To the Editor The systematic review by Dr Meier and colleagues1 demonstrated that most research on acute mountain sickness (AMS) conducted during the last 2 decades used either the self-reported Lake Louise Questionnaire Score (LLQS) or the Acute Mountain Sickness-Cerebral (AMS-C) score for diagnosing AMS. Because no criterion standard exists, the authors used the LLQS as a reference for comparison with the AMS-C score. Compared with an LLQS of 5 or greater, using an AMS-C score of 0.7 or greater to indicate AMS had a sensitivity of 67% and a specificity of 92%, with a positive likelihood ratio (LR) of 8.2 and a negative LR of 0.36. Two recent field studies found better agreement of the AMS-C score with the LLQS.2,3 In the first study, 235 participants completed both questionnaires at an altitude of 3450 m; the sensitivity of the AMS-C score was 91%, specificity was 94%, positive LR was 15.2, and negative LR was 0.1.3 In the second study, 191 participants answered questionnaires at an altitude of 4559 m; the sensitivity of the AMS-C score was 80%, specificity was 98%, positive LR was 40, and negative LR was 0.2.2 In contrast to the pooled data analysis from Meier et al,1 which showed significant data heterogeneity (I2 = 98%), data from the 2 studies were obtained by the same investigators with the same methods and in comparable study populations.2,3
Macholz F, Sareban M, Berger MM. Diagnosing Acute Mountain Sickness. JAMA. 2018;319(14):1509. doi:10.1001/jama.2018.0220
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