STUDY FOR THE PREDICTION OF RISK AND CREATION OF A RISK SCORE FOR HIGH ALTITUDE-RELATED ILLNESSES.

A multi-centre prospective evaluation of self-assessed and –reported predictors of risk for high altitude-related illnesses.

Purpose

This questionnaire is for evaluation of the risk for and detection of high altitude-related illnesses, and does not include recommendations for clinical care.

After evaluation in a large, multi-centre prospective study,statistical analysis will be performed to determine a useful subset of these questions to be used to helppredict riskforhigh altitude-related illnesses, such as acute mountain sickness (AMS), high altitude cerebral edema (HACE), and high altitude pulmonary edema (HAPE). The goal is to create a questionnaire that can be easily completed by laypeople, and to use the information to create a risk score that can be generated without any need for clinical examination or objective physiological measurement.

KEN – YOU PROPOSE (BELOW) THAT A SUBJECT SELF-REPORT, AND ALSO THAT AN OBSERVER REPORT ON THE SUBJECT AS WELL. YOU DON’T NEED TO DECIDE NOW, BUT THIS ADDS COMPLEXITY TO THE SITUATION IF YOU WISH FOR THIS TO BE TRULY A “SELF-ASSESSMENT.” PERSONALLY, I THINK IT IS FINE TO HAVE BOTH SELF-REPORTING AND EXTERNAL OBSERVATION REPORTING, BUT THE EXTERNAL OBSERVATION REPORTING SHOULD PROBABLY ONLY BE TO DETERMINE IF SOMEONE IS ACTUALLY BECOMING ILL, AND IS NOT SELF-AWARE. OF THAT SITUATION. WE NEED TO THINK THROUGH THIS VERY CAREFULLY. TAKEN AT THE EXTREME, SOMEONE WHO IS MORE THAN MINIMALLY ILL WITH AMS, HACE, OR HAPE WILL NOT LIKELY TO BE ABLE TO COMPLETE THIS FORM. SO, THIS MAKES THE BASELINE DATA EVEN MORE IMPORTANT AND PERHAPS MANDATES HAVING SOMEONE BEYOND THE SUBJECT BE INVOLVED WITH RECORDING OBSERVATIONS. THIS WILL ULTIMATELY NEED TO BE FACTORED INTO RECOMMENDATIONS THAT ARE MADE ABOUT HOW TO USE THIS NEW SCORING SYSTEM(S).[CG1]

Study Design: cohort study

Accurate follow-up recording is essential.

Subjects will be recruited at any time before travel to high altitude. KEN – DO WE NEED BASELINE DATA? I WOULD SUGGEST THAT THIS MIGHT BE USEFUL. FOR INSTANCE, IF SOMEONE SUFFERS FROM FREQUENT HEADACHES PRIOR TO ASCENT, WE WOULD LIKE TO KNOW THE NATURE AND FREQUENCY OF THESE HEADACHES. SAME THING FOR ALL THE OTHER SYMPTOMS.The duration of each person’s participation will be the length of their journey to the highest altitude attained and for two days thereafter. Questionnaires will be completed at least once per day for the duration of the study. The primary endpoint is two days after reaching the highest altitude, or unplanned descent for any reason. WE WILL NEED AN EASY WAY TO COMPLETE THE QUESTIONNAIRE BOTH ON PAPER AND ELECTRONICALLY.

A record will be kept of all subjects who are recruited into each study. Careful follow-up is essential to ensure that 100% of subjects recruited complete the questionnaires as planned until (a) they complete the planned study period, or (b) they record an unplanned descent.

Results will be analysed to achieve the best possible statistical precision.

Availability

The questionnaire will remain freely downloadable from altitude.org/ams

Reporting

This document was created by volunteers from the international scientific community. It is free to use for any purpose, under the conditions that (a) the source is attributed to the altitude risk prediction study, and (b) at the time of publication of any results of audit or research using this tool, full subject-level data, in an electronically readable format, should be made freely available to the global community. KEN – I WOULD DELETE THIS ENTIRE SECTION AND ITS REQUIREMENTS. WE SHOULD SIMPLY PUT THE QUESTIONNIARE INTO THE PUBLIC DOMAIN AND LET PEOPLE USE IT IF THEY WISH. WE SHOULD CONTROL THIS STUDY AND THE DATA THAT ENTER INTO IT. WE SHOULD NOT CONTROL WHAT PEOPLE WISH TO DO WITH THE TOOL GOING FORWARD AFTER OUR STUDY.

Altitude-related illnessesrisk score (AIRS)v0.23

FOR EVALUATION OF RISK PURPOSES ONLY

Please circle one statement in each row that most closely applies to you.

