Comparison of Scoring Systems for Assessment of Acute Mountain Sickness

Abstract

The purpose of this study was to compare three commonly used scoring systems of acute mountain sickness (AMS)-the 5-item Lake Louise Self-report (LLS), the 11-item abridged version of the Environmental Symptoms Questionnaire (ESQ-III), and a 100 mm visual analog scale (VAS)-on climbers (N=63; 34.6±9.9 years) making a 1-day ascent of a 5640 m peak after a rest of ~10 h at 4260 m. The prevalence of AMS was 63% when defined as LLS ≥3, 49% when defined as either LLS ≥5 or ESQ-III ≥0.7, and 41% when defined as the combined LLS and ESQ-III criteria. Despite the agreement in prevalence between the LLS ≥5 and ESQ-III ≥0.7, there was a discrepancy in AMS classification in 16% of the cases. A VAS cut-off point corresponding to the combined LLS and ESQ-III criteria was 16 mm. The sensitivity and specificity of the VAS for diagnosing AMS compared to combined LLS and ESQ-III criteria were 85% and 92%, respectively. All of the scoring systems were significantly correlated (τ=0.60 to 0.73, p<0.01); however, residual scores were large. We cannot recommend interchanging the diagnostic results from the LLS, ESQ-III, and VAS, and standardization is needed for the administration of the VAS.

Risk Determinants of Acute Mountain Sickness and Summit Success on a 6-Day Ascent of Mount Kilimanjaro (5895 m)

“…We note the conclusions of others that suggest the best system for AMS assessment remains undetermined and that further work to re-evaluate the optimal cut-offs for research is required. 6,29,30 SUMMIT SUCCESS The rate of summit success in our cohort was high, with 88% reaching Uhuru Peak (5895 m), and 94% achieving Gilman's Point (5861 m) or above. This is in contrast to success rates of 51% and 61% in previous research on 4and 5-day ascents.…”

Does This Patient Have Acute Mountain Sickness?

“…Using an LLQS score of 5 or greater as the reference standard for establishing a diagnosis of AMS (Table 4) Abbreviations: AMS, acute mountain sickness; AMS-C, AMS-Cerebral score; LLQS, Lake Louise Questionnaire Score. The number of studies was too low for meaningful meta-regression of the Hackett clinical score with a different cutoff (Ն2; 4 studies 34,48-50 ), the visual analog scale score (4 studies with only 2 allowing prevalence analysis 45,46 ), the clinical functional score (2 studies 22,47 ), and the LLQS (Ն7 points; 1 study 51 ). c Some studies reported more than 1 instrument at a given altitude, explaining why the total number of studies for pooled analyses is greater than the number of included studies (91).…”

“…The data markers represent the size of each study. For indicative purpose, the few data points available for the instrument-in-comparison studies (visual analog scale score 45,46 and clinical functional score 22,47 ), not included in the meta-regression, are also shown. Detailed results of pooled analyses are shown in Table 2.…”

Acute Mountain Sickness Symptoms Depend on Normobaric versus Hypobaric Hypoxia

“…The second questionnaire, developed by a consensus committee, consists of five self-reported items and is known as the Lake Louise Self-report (LLS) [7]. There is no single gold-standard assessment tool [8, 9] and, unfortunately, the two questionnaires do not always produce the same diagnosis [10]. …”