# MESS MESS Status: LIVE Price: $0.005 USDC `GET /api/calc/mess` HTML: https://magentlab.com/docs/mess Markdown: https://magentlab.com/docs/mess.md Not a medical device. Not a diagnosis, dose, or listing recommendation. ## What it computes Compute the Johansen 1990 Mangled Extremity Severity Score from caller-assigned skeletal/soft-tissue, limb ischemia, shock, and age integers, doubling ischemia when time exceeds 6 hours, and return the published 0-6 / ≥7 band. ## When to use When an agent has already assigned Johansen 1990 MESS category integers and needs the published total and ≥7 band, not an amputation or limb-salvage decision. ## When not to use - Not a medical device and not an amputation, revascularization, or limb-salvage decision or protocol. - Category integers are caller-assigned. magent does not examine the limb, pulses, perfusion, or blood pressure. - This is Johansen 1990 MESS only. MESS ≥7 predicted amputation with 100% accuracy in that series. It does not use later papers' cutoff of 8. ## Formula ``` MESS = skeletal_soft_tissue (1-4) + limb_ischemia (1-3, doubled if ischemia_over_6h) + shock (0-2) + age_points (<30 → 0, 30-50 → 1, >50 → 2); Johansen 1990 band 0-6 / >=7; max 14 ``` ## Citation [Objective criteria accurately predict amputation following lower extremity trauma](https://doi.org/10.1097/00005373-199005000-00007) Johansen K, Daines M, Howey T, Helfet D, Hansen ST J Trauma. 1990;30(5):568-572 DOI: [10.1097/00005373-199005000-00007](https://doi.org/10.1097/00005373-199005000-00007) ## Worked example ### Low-energy limb, young adult, no shock Given: `age=25, ischemia_over_6h=false, limb_ischemia=1, shock=0, skeletal_soft_tissue=1` 1. skeletal_soft_tissue 1 + limb_ischemia 1 (not doubled) + shock 0 + age 25 → 0 2. Score = 2 (max 14); mess_band 0-6 ### Very high energy and grade-3 ischemia, not doubled Given: `age=25, ischemia_over_6h=false, limb_ischemia=3, shock=0, skeletal_soft_tissue=4` 1. skeletal_soft_tissue 4 + limb_ischemia 3 (not doubled) + shock 0 + age 25 → 0 2. Score = 7 (max 14); mess_band >=7 ## Also searched as - MESS - mangled extremity severity score - Johansen MESS - mangled extremity score - MESS trauma - limb ischemia MESS - MESS ≥7 ## Parameters - `skeletal_soft_tissue` (integer, required): Caller-assigned Johansen 1990 skeletal/soft-tissue energy (integer 1 low, 2 medium, 3 high, or 4 very high). magent does not examine the limb. - `limb_ischemia` (integer, required): Caller-assigned Johansen 1990 limb ischemia (integer 1 pulse reduced but perfusion normal, 2 pulseless with paresthesia, or 3 cool paralyzed insensate). Doubled when ischemia_over_6h is true. - `shock` (integer, required): Caller-assigned Johansen 1990 shock (integer 0 SBP always >90, 1 transient <90, or 2 persistent <90). - `age` (integer, required): Age in years (integer 0-120). Johansen 1990 points: <30 → 0, 30-50 → 1, >50 → 2. Not the adult 18-120 clamp. - `ischemia_over_6h` (boolean, required): true if limb ischemia time is greater than 6 hours (Johansen 1990 doubles the ischemia score). true or false as assigned by the caller. ## Bulk (POST) POST the same path with a JSON items array. The first item is the GET unit; each additional item is $0.002. Invalid items return HTTP 400 before settlement. Method: `POST /api/calc/mess` Max items: 25 Price: unit_amount + extra_item_amount * (n - 1) (unit 5000 atomic, extra 2000 atomic) Status: PREVIEW - 1 to 25 items. Each item uses the same keys as the GET query parameters. - POST of 1 item costs the same as GET. Lists longer than 25: chunk into multiple POSTs. Extra items still execute; do not pad dummy rows. - The first invalid item fails the whole request (index in the 400 JSON). You are not charged. - HTTP 200 is {count, path, items}. Each items[i] is the GET 200 body for that row. - Catalog misses (empty matches, found=false) stay paid 200s inside that slot. - x402 resource URL is this path plus n and body_sha256. Browsers that prefer text/html get the same paywall as GET; Pay retries POST with the same items. Example request: ```json { "items": [ { "age": "25", "ischemia_over_6h": "false", "limb_ischemia": "1", "shock": "0", "skeletal_soft_tissue": "1" }, { "age": "25", "ischemia_over_6h": "false", "limb_ischemia": "1", "shock": "0", "skeletal_soft_tissue": "1" } ] } ``` Human paywall (two-item fixture): https://api.magentlab.com/paywall/bulk/mess Example 200: ```json { "count": 2, "path": "/api/calc/mess", "items": [ { "components": [ { "value": 1, "factor": "skeletal_soft_tissue", "points": 1, "present": true }, { "value": 1, "factor": "limb_ischemia", "points": 1, "present": true, "doubled": false }, { "value": 0, "factor": "shock", "points": 0, "present": false }, { "value": 25, "factor": "age", "points": 0, "present": false } ], "age": 25, "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.", "citation": { "authors": "Johansen K, Daines M, Howey T, Helfet D, Hansen ST", "doi": "10.1097/00005373-199005000-00007", "id": "johansen-1990", "pmid": "2342140", "source": "J Trauma. 