KEN – HERE IS WHERE I WOULD ADD COMPLETION OF A BASELINE SURVEY. I WILL ALSO INDICATE FURTHER REFINEMENT OF SOME OF THE QUESTIONS.

FOR THE BASELINE HISTORY, I THINK WE SHOULD CONSIDER ADDING:

  1. HAVE YOU PREVIOUSLY SUFFERED FROM:
  2. ACUTE MOUNTAIN SICKNESS
  3. HIGH ALTITUDE CEREBRAL EDEMA (BRAIN SWELLING)
  4. ,HIGH ALTITUDE PULMONARY EDEMA (FLUID IN THE LUNGS)
  5. [CG2]HAVE YOU PREVIOUSLY SUFFERED FROM CHRONIC:
  6. DIZZINESS OR OTHER PROBLEM WITH BALANCE
  7. BREATHLESSNESS OR OTHER REGULAR BREATHING PROBLEM (SHORTNESS OF BREATH, SUCH AS ASTHMA)
  8. BLURRED VISION
  9. SLEEP DISTURBANCE
  10. COUGH
  11. HEADACHES
  12. MIGRAINE
  13. TENSION
  14. OTHER

[CG3]

KEN – HERE ARE ADDITIONAL COMMENTS ABOUT THE FEATURES BELOW. THEY ARE ALL DIRECTED AT ATTEMPTING TO ACHIEVE PRECISION:

  1. THERE IS A DIFFERENCE BETWEEN “NONE” AND “MILD.” “NONE” IS THE TOTAL ABSENCE OF A SYMPTOM. SO, YOU SHOULD HAVE 0,1,2, AND 3. YOU MAY EVEN CONSIDER “4” AS “WORST HEADACHE OF MY LIFE.”
  2. CONSIDER ADDING LOCATION (FOCALITY) OF THE HEADACHE: FRONTAL, TEMPORAL, OCCIPITAL, GLOBAL.[CG4]
  3. CONSIDER ADDING NATURE OF HEADACHE: THROBBING, CONSTANT, INTERMITTENT[CG5]
  4. NAUSEA AND VOMITING NEED TO BE SEPARATED. IN OTHER WORDS, NAUSEA ALONE WITHOUT VOMITING SHOULD BE A CATEGORY, AND THEN VOMITING SHOULD BE CATEGORIZED AS SINGLE EPISODE OR MULTIPLE EPISODES.[CG6]
  5. CONSIDER ADDING LOSS OF APPETITE AS A SYMPTOM. THIS IS DIFFERENT FROM NAUSEA[CG7].
  6. SLEEP SEEMS OK, BUT YOU MIGHT WISH TO INCLUDE SOMETHING LIKE “AWAKENED SPONTANEOUSLY DURING SLEEP FEELING SHORT OF BREATH”[CG8]
  7. WITHIN SLEEP, YOU MAY WISH TO ADD SOMETHING LIKE “AWAKENED FEELING RESTED” VERSUS “AWAKENED NOT FEELING RESTED”
  8. EXHAUSTED SHOULD BE QUALIFIED FOR THE DEGREE OF EXERTION. IF WE ARE LOOKING FOR FATIGUE AT REST OR WITH MINIMAL EXERTION THAT SEEMS OUT OF THE ORDINARY, LET’S BE SPECIFIC ABOUT IT.
  9. COUGH SHOULD BE FURTHER CHARACTERIZED BY NATURE OF COUGH: PRODUCTIVE OF SPUTUM (AND COLOR) VERSUS NON-PRODUCTIVE. WE MAY WISH TO ASK IF THE COUGH IS RELIEVED BY ANYTHING.
  10. COMPARISON WITH OTHERS SEEMS LIKE IT SHOULD HAVE SOME CHARACTERISTICS MENTIONED. IT IS VERY VAGUE AS LISTED. CONSIDER SOMETHING LIKE BEING ABLE TO KEEP UP WITH OTHERS.
  11. [CG9]UNSTEADINESS SHOULD BE CHARACTERIZED BY BALANCE, SELF-PERCEIVED GAIT DISTURBANCE, ANY LOSS OF COORDINATION.
  12. “NONE OR BREATHLESS WALKING UPHILL” SEEMS LIKE AN ODD COMBINATION. SEPARATE THEM. TRY TO QUANTIFY WHAT YOU MEAN BY BREATHLESSNESS (E.G., PERHAPS RESPIRATORY RATE, AIR HUNGER, ETC.)
  13. WE WANT TO KNOW THE AMOUNT OF ASCENT ON A DAY BY DAY BASIS AND CERTAINLY IN THE PRECEDING 24 HOURS PRIOR TO ANY WORSENING IN STATUS. WE WANT TO KNOW THE SLEEP ALTITUDE AS WELL.
  14. DO WE WISH TO KNOW THE DRUGS (AND DOSES) TAKEN FOR ANY REASON ON A DAILY BASIS?
  15. INFECTION COULD USE SOME CATEGORIES: UPPER RESPIRATORY, SKIN, URINE, GASTROENTERIC, AND SO FORTH. WHY “IN THE LAST 7 DAYS?” I WOULD INCLUDE 3 DAYS PRIOR TO THE BEGINNING OF ASCENT AND THEN ON A DAILY BASIS AFTERWARDS.

