successful at 6 months contributed to the analysis. We used partial correlation statistics and multiple regression analyses to quantify the association between severity scores and SIP outcomes holding subjects' age constant.

Results: None of the scoring systems were predictive of SIP outcomes at 6 or 24 months to any reasonable degree. Likewise, none were predictive of patient recovery from 6-24 months as measured by change in SIP scores on either of the physical and psychosocial domains. The strongest and most statistically significant association with physical function at 6 months was exhibited by the MESS (r = -0.08, P = .14). We observed little evidence of a difference in outcomes between those reconstruction subjects from whom amputation was recommended by the injury severity scores (MESS 7, PSI 8, LSI 6) and those for whom it was not (MESS <7, PSI <8, LSI <6).

Conclusions/Significance: The injury severity scores are not predictive of functional recovery among patients who undergo successful limb reconstruction.

If noted, the author indicates something of value received. The codes are identified as a-research or institutional support; b-miscellaneous funding; c-royalties; d-stock options; e-consultant or employee; n-no conflicts disclosed, and *disclosure not available at time of printing.
· The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an "off label" use). · · FDA information not available at time of printing.