Lake Louise Questionnaire for the Symptoms of Acute Mountain Sickness: Difference between revisions
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'''Original Editor '''- [[User:User Name| | '''Original Editor '''- [[User:User Name|Kapil Narale]] | ||
'''Top Contributors''' - {{Special:Contributors/{{FULLPAGENAME}}}} | '''Top Contributors''' - {{Special:Contributors/{{FULLPAGENAME}}}} | ||
</div> | </div> | ||
== Introduction == | == Introduction == | ||
==== Acute Mountain Sickness ==== | ==== Acute Mountain Sickness ==== | ||
Acute Mountain Sickness (AMS) is the most common acute altitude illness that can occur in | [[File:Mountain with landscape.jpeg|thumb]] | ||
[[Acute Mountain Sickness (AMS)]] is the most common acute altitude illness that can occur in [[Acclimatisation|unacclimatised]] individuals at altitudes >2500m. Risk factors include, rate of ascent, altitude of ascent, and individual [[Body Composition|physical characteristics]]. <ref name=":0">Roach Robert C, Hackett Peter H, Olez Oswald, Bartsch Peter, Luks Andrew M, MacInnis Martin J, Baillie J Kenneth, The Lake Louise AMS Score Consensus Committee. [https://www.liebertpub.com/doi/pdf/10.1089/ham.2017.0164#:~:text=The%20Lake%20Louise%20AMS%20score%20for%20an%20individual%20is%20the,of%20at%20least%20three%20points. Lake Louise Acute Mountain Sickness Score.] High Altitude Medicine & Biology. 2018:19(1):4-6. </ref> However, even if someone has AMS, or mild AMS, it does not mean that they <u>must</u> descend immediately. <ref name=":1">Ultimate Kilimanjaro - the #1 Guide Service on Mount Kilimanjaro. Lake Louise Questionnaire - Lake Louise Scoring System (LLSS) for Acute Mountain Sickness (AMS). Available from: https://www.ultimatekilimanjaro.com/lake-louise-ams-questionnaire/ (accessed 8 June 2022). </ref> | |||
AMS must not be interchanged with high-altitude cerebral edema (HACE). It is not a neurological condition, and is known to be self-limited. Contrarily, HACE may occur between 24-72 hours after ascent, has characteristics of an altered mental state and/or ataxia. It usually occurs in conjunction with AMS or high-altitude pulmonary | AMS must not be interchanged with high-altitude cerebral edema (HACE). It is not a [[Neurological Disorders|neurological condition]], and is known to be self-limited. AMS effects may become apparent within 6 hours of ascent. Contrarily, HACE may occur between 24-72 hours after ascent, has characteristics of an [[Mental Health|altered mental state]] and/or [[ataxia]]. It usually occurs in conjunction with AMS or [[High-Altitude Pulmonary Oedema|high-altitude pulmonary oedema (HAPE)]], and would be characterised as a medical emergency. <ref name=":0" /> | ||
==== Introduction to the Lake Louise Acute Mountain Sickness scale ==== | ==== Introduction to the Lake Louise Acute Mountain Sickness scale ==== | ||
| Line 21: | Line 18: | ||
The symptoms measured on the initial test included, <ref name=":0" /> | The symptoms measured on the initial test included, <ref name=":0" /> | ||
* Headache | * [[Headache]] | ||
* Gastrointestinal Upset | * Gastrointestinal Upset | ||
* Fatigue/Weakness | * Fatigue/Weakness | ||
* Dizziness/Light-Headedness | * Dizziness/Light-Headedness | ||
* Sleep Disturbance | * [[Sleep Deprivation and Sleep Disorders|Sleep Disturbance]] | ||
<nowiki>*</nowiki>the double words are for general feelings and descriptions | <nowiki>*</nowiki>the double words are for general feelings and descriptions | ||
These | These are rated with an intensity level of 0-3. A total score that is ≥3, including a headache, is indicative of AMS. <ref name=":0" /> | ||
Of the five symptoms assessed for AMS, disturbed sleep is the most likely symptom to occur due to altitude hypoxia. However, this symptom was seen to be poorly related to the other symptoms, and AMS. It was questioned if sleep disturbance was a symptom of AMS or an effect of hypoxia. Considering this fact, a revised scoring system does not include disturbed sleep as a symptom. Comparing daytime vs. night time effects of altitude was also a factor. <ref name=":0" /> | Of the five symptoms assessed for AMS, disturbed sleep is the most likely symptom to occur due to altitude hypoxia. However, this symptom was seen to be poorly related to the other symptoms, and AMS. It was questioned if sleep disturbance was a symptom of AMS or an effect of hypoxia. Considering this fact, a revised scoring system does not include 'disturbed sleep' as a symptom. Comparing daytime vs. night time effects of altitude was also a factor. <ref name=":0" /> | ||
