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Nerve Injury, Ischemia, Soft-tissue, Skeletal Injury, Shock, Age (NISSSA)
Mangled Extremity Evaluation
Enter Clinical Data
Provide parameters for nerve injury, ischemia, and tissue damage to see the prediction.
Guidelines & Evidence
Verified
Last Review: 2026
When to Use
The NISSSA score was developed as an expansion of the Mangled Extremity Severity Score (MESS) to improve sensitivity and specificity in predicting the need for primary amputation in severe lower extremity trauma. It adds assessments for Nerve injury and Soft-tissue injury to the original MESS parameters.
Amputation decisions are multidisciplinary. Scoring systems like NISSSA should be used as adjuncts to clinical judgment and never as the sole determinant for life-altering surgery.
Related Scores in Practice
In clinical practice, this assessment is frequently evaluated alongside other validated measures. Depending on the patient's presentation and specific diagnostic requirements, you may also need to utilize the Mess Score, Lsi Score, Psi Score, or the Abi Trauma to formulate a comprehensive care plan.