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 help predict risk for high altituderelated 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).
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.
Name/identifier:
Altitude-related illnesses risk score (AIRS)
v0.23
FOR EVALUATION OF RISK PURPOSES ONLY
Please circle one statement in each row that
most closely applies to you.
Date:
Time:
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:
a. ACUTE MOUNTAIN SICKNESS
b. HIGH ALTITUDE CEREBRAL EDEMA (BRAIN SWELLING)
c. ,HIGH ALTITUDE PULMONARY EDEMA (FLUID IN THE LUNGS)
2. HAVE YOU PREVIOUSLY SUFFERED FROM CHRONIC:
a. DIZZINESS OR OTHER PROBLEM WITH BALANCE
b. BREATHLESSNESS OR OTHER REGULAR BREATHING PROBLEM (SHORTNESS OF
BREATH, SUCH AS ASTHMA)
c. BLURRED VISION
d. SLEEP DISTURBANCE
e. COUGH
f. HEADACHES
i. MIGRAINE
ii. TENSION
iii. OTHER
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.
3. CONSIDER ADDING NATURE OF HEADACHE: THROBBING, CONSTANT, INTERMITTENT
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.
5. CONSIDER ADDING LOSS OF APPETITE AS A SYMPTOM. THIS IS DIFFERENT FROM NAUSEA.
6. SLEEP SEEMS OK, BUT YOU MIGHT WISH TO INCLUDE SOMETHING LIKE “AWAKENED
SPONTANEOUSLY DURING SLEEP FEELING SHORT OF BREATH”
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. 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.
SELFASSESSMENT
0
1
2
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
Sleep
Good night’s sleep
Moderately disturbed sleep
Terrible night’s sleep
Not exhausted
Slightly exhausted
Completely exhausted
No cough
Any cough
Severe cough
I feel better than most
About average
I feel worse than most
None
Slightly unsteady on feet
Very unsteady on feet
None or breathless
walking uphill
Breathless walking slowly
on flat surface
Breathless at rest
Exhaustion
Cough
Comparison
with others
Unsteadiness
Breathlessness
Past history
No history of HAPE or
HACE, or don’t know
I believe I have previously had
HAPE or HACE.
Speed of ascent
in last 3 days
Less than 1000m
< 3280feet
Any infection in
last 7 days
None
Recent infection
(eg. cough/cold/ vomiting/
diarrhoea)
Female
Male
Sex
More than 1000m
> 3280feet
More than 2000m
> 6560feet
SCORE
Physical fitness
Other illnesses
I’m quite unfit
About average
I’m fitter than most
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
Please ask 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
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
He/she appears to be out of
breath only when
breath when walking on a
walking/climbing
flat surface
uphill
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
SCORE
Total score:
Please record your outcomes for today:
TICK BOX
OUTCOME ASSESSMENT - TODAY
CONTINUING AS PLANNED:
CHANGING PLANS DUE TO ILLNESS:
UNPLANNED DESCENT FOR ANY REASON:
IF UNPLANNED DESCENT, PLEASE SPECIFY REASON:
SUSPECTED HIGH ALTITUDE CEREBRAL EDEMA (HACE)
SUSPECTED HIGH ALTITUDE PULMONARY EDEMA (HAPE)
SUSCPECTED ACUTE MOUNTAIN SICKNESS
TICK BOX
ACCIDENT OR INJURY
OTHER REASON (please describe in free text):