Table I. Mangled Extremity Severity Score (MESS)
Skeletal/soft-tissue injury  
low energy (stab ; simple fracture ; civilian gunshot wound) 1
medium energy (open or multiple fractures, dislocation) 2
high energy (shotgun; military gunshot wound, crush injury) 3
very high energy (as above, plus gross contamination, 4
soft-tissue avulsion)  
Limb ischaemia  
pulse reduced or absent but normal perfusion 1
pulseless ; paraesthesiae ; reduced capillary refill 2
cool, paralysed, insensate, numb 3
(score doubled for ischaemia longer than six hours)  
Shock  
systolic BP maintained above 90 mmHg 0
transient hypotension 1
persistent hypotension 2
Age (years)  
<30 0
30 to 50 1
>50 2