== About the Test == | == About the Test == | ||
Since the 'sleep disturbance' symptom was removed, a scoring of ≥3 from the four symptoms, including a headache, is indicative of AMS. <ref name=":0" /> | Since the 'sleep disturbance' symptom was removed, a scoring of ≥3 from the <u>four</u> remaining symptoms, including a headache, is indicative of AMS. <ref name=":0" /> | ||
If someone wanted a more detailed scoring system, they could | If someone wanted a more detailed scoring system, they could categorise intensity values as: <ref name=":0" /> | ||
* 3-5 points as Mild | * 3-5 points as Mild | ||
* 6-9 points as Moderate | * 6-9 points as Moderate | ||
* 10-12 points as Severe | * 10-12 points as Severe | ||
== Characteristics of the Test | Despite the symptoms being able to develop within 6 hours of ascent to altitude, it is recommended that the score be assessed subsequent to 6 hours, to bypass any symptoms of travel or effects of acute hypoxia via vagal responses. <ref name=":0" /> | ||
== Characteristics of the Test == | |||
The AMS Clinical Functional Score can be used if someone wanted to assess the effect of AMS symptoms on overall health, function, and performance. <ref name=":0" /> | The AMS Clinical Functional Score can be used if someone wanted to assess the effect of AMS symptoms on overall health, function, and performance. <ref name=":0" /> | ||
The scoring system | The scoring system is presented as follows: <ref name=":0" /> | ||
<u>2018 Lake Louise Acute Mountain Sickness Score</u> | <u>2018 Lake Louise Acute Mountain Sickness Score</u> | ||
| Line 56: | Line 54: | ||
* 2 - Moderate headache | * 2 - Moderate headache | ||
* 3 - Severe headache, incapacitating | * 3 - Severe headache, incapacitating | ||
<u>Gastrointestinal Symptoms</u> | <u>Gastrointestinal Symptoms</u> | ||
| Line 65: | Line 62: | ||
* 3 - Severe nausea and vomiting, incapacitating | * 3 - Severe nausea and vomiting, incapacitating | ||
<u>Fatigue/weakness</u> | |||
<u>Fatigue | |||
* 0 - Not tired or weak | * 0 - Not tired or weak | ||
* 1 - Mild fatigue/weakness | * 1 - Mild fatigue/weakness | ||
* 2 - Moderate fatigue/weakness | * 2 - Moderate fatigue/weakness | ||
* 3 - | * 3 - Severe fatigue/weakness, incapacitating | ||
<u>Dizziness/light-headedness</u> | <u>Dizziness/light-headedness</u> | ||
| Line 80: | Line 75: | ||
* 2 - Moderate dizziness/light-headedness | * 2 - Moderate dizziness/light-headedness | ||
* 3 - Severe dizziness/light-headedness | * 3 - Severe dizziness/light-headedness | ||
<u>AMS Clinical Functional Score</u> - Overall, if you had AMS symptoms, how did they affect your activities? | <u>AMS Clinical Functional Score</u> - Overall, if you had AMS symptoms, how did they affect your activities? | ||
| Line 90: | Line 84: | ||
== A Conflict - a measurement for all ages? == | == A Conflict - a measurement for all ages? == | ||
It appears that the language used in the Lake Louise AMS scoring system may underestimate symptoms for children from 4-11 years of age, due to the complexity of the terminology used. This may be due to individual language, behavioural, and cognitive development at their given age. Young children were seen to report symptoms without any altitude gain, therefore the wording of the scale needed to be revised.<ref name=":2">Southard Andrew, Niermeyer Susan, Yaron Michael. Language Used in Lake Louise Scoring System Underestimates Symptoms of Acute Mountain Sickness in 4- to 11-Year-Old Children. High Altitude Medicine & Biology. 2007:8(2):124-130.</ref> | It appears that the language used in the Lake Louise AMS scoring system may underestimate symptoms for children from 4-11 years of age, due to the complexity of the terminology used. This may be due to individual language, behavioural, and cognitive development at their given age. Young children were seen to report symptoms without any altitude gain, therefore the wording of the scale needed to be revised.<ref name=":2">Southard Andrew, Niermeyer Susan, Yaron Michael. [https://www.liebertpub.com/doi/10.1089/ham.2006.1014?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed Language Used in Lake Louise Scoring System Underestimates Symptoms of Acute Mountain Sickness in 4- to 11-Year-Old Children.] High Altitude Medicine & Biology. 2007:8(2):124-130.</ref> | ||
