Ray HM, et al. - Researchers analyzed 108 patients who were admitted between September 1999 and July 2015 and had undergone infrainguinal arterial bypass for trauma at a single level I trauma center for assessing the predictors of poor outcomes in these patients. Age >40 years, Mangled Extremity Severity Score (MESS) ≥7, blunt mechanism, popliteal artery injury, and below-knee target vessel were univariate risk factors for poor outcome. The MESS was identified as a significant predictor of poor outcomes in infrainguinal bypass for trauma. They noted poor outcomes >50% of the time when MESS was ≥9 and >75% of the time when MESS was ≥11. Whereas nerve and soft tissue damage and other comorbidities were identified influencing the amputation vs revascularization decision, the MESS may assist in framing the data for the clinician and can help in decision-making. When MESS is ≥9, patients and family should understand that poor outcomes are more frequent. Consideration to primary amputation can be given for patients with MESS ≥11.