[CG10]

SELF-ASSESSMENT / 0 / 1 / 2 / SCORE
Headache / None or mild / Moderate headache / Severe headache
Nausea/ Vomiting / None or mild
(not feeling sick) / Moderate nausea / Severe nausea
OR have vomited any time in last 24h[CG11]
Sleep / Good night’s sleep / Moderately disturbed sleep / Terrible night’s sleep
Exhaustion / Not exhausted / Slightly exhausted / Completely exhausted
Cough / No cough / Any cough / Severe cough
Comparison with others / I feel better than most / About average / I feel worse than most
Unsteadiness / None / Slightly unsteady on feet / Very unsteady on feet
Breathlessness / None or breathless walking uphill / Breathless walking slowly on flat surface / Breathless at rest
Past history / No history of HAPE or HACE, or don’t know / I believe I have previously had HAPE or HACE.[CG12]
Speed of ascent in last 3 days / Less than 1000m
< 3280feet / More than 1000m
3280feet / More than 2000m
6560feet
Any infection in last 7 days / None / Recent infection
(eg. cough/cold/ vomiting/ diarrhoea)
Sex / Female / Male
Physical fitness / I’m quite unfit / About average / I’m fitter than most
Other illnesses / No other illnesses / Any other illness for which I currently have a prescription from a doctor
(eg. inhalers, tablets) / I have another illness that normally limits my ability to exercise
Total score:

Altitude Sickness Performance Score (ASPS)

FOR EVALUATION PURPOSES ONLY

Pleaseask another person who is observing you to complete this questionnaire regarding your performance.

KEN – THIS IS A DIFFERENT SURVEY. IT IS AN OBSERVATION OF PERFORMANCE BY ANOTHER PERSON, AND INCLUDES DIFFERENT FEATURES. SO, I THINK IT SHOULD HAVE ANOTHER NAME.

EXTERNAL ASSESSMENT / 0 / 1 / 2 / SCORE
Comparison with others / He/she is doing better than most / His/her performance is about average / He/she is doing worse than most
Breathing / He/she appears out of breath only when walking/climbing uphill / He/she appears to be out of breath when walking on a flat surface / He/she appears to be out of breath at rest
Unsteadiness / He/she is completely steady / He/she seems to be a little unsteady when standing or walking / He/she seems to be quite unsteady when standing or walking
Total score:

Please record your outcomes for today:

OUTCOME ASSESSMENT - TODAY / TICK BOX
CONTINUING AS PLANNED:
CHANGING PLANS DUE TO ILLNESS:
UNPLANNED DESCENT FOR ANY REASON:
IF UNPLANNED DESCENT, PLEASE SPECIFY REASON: / TICK BOX
SUSPECTED HIGH ALTITUDE CEREBRAL EDEMA (HACE)
SUSPECTED HIGH ALTITUDE PULMONARY EDEMA (HAPE)
SUSCPECTED ACUTE MOUNTAIN SICKNESS
ACCIDENT OR INJURY
OTHER REASON (please describe in free text):

[CG1]Agree with Paul on this

[CG2]I agree that you should separate prior hx of AMS, HAPE, and HACE in the questions.

[CG3]I think this is too much information for the purpose of this study. I would keep things simple so that you could make this survey electronic with drop down menus for choices to answer questions. I do not think that self reported medical histories from lay persons will be that useful.

[CG4]Could use a drop down menu for this. It is important information

[CG5]Too much. I would not ask for characterization of pain.

[CG6]Agree, separate nausea and vomiting.

[CG7]agree

[CG8]I think the sleep question is good currently

[CG9]I think this is too specific and will lead to information that we cannot use.

[CG10]I agree with Paul on these.

[CG11]Agree with Paul on separating nausea and vomiting.

[CG12]Agree with Paul on separating HAPE and HACE.