Self-Assessment of Acute Mountain Sickness in Adolescents: A Pilot Study☆

Imray, Christopher; Kennedy, Caroline; Pattinson, Kyle T.S.; Brearey, Stephen; Wright, Alex

doi:10.1580/1080-6032(2004)15[202:soamsi]2.0.co;2

Cited by 21 publications

(32 citation statements)

References 20 publications

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“…We found no significant difference in the incidence of AMS (defined as LLS >3, validated in adolescents3) between young people and adults on any day, supporting previous studies 4. The proportion of subjects reaching the summit was similar between the two groups, with 110/181 adults and 6/12 children summiting (p = 0.460).…”

supporting

confidence: 87%

Adolescents with altitude: young people do well on Kilimanjaro

Stokes

Kalson

Frost

et al. 2009

Archives of Disease in Childhood

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supporting

confidence: 87%

Adolescents with altitude: young people do well on Kilimanjaro

Stokes

Kalson

Frost

et al. 2009

Archives of Disease in Childhood

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“…Due to battery limitations while trekking, measurements were restricted to once daily in the morning. Subjects completed a self-assessment diary twice daily to elucidate AMS symptomatology using the standardized Lake Louise scoring system (LLSS) (Imray et al, 2004). This comprises 4 graded responses (0 ϭ none, 3 ϭ severe) to 5 symptoms: headache, gastrointestinal symptoms, fatigue, dizziness, and difficult sleeping.…”

Section: Pupillometer Measurement Descriptionmentioning

confidence: 99%

Changes in Pupil Dynamics at High Altitude—An Observational Study Using a Handheld Pupillometer

Wilson

Edsell

Imray³

et al. 2008

High Altitude Medicine & Biology

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Gross pupil dynamics are used as an indirect measure of brain function. Changes in hypoxia and intracranial pressure are thought to alter pupil responses to light. This study assessed a portable handheld pupil measuring device (pupillometer) in the field investigating the changes in pupil size, speed of reaction, and rate of constriction/dilatation with hypoxia induced by changes in altitude. A correlation between pupil dynamics and acute mountain sickness was sought. Seventeen volunteers were studied following acute exposure to 3450 m and then during a trek to 4770 m in Ladakh, India. The pupillometer was used to record maximum and minimum pupil diameter in response to a standard light source with calculation of latency, constriction and dilatation velocities. Acute mountain sickness (AMS) was recorded using Lake Louise self completed questionnaires both in the morning and afternoon on each day. Acute altitude exposure resulted in a significant reduction of percentage change in pupil size (36.5% to 24.1% p=<0.001), significant delay in pupillary contraction (latency; 0.208 to 0.223 seconds p=0.015) and a significant slowing of the rate of contraction (constriction velocity; -2.77 mm/s to -1.75 mm/s p=0.012). These changes reverted to normal during a period of acclimatization. A significant diurnal variation in pupil size was also observed. There was no significant difference between subjects with and without AMS. The handheld pupillometer is a suitable robust tool for monitoring changes in pupil dynamics in the field. With acute exposure to hypobaric hypoxia associated with an ascent to a moderate altitude, there is a general slowing of pupil function which reverts to normal within a few days of acclimatization. There appears to be a marked diurnal variation in pupil size. The measurements clearly demonstrated an effect of hypoxia on cerebral function, but these changes did not relate to moderate AMS.

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“…While not designed for use in children, a recent pilot study of the LLSS suggested that teenagers (15 to 18 yr old) are capable of using the self-assessment tool to identify AMS symptoms (Imray et al, 2004). Most previous studies have suggested that children develop AMS at a rate similar to adults when ascending to comparable altitudes over similar time periods Pollard et al, 2001;Moraga et al, 2002;Yaron et al, 2002).…”

Section: Introductionmentioning

confidence: 99%

Language Used in Lake Louise Scoring System Underestimates Symptoms of Acute Mountain Sickness in 4- to 11-Year-Old Children

Southard

Niermeyer

Yaron

2007

High Altitude Medicine & Biology

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The Lake Louise Scoring System (LLSS) was designed to evaluate adults for symptoms of acute mountain sickness (AMS). The language used in the LLSS may be too complex for young children to comprehend. This study evaluates if age-appropriate language alters the results of AMS diagnostic scores in 4- to 11-yr-old children. With parental help, subjects completed the LLSS and an equivalent Lake Louise Age-Adjusted Symptom Score (LLAASS) daily for 3 days. Measurements were made at 1605 m, in the subjects' homes, without any altitude change. Equivalent questions between the two surveys were assessed for agreement on the day when the most symptoms were recorded for each question. Thirty-seven children (19 girls), ages 4 to 11 yr (mean age 7.4 +/- 2.3 yr) completed the study. Kappa values: headache (kappa = 0.22), gastrointestinal (kappa = 0.34), fatigue (kappa = 0.88), dizziness (kappa = 0.65), and sleep (kappa = 0.88) ranged from fair to very good. The LLAASS resulted in higher mean symptom scores (1.14 +/- 0.98) compared to LLSS questions (0.61 +/- 0.82) (p < 0.01). The AMS diagnostic threshold was reached in 9% (95% CI, 4-16) of measurements using the LLAASS and 4.5% (95% CI, 1.5-10) with the LLSS. The LLSS results in reporting of fewer AMS symptoms in this population when compared with a diagnostic tool using age-appropriate language and/or visual representations. Age-appropriate communication must be used to assess AMS, particularly for headache (the key symptom of AMS) and gastrointestinal symptoms. Young children report symptoms of AMS at baseline without altitude gain; therefore, the AMS diagnostic threshold in this population may require modification.

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Self-Assessment of Acute Mountain Sickness in Adolescents: A Pilot Study☆

Cited by 21 publications

References 20 publications

Adolescents with altitude: young people do well on Kilimanjaro

Adolescents with altitude: young people do well on Kilimanjaro

Changes in Pupil Dynamics at High Altitude—An Observational Study Using a Handheld Pupillometer

Language Used in Lake Louise Scoring System Underestimates Symptoms of Acute Mountain Sickness in 4- to 11-Year-Old Children

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