Travel At High Altitude, a booklet that can be freely download by clicking this link - a guide to staying healthy in the mountains.

1. Altitude Symposium Wednesday 3rd December 2008 at Worcester College, Oxford.

2. Mountain Medicine and High Altitude, Physiology Course, December 5th-7th 2008

3. Important dates for 2008

4. Research proposals for Hidden Valley Expedition 2008

5. The International HAPE Database www.altitude.org/hape.htm

6. Medex Hidden Valley Expedition 2008 Blogsite

7. Booking Information for Medex Hidden Valley Expedition 2008

Scoring of Mountain Sickness

There have been several scoring systems used to diagnose and quantify mountain sickness in altitude research, most consisting of questionnaires and some with an additional examination by a physician. Some such as the Environmental Symptom Questionnaire (ESQ) are long at 67 questions and an attempt has been made to simplify and standardise a scoring system to enable easy comparisons of results between studies. The Lake Louise Score is such a system arising from consensus meetings in Lake Louise in Canada in 1991 and 1993. Although primarily developed for research use, it’s short, simple format, which is easy to complete in difficult situations, has led to its adoption by general trekkers and mountaineers. It is sensitive enough to detect AMS whilst having sufficient specificity not to lead to undue over diagnosis.

It is however important to realise that all scoring systems can over diagnose AMS. A hangover or ‘flu for instance will give a positive AMS score even at sea level, so it is important to use them in the context of a recent rise in altitude and to take allowance of any confounding illness.

Calculating the Lake Louise Acute Mountain Sickness (AMS) Score

 Add up the responses to each of the questions of the self-report score (Questions 1-5)

A diagnosis of AMS is based on a recent rise in altitude, the presence of a headache with the presence of at least 1 other symptom, and a total score of at least 3. (Some researchers use a threshold score of 4)

 AMS = Altitude Gain AND Headache AND at least 1 other symptom AND a total score of 3 or more

Self Report Questionnaire:

1. Headache                                                           0       No headache

                                                                              1       Mild headache

                                                                              2       Moderate headache

                                                                              3       Severe headache, incapacitating

2. Gastrointestinal symptoms                                   0       No gastrointestinal symptoms

                                                                              1       Poor appetite or nausea

                                                                              2       Moderate nausea or vomiting

                                                                              3       Severe nausea & vomiting, incapacitating

3. Fatigue and/or weakness                                     0       Not tired or weak

                                                                              1       Mild fatigue/ weakness

                                                                              2       Moderate fatigue/weakness

                                                                              3       Severe fatigue/ weakness, incapacitating

4. Dizziness / lightheadedness                                  0       Not dizzy

                                                                              1       Mild dizzy

                                                                              2       Moderate dizziness

                                                                              3       Severe dizziness, incapacitating

5. Difficulty sleeping                                                0       Slept as well as usual

                                                                              1       Did not sleep as well as usual

                                                                              2       Woke many times, poor nights sleep

                                                                              3       Could not sleep at all   

Paul Richards 2004

Additional Lake Louise Scoring

The Self-Report Score above (questions 1-5) stands alone and this is recommended for general mountain travellers.

Additional observations are sometimes used by researchers:

The Clinical Assessment score (Questions 6-8) can be added to the Self Report Score, in which case, in the context of a recent rise in altitude, a score of 5 or more would be taken as AMS 

AMS=Altitude Rise AND Headache AND at least 1 other symptom (from Q1-5) AND a total score of 5 or more (Q1-8)

Clinical Assessment:

6. Change in mental status                                       0       No change in mental status

                                                                              1       Lethargy/lassitude

                                                                              2       disorientated/confused

                                                                              3       Stupor / semi conscious

7. Ataxia (heel-toe-walking)                                    0       No ataxia

                                                                              1       Manoeuvres to maintain balance

                                                                              2       Steps off line

                                                                              3       Falls down

                                                                              4       Can’t stand

8. Peripheral oedema                                              0       No peripheral oedema

                                                                              1       Peripheral oedema in one location

                                                                              2       Peripheral oedema in two or more locations

Functional Score:

Overall, if you had any symptoms,                           0       No reduction in activity

how did they affect your activity?                            1       Mild reduction in activity

                                                                              2       Moderate reduction in activity

                                                                              3       Severe reduction in activity (eg bedrest)

   Paul Richards, February 2004

 paul@medex.org.uk

  1.         Roach, R., et al., The Lake Louise acute mountain sickness scoring system, in Hypoxia and mountain medicine: proceeding of the international hypoxia symposium., J. Sutton, C. Houston, and G. Coates, Editors. 1993, Queen City Printers: Burlington VT. p. 272-274.

[ Home ] [ Up ]

Send mail to simon@medex.org.uk with questions or comments about this web site.
Last modified: Saturday, 23 August 2008 01:36