1. Validation of a Score for the Detection of Subjects with High Risk for Severe High-Altitude Illness
- Author
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Guy Duperrex, Guido Giardini, Olivier Mesland, François Lecoq, Stéphane Doutreleau, David Le Moal, Hervé Douard, Mathias Poussel, François J. Lhuissier, Philippe Oriol, Bruno Chenuel, Sophie Demanez, Maurice Hayot, Jean-Paul Richalet, Romain Remetter, Samuel Verges, David Debeaumont, Alain Frey, Maryse Dupré, Michel Vergnion, Christophe Hedon, Evelyne Lonsdorfer-Wolf, Daniel Rivière, Fabien Pillard, Jean-Michel Boulet, Louis Vilcoq, Anne Nedelec Jaffuel, Institut national du sport, de l'expertise et de la performance (INSEP), Hypoxie et Poumon : pneumopathologies fibrosantes, modulations ventilatoires et circulatoires (H&P), UFR SMBH-Université Sorbonne Paris Nord, Institut des Maladies Métaboliques et Cardiovasculaires (I2MC), Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut National de la Santé et de la Recherche Médicale (INSERM), Hôpital Pierre-Paul Riquet [Toulouse], CHU Toulouse [Toulouse], CHU Saint-Etienne, Développement, Adaptation et Handicap. Régulations cardio-respiratoires et de la motricité (DevAH), Université de Lorraine (UL), Hypoxie : Physiopathologie Respiratoire et Cardiovasculaire (HP2), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Grenoble Alpes (UGA), CHU Grenoble, Centre de physiologie de l'effort - CB Move [Herve], CHU Bordeaux [Bordeaux], Centre hospitalier universitaire de Nantes (CHU Nantes), Nouvel Hôpital Civil de Strasbourg, CHI Poissy-Saint-Germain, Centre d'Investigation Clinique [CHU Rouen] (CIC Rouen), Hôpital Charles Nicolle [Rouen]-CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Hôpitaux du Pays du Mont-Blanc, Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Université de Montpellier (UM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Ospedale regionale Umberto Parini [Aosta], Hôpital Jean Verdier [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées, Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Hypoxie et PhysioPathologie (HP2), Hôpital Charles Nicolle [Rouen], CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-CHU Rouen, Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), and MORNET, Dominique
- Subjects
Adult ,Male ,medicine.medical_specialty ,[SDV]Life Sciences [q-bio] ,Acclimatization ,Physical Therapy, Sports Therapy and Rehabilitation ,Altitude Sickness ,Individual risk ,Medication Adherence ,03 medical and health sciences ,0302 clinical medicine ,Altitude ,Risk Factors ,Internal medicine ,Medicine ,Humans ,Orthopedics and Sports Medicine ,business.industry ,Decision Trees ,030229 sport sciences ,Limiting ,Effects of high altitude on humans ,Middle Aged ,Predictive value ,[SDV] Life Sciences [q-bio] ,Acetazolamide ,Multicenter study ,Anticonvulsants ,Female ,business - Abstract
International audience; Purpose: A decision tree based on a clinico-physiological score (SHAI score) has been developed to detect subjects susceptible to Severe High Altitude Illness (SHAI). We aimed to validate this decision tree, to rationalize the prescription of acetazolamide (ACZ) and to specify the rule for a progressive acclimatization.Methods: Data were obtained from 641 subjects in 15 European medical centers before and during a sojourn at high altitude. Depending on the value of SHAI score, advice was given and ACZ was eventually prescribed. The outcome was the occurrence of SHAI at high altitude as a function of SHAI score, ACZ prescription and use and fulfillment of the acclimatization rule.Results: The occurrence of SHAI was 22.6%, similar to what was observed 18 years before (23.7%), while life-threatening forms of SHAI (High Altitude Pulmonary and Cerebral Edema