AMS can also occur in children, those children from families who go on mountain hiking and trekking trips. It is seen that this scale is not suitable for use by children, it is suitable for teenagers to understand and | AMS can also occur in children, those children from families who go on mountain hiking and trekking trips. It is seen that this scale is not suitable for use by children, but it is suitable for teenagers to understand and categorise their physical and physiological feelings. <ref name=":2" /> | ||
It is seen that children can develop AMS at a comparable rate to adults when ascending to similar altitudes, over the same | It is seen that children can develop AMS at a comparable rate to adults when ascending to similar altitudes, over the same durations. <ref name=":2" /> | ||
When assessing children on the LLSS, there was an age-adjusted scoring system used. Descriptions such as "severe nausea and vomiting, incapacitating" | When assessing children on the Lake Louise Scoring System (LLSS), there was an age-adjusted scoring system used. Descriptions such as "severe nausea and vomiting, incapacitating" were modified with "really upset stomach and throwing up a lot". The word "hurt" was used to describe "pain", and the [[Faces Pain Scale|Wong-Baker FACES pain scale]] was used to describe the severity of headaches. The FACES scale can be seen on pg. 3 (126) in the Southard et al, reference. <ref name=":2" /> | ||
When the results of the age-adjusted assessment were compared to that of the LLSS, the age-adjusted assessment produced results that were | When the results of the age-adjusted assessment were compared to that of the LLSS, the age-adjusted assessment produced results that were higher, more severe, than that of the LLSS. The FACES scale was effective in assessing feelings of headache. <ref name=":2" /> | ||
It is seen that younger children are more satisfied with the FACES scale, and simplified wording due to lack of understanding, whereas older children may select more specific descriptions | It is seen that younger children are more satisfied with the FACES scale, and simplified wording due to lack of understanding, whereas older children may select more specific descriptions and moderate values for the pain scale. <ref name=":2" /> | ||
For this reason, it is shown that when the language is simplified, more honest and reliable | For this reason, it is shown that when the language is simplified, more honest, valid, and reliable symptom descriptions are reported. The simplification in language does help this age group. <ref name=":2" /> | ||
=== How to Conduct the Test === | === How to Conduct the Test === | ||
According to Roach et al, 2018, this test is only to be conducted by investigators, and <u>not</u> Clinicians, Professional Outdoor Guides, and general individuals, for the diagnosis and management of AMS. <ref name=":0" /> | According to Roach et al, 2018, this test is only to be conducted by investigators, and <u>not</u> Clinicians, Professional Outdoor Guides, and general individuals, for the diagnosis and management of AMS. <ref name=":0" /> However, it is safe for the general public to use on their own mountain climbing trips. When on tour on the mountain, guides will conduct an assessment twice a day, which includes the LLSS, [[Pulse Oximeter|pulse oximetry]], and other criteria, to check for health and fitness of the climbers on the mountain. <ref name=":1" /> | ||
The Lake Louise AMS score can be administered as: <ref name=":0" /> | The Lake Louise AMS score can be administered as: <ref name=":0" /> | ||
* A self-reporting tool | * A self-reporting tool | ||
* Completed by researcher asking about the symptoms | * Completed by guide/researcher asking about the symptoms | ||
* Individual filling in the score, and researcher reading it back to the individual | * Individual filling in the score, and guide/researcher reading it back to the individual | ||
| Line 118: | Line 112: | ||
* Ascent in altitude within the previous 4 days | * Ascent in altitude within the previous 4 days | ||
* Presence of a headache | * Presence of a headache | ||
* Presence of atleast one other symptom, listed above | * Presence of atleast one other symptom, of the 4 symptoms listed above (or directly below) | ||
* A score of ≥3 from the entire test | * A score of ≥3 from the entire test | ||
=== What the Results Mean === | === What the Results Mean === | ||
The total AMS score would be the sum of scores for each of the <u>four</u> symptoms, listed | The total AMS score would be the sum of scores for each of the <u>four</u> symptoms, listed below: <ref name=":0" /> | ||