1990;30(5):568-572", "title": "Objective criteria accurately predict amputation following lower extremity trauma" }, "formula": "mess", "formula_expression": "MESS = skeletal_soft_tissue (1-4) + limb_ischemia (1-3, doubled if ischemia_over_6h) + shock (0-2) + age_points (<30 → 0, 30-50 → 1, >50 → 2); Johansen 1990 band 0-6 / >=7; max 14", "max_score": 14, "score": 2, "age_points": 0, "ischemia_over_6h": false, "ischemia_points": 1, "limb_ischemia": 1, "mess_band": "0-6", "shock": 0, "skeletal_soft_tissue": 1 }, { "components": [ { "value": 1, "factor": "skeletal_soft_tissue", "points": 1, "present": true }, { "value": 1, "factor": "limb_ischemia", "points": 1, "present": true, "doubled": false }, { "value": 0, "factor": "shock", "points": 0, "present": false }, { "value": 25, "factor": "age", "points": 0, "present": false } ], "age": 25, "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.", "citation": { "authors": "Johansen K, Daines M, Howey T, Helfet D, Hansen ST", "doi": "10.1097/00005373-199005000-00007", "id": "johansen-1990", "pmid": "2342140", "source": "J Trauma. 1990;30(5):568-572", "title": "Objective criteria accurately predict amputation following lower extremity trauma" }, "formula": "mess", "formula_expression": "MESS = skeletal_soft_tissue (1-4) + limb_ischemia (1-3, doubled if ischemia_over_6h) + shock (0-2) + age_points (<30 → 0, 30-50 → 1, >50 → 2); Johansen 1990 band 0-6 / >=7; max 14", "max_score": 14, "score": 2, "age_points": 0, "ischemia_over_6h": false, "ischemia_points": 1, "limb_ischemia": 1, "mess_band": "0-6", "shock": 0, "skeletal_soft_tissue": 1 } ] } ``` ## Response fields - `formula` (string): mess - `formula_expression` (string): Exact expression used - `score` (integer): MESS points 2-14 - `max_score` (integer): 14 - `mess_band` (string): Johansen 1990 band: 0-6 or >=7. MESS ≥7 predicted amputation with 100% accuracy in that series. Not an amputation order. - `skeletal_soft_tissue` (integer): Caller-assigned skeletal/soft-tissue energy 1-4 - `limb_ischemia` (integer): Caller-assigned limb ischemia 1-3 - `shock` (integer): Caller-assigned shock 0-2 - `age` (integer): Caller age in years 0-120 - `age_points` (integer): Johansen 1990 age points 0, 1, or 2 - `ischemia_over_6h` (boolean): Whether the published >6 hour ischemia doubling was applied - `ischemia_points` (integer): Limb ischemia points after the optional >6 hour doubling (1-6) - `components` (array): Per-factor points - `citation` (object): Johansen et al. J Trauma 1990 citation - `disclaimer` (string): Not-a-device notice ## Example JSON Frozen fixture. Not a live lookup. ```json { "components": [ { "value": 1, "factor": "skeletal_soft_tissue", "points": 1, "present": true }, { "value": 1, "factor": "limb_ischemia", "points": 1, "present": true, "doubled": false }, { "value": 0, "factor": "shock", "points": 0, "present": false }, { "value": 25, "factor": "age", "points": 0, "present": false } ], "age": 25, "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.", "citation": { "authors": "Johansen K, Daines M, Howey T, Helfet D, Hansen ST", "doi": "10.1097/00005373-199005000-00007", "id": "johansen-1990", "pmid": "2342140", "source": "J Trauma. 