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

Abstract

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.