* Headache | * Headache | ||
| Line 130: | Line 124: | ||
To be categorized as having AMS, one would need to have atleast 1 point for a headache, and ≥3 points in total. | To be categorized as having AMS, one would need to have atleast 1 point for a headache, and ≥3 points in total. | ||
<nowiki>*</nowiki>A severe headache of 3 point, with no other AMS symptoms, would also be categorized as AMS. <ref name=":0" /> | <nowiki>*</nowiki>A severe headache of 3 point, with no other AMS symptoms, would also be categorized as AMS. <ref name=":0" /> | ||
== References == | == References == | ||
<references /> | <references /> | ||
[[Category:Objective Assessment]] | |||
[[Category:Screening Tools]] | |||
Latest revision as of 15:36, 12 December 2023
Original Editor - Kapil Narale
Top Contributors - Kapil Narale and Kim Jackson
Introduction[edit | edit source]
Acute Mountain Sickness[edit | edit source]
Acute Mountain Sickness (AMS) is the most common acute altitude illness that can occur in unacclimatised individuals at altitudes >2500m. Risk factors include, rate of ascent, altitude of ascent, and individual physical characteristics. [1] However, even if someone has AMS, or mild AMS, it does not mean that they must descend immediately. [2]
AMS must not be interchanged with high-altitude cerebral edema (HACE). It is not a neurological condition, and is known to be self-limited. AMS effects may become apparent within 6 hours of ascent. Contrarily, HACE may occur between 24-72 hours after ascent, has characteristics of an altered mental state and/or ataxia. It usually occurs in conjunction with AMS or high-altitude pulmonary oedema (HAPE), and would be characterised as a medical emergency. [1]
Introduction to the Lake Louise Acute Mountain Sickness scale[edit | edit source]
The Lake Louise Acute Mountain Sickness (AMS) scale was created to assess adults of AMS. [2] It was first developed in 1991. It is a very useful scale to help diagnose and score the severity of AMS. [1]
The symptoms measured on the initial test included, [1]
- Headache
- Gastrointestinal Upset
- Fatigue/Weakness
- Dizziness/Light-Headedness
- Sleep Disturbance
*the double words are for general feelings and descriptions
These are rated with an intensity level of 0-3. A total score that is ≥3, including a headache, is indicative of AMS. [1]
Of the five symptoms assessed for AMS, disturbed sleep is the most likely symptom to occur due to altitude hypoxia. However, this symptom was seen to be poorly related to the other symptoms, and AMS. It was questioned if sleep disturbance was a symptom of AMS or an effect of hypoxia. Considering this fact, a revised scoring system does not include 'disturbed sleep' as a symptom. Comparing daytime vs. night time effects of altitude was also a factor. [1]
About the Test[edit | edit source]
Since the 'sleep disturbance' symptom was removed, a scoring of ≥3 from the four remaining symptoms, including a headache, is indicative of AMS. [1]
If someone wanted a more detailed scoring system, they could categorise intensity values as: [1]
- 3-5 points as Mild
- 6-9 points as Moderate
- 10-12 points as Severe
Despite the symptoms being able to develop within 6 hours of ascent to altitude, it is recommended that the score be assessed subsequent to 6 hours, to bypass any symptoms of travel or effects of acute hypoxia via vagal responses. [1]
Characteristics of the Test[edit | edit source]
The AMS Clinical Functional Score can be used if someone wanted to assess the effect of AMS symptoms on overall health, function, and performance. [1]
The scoring system is presented as follows: [1]
2018 Lake Louise Acute Mountain Sickness Score
Headache
- 0 - None at all
- 1 - A mild headache
- 2 - Moderate headache
- 3 - Severe headache, incapacitating
Gastrointestinal Symptoms
- 0 - Good appetite
- 1 - Poor appetite or nausea
- 2 - Moderate nausea or vomiting
- 3 - Severe nausea and vomiting, incapacitating
Fatigue/weakness
- 0 - Not tired or weak
- 1 - Mild fatigue/weakness
- 2 - Moderate fatigue/weakness
- 3 - Severe fatigue/weakness, incapacitating
Dizziness/light-headedness
- 0 - No dizziness/light-headedness
- 1 - Mild dizziness/light-headedness
- 2 - Moderate dizziness/light-headedness
- 3 - Severe dizziness/light-headedness
AMS Clinical Functional Score - Overall, if you had AMS symptoms, how did they affect your activities?