1990;30(5):568-572", "title": "Objective criteria accurately predict amputation following lower extremity trauma" }, "formula": "mess", "formula_expression": "MESS = skeletal_soft_tissue (1-4) + limb_ischemia (1-3, doubled if ischemia_over_6h) + shock (0-2) + age_points (<30 → 0, 30-50 → 1, >50 → 2); Johansen 1990 band 0-6 / >=7; max 14", "max_score": 14, "score": 2, "age_points": 0, "ischemia_over_6h": false, "ischemia_points": 1, "limb_ischemia": 1, "mess_band": "0-6", "shock": 0, "skeletal_soft_tissue": 1 } ``` ## Errors - HTTP 400 `invalid_mess_item`: skeletal_soft_tissue 1-4, limb_ischemia 1-3, and shock 0-2 (Johansen 1990). Returned before settlement; you are not charged. - HTTP 400 `invalid_mess_age`: age must be an integer from 0 to 120 (Johansen 1990 includes children). Returned before settlement; you are not charged. - HTTP 400 `invalid_flag`: boolean clinical flags must be true or false Returned before settlement; you are not charged. - HTTP 400 `invalid_items`: POST body must be a JSON object with only an items array Returned before settlement; you are not charged. - HTTP 400 `invalid_item_count`: items must be an array of 1 to 25 objects Returned before settlement; you are not charged. - HTTP 400 `invalid_item`: each items entry must be a JSON object Returned before settlement; you are not charged. Shared HTTP 402 and 503: https://magentlab.com/docs/payments ## Related tools - [ISS](https://magentlab.com/docs/iss) — Compute the Baker 1974 Injury Severity Score as the sum of squares of the three highest caller-assigned AIS body-region grades, or 75 if any region is AIS 6. - [RTS](https://magentlab.com/docs/rts) — Compute Champion 1989 coded GCS, SBP, and respiratory-rate values, the triage T-RTS sum, and the weighted RTS used for outcome evaluation. - [ABC score](https://magentlab.com/docs/abc-score) — Sum the four Nunez 2009 ABC (assessment of blood consumption) arrival factors and return score_ge_2 at the published ≥2 cutoff. ## Payment Unpaid requests return HTTP 402 even if query parameters or POST items are missing or invalid, so CDP and agents can index the path. After a PAYMENT-SIGNATURE, invalid params return HTTP 400 JSON before settlement. magent does not charge. Fix the params, then request a new 402 quote for that complete URL. Catalog misses (empty matches, found=false) are valid paid 200s. - GET the tool with Accept: application/json (do not send Accept: text/html unless you want the human paywall). - HTTP 402 means you have not paid. Decode the base64 PAYMENT-REQUIRED header. HTTP 503 is not a new quote. - Sign accepts[0] (exact, EIP-3009) with validBefore = now + maxTimeoutSeconds (600 seconds), or accepts[1] (batch-settlement deposit/voucher) on product GET. Ping and POST {items} stay exact. Magent retries transient facilitator 429/5xx before answering. - Retry the same URL with PAYMENT-SIGNATURE (base64 JSON echoing accepted, payload, and extensions when present). - Success is HTTP 200 JSON plus PAYMENT-RESPONSE. exact settles before the tool. batch-settlement verifies (and deposit-settles) before the tool and commits the charge after HTTP 2xx. HTTP 503: retry the same PAYMENT-SIGNATURE. Mint a new exact nonce only after a new HTTP 402. - offered `exact` on eip155:8453: Fixed-price USDC on Base. The buyer authorizes the advertised amount (EIP-3009). magent settles before the tool runs (paymentFlow upfront). extra.assetTransferMethod=eip3009 extra.paymentFlow=upfront. - offered `batch-settlement` on eip155:8453: Payment-channel vouchers claimed later in batches. Exact stays accepts[0]. Same-path POST {items} is still exact. extra.assetTransferMethod=eip3009 extra.paymentFlow=authorization. - not offered `upto`: Not offered. Usage-based: buyer authorizes a ceiling, seller settles the actual amount after work. Reserved for a future metered tool. Not for current calculators or code search. Same-path POST {items} is still scheme exact: one EIP-3009 authorization for GET unit plus $0.002 per extra item. That is not x402 batch-settlement (payment channels / vouchers). Shared HTTP 402 and 503 table: https://magentlab.com/docs/payments Stdio MCP (one process per host): https://magentlab.com/docs/mcp ## Guarantees - HTTP 402 is unpaid, including a missing query. After PAYMENT-SIGNATURE, invalid parameters return HTTP 400 before settlement. You are not charged. - exact: settlement finishes before the tool (paymentFlow upfront). batch-settlement: verify/deposit before the tool; chargedCumulativeAmount commits after HTTP 2xx. Uncertain or failed settlement fails closed (HTTP 503). Retry the same PAYMENT-SIGNATURE. - HTTP 402 is unpaid only. Do not sign a second authorization because of a 503. - Execution is timeout-bounded and concurrency-capped. - Calculator inputs are stored encrypted for allowlisted operators (Magent Console). They are not in public logs, SSH lookups, catalog, or rollups. Request logs store path without query.