The MangLE score: A novel simple tool to identify patients who are unlikely to require amputation following severe lower extremity injury.

IF 2.9 2区医学 Q2 CRITICAL CARE MEDICINE Journal of Trauma and Acute Care Surgery Pub Date : 2024-11-07 DOI:10.1097/TA.0000000000004453

Maximilian Peter Forssten, Bruno Coimbra, Mary Matecki, Saundra Godshall, Yang Cao, Shahin Mohseni, Babak Sarani

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Abstract

Background: There are no validated and sensitive models that can guide the decision regarding amputation in patients with mangled lower extremities. We sought to describe a simple scoring model, the Mangled Lower Extremity (MangLE) score, which can predict those who are highly unlikely to need an amputation as a means to direct resources to this cohort.

Methods: This is a retrospective study using the 2013-2021 American College of Surgeons Trauma Quality Improvement Program data set. Adult patients with a mangled lower extremity, defined as a crush injury or a fracture of the femur or tibia combined with severe soft tissue injury, arterial injury, or nerve injury, were included. Patients who suffered a traumatic lower extremity amputation, underwent amputation within 24 hours of admission, or who died within 24 hours of admission were excluded. Patients were divided into those who did/did not undergo amputation during their hospital stay. Demographics, injury mechanism, Injury Severity Score, and Abbreviated Injury Scale score, initial vital signs, and comorbid conditions were abstracted. A logistic regression model was constructed and the top five most important variables were used to create the score.

Results: The study includes 107,620 patients, of whom 2,711 (2.5%) underwent amputation. The five variables with the highest predictive value for amputation were arterial injury, lower-extremity Abbreviated Injury Scale score of ≥3, crush injury, blunt mechanism, and shock index. The lowest possible MangLE score was 0, and the highest was 15. The model demonstrated an excellent predictive ability for lower extremity amputation in both the development and validation data set with an area under the receiver operating characteristic curve of 0.81 (95% confidence interval, 0.80-0.82) and 0.82 (95% confidence interval, 0.81-0.84), respectively. The negative predictive value for a score of <8 is 99%.

Conclusion: The MangLE score is able to identify patients who are unlikely to require amputation. Resources for limb salvage can be directed to this cohort.

Level of evidence: Prospective and Epidemiologic; Level IV.

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MangLE 评分：一种新型简便工具，用于识别严重下肢损伤后不太可能需要截肢的患者。

背景：目前还没有经过验证的灵敏模型可以指导下肢残缺患者做出截肢决定。我们试图描述一个简单的评分模型，即下肢残缺（Mangled Lower Extremity，MangLE）评分，它可以预测那些极不可能需要截肢的患者，从而将资源导向这一群体：这是一项使用 2013-2021 年美国外科医生学会创伤质量改进计划数据集进行的回顾性研究。研究纳入了下肢粉碎性骨折的成年患者，其定义为股骨或胫骨挤压伤或骨折合并严重软组织损伤、动脉损伤或神经损伤。外伤性下肢截肢、入院 24 小时内接受截肢手术或入院 24 小时内死亡的患者不包括在内。患者分为住院期间截肢和未截肢两种情况。研究人员对患者的人口统计学特征、受伤机制、受伤严重程度评分、简易伤害量表评分、初始生命体征和合并症进行了抽象分析。建立了一个逻辑回归模型，并使用前五个最重要的变量来创建评分：研究包括 107,620 名患者，其中 2,711 人（2.5%）接受了截肢手术。对截肢预测价值最高的五个变量是动脉损伤、下肢简易损伤量表评分≥3分、挤压伤、钝性机制和休克指数。MangLE 评分的最低值为 0，最高值为 15。在开发数据集和验证数据集中，该模型对下肢截肢的预测能力都非常出色，接收器操作特征曲线下面积分别为 0.81（95% 置信区间，0.80-0.82）和 0.82（95% 置信区间，0.81-0.84）。得分的阴性预测值为结论：MangLE 评分能够识别不太可能需要截肢的患者。可将用于肢体挽救的资源用于这一群体：证据级别：前瞻性和流行病学；IV 级。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Trauma and Acute Care Surgery 医学-外科

CiteScore

6.00

自引率

11.80%

发文量

637

审稿时长

2.7 months

期刊介绍： The Journal of Trauma and Acute Care Surgery® is designed to provide the scientific basis to optimize care of the severely injured and critically ill surgical patient. Thus, the Journal has a high priority for basic and translation research to fulfill this objectives. Additionally, the Journal is enthusiastic to publish randomized prospective clinical studies to establish care predicated on a mechanistic foundation. Finally, the Journal is seeking systematic reviews, guidelines and algorithms that incorporate the best evidence available.