- 0 - Not at all
- 1 - Symptoms present, but did not force any change in activity or itinerary
- 2 - My symptoms forced me to stop the ascent or to go down on my own power
- 3 - Had to be evacuated to a lower altitude
A Conflict - a measurement for all ages?[edit | edit source]
It appears that the language used in the Lake Louise AMS scoring system may underestimate symptoms for children from 4-11 years of age, due to the complexity of the terminology used. This may be due to individual language, behavioural, and cognitive development at their given age. Young children were seen to report symptoms without any altitude gain, therefore the wording of the scale needed to be revised.[3]
AMS can also occur in children, those children from families who go on mountain hiking and trekking trips. It is seen that this scale is not suitable for use by children, but it is suitable for teenagers to understand and categorise their physical and physiological feelings. [3]
It is seen that children can develop AMS at a comparable rate to adults when ascending to similar altitudes, over the same durations. [3]
When assessing children on the Lake Louise Scoring System (LLSS), there was an age-adjusted scoring system used. Descriptions such as "severe nausea and vomiting, incapacitating" were modified with "really upset stomach and throwing up a lot". The word "hurt" was used to describe "pain", and the Wong-Baker FACES pain scale was used to describe the severity of headaches. The FACES scale can be seen on pg. 3 (126) in the Southard et al, reference. [3]
When the results of the age-adjusted assessment were compared to that of the LLSS, the age-adjusted assessment produced results that were higher, more severe, than that of the LLSS. The FACES scale was effective in assessing feelings of headache. [3]
It is seen that younger children are more satisfied with the FACES scale, and simplified wording due to lack of understanding, whereas older children may select more specific descriptions and moderate values for the pain scale. [3]
For this reason, it is shown that when the language is simplified, more honest, valid, and reliable symptom descriptions are reported. The simplification in language does help this age group. [3]
How to Conduct the Test[edit | edit source]
According to Roach et al, 2018, this test is only to be conducted by investigators, and not Clinicians, Professional Outdoor Guides, and general individuals, for the diagnosis and management of AMS. [1] However, it is safe for the general public to use on their own mountain climbing trips. When on tour on the mountain, guides will conduct an assessment twice a day, which includes the LLSS, pulse oximetry, and other criteria, to check for health and fitness of the climbers on the mountain. [2]
The Lake Louise AMS score can be administered as: [1]
- A self-reporting tool
- Completed by guide/researcher asking about the symptoms
- Individual filling in the score, and guide/researcher reading it back to the individual
Diagnosis of AMS encompasses the following conditions: [2]
- Ascent in altitude within the previous 4 days
- Presence of a headache
- Presence of atleast one other symptom, of the 4 symptoms listed above (or directly below)
- A score of ≥3 from the entire test
What the Results Mean[edit | edit source]
The total AMS score would be the sum of scores for each of the four symptoms, listed below: [1]
- Headache
- Nausea/Vomiting
- Fatigue
- Dizziness/Light-Headedness
To be categorized as having AMS, one would need to have atleast 1 point for a headache, and ≥3 points in total.
*A severe headache of 3 point, with no other AMS symptoms, would also be categorized as AMS. [1]
References[edit | edit source]
- ↑ 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 1.11 1.12 1.13 1.14 Roach Robert C, Hackett Peter H, Olez Oswald, Bartsch Peter, Luks Andrew M, MacInnis Martin J, Baillie J Kenneth, The Lake Louise AMS Score Consensus Committee. Lake Louise Acute Mountain Sickness Score. High Altitude Medicine & Biology. 2018:19(1):4-6.
- ↑ 2.0 2.1 2.2 2.3 Ultimate Kilimanjaro - the #1 Guide Service on Mount Kilimanjaro. Lake Louise Questionnaire - Lake Louise Scoring System (LLSS) for Acute Mountain Sickness (AMS). Available from: https://www.ultimatekilimanjaro.com/lake-louise-ams-questionnaire/ (accessed 8 June 2022).
- ↑ 3.0 3.1 3.2 3.3 3.4 3.5 3.6 Southard Andrew, Niermeyer Susan, Yaron Michael. Language Used in Lake Louise Scoring System Underestimates Symptoms of Acute Mountain Sickness in 4- to 11-Year-Old Children. High Altitude Medicine & Biology. 2007:8(2):124-130.
