Predictive Validity Testing of Severely Injured Limb Scoring Systems

BACKGROUND—To salvage or amputate a severely injured limb is one of the most difficult decisions an orthopedic surgeon may face. We evaluated the efficacy of the different limb injury scoring systems in predicting results of limb saving surgery. Patients AND METHODS—Thirty-one patients with 33 severely injured limbs and arterial damage were studied. The discriminated validity of the four injury-severity scores of lower-extremity, sensitivity, specificity, and Yourdon’s J for predicting amputation were calculated.RESULTS—Eight (24.2%) of the limbs were amputated; seven (88%) amputations were lower extremity, and one (12%) was upper extremity. The modified scoring system: nerve injury, ischemia, soft tissue injury, skeletal injury, shock, and age of patients (NISSSA) demonstrated a high specificity (88%) and sensitivity (87%). CONCLUSION—NISSSA had greater predictive value in damaged lower and upper extremities than other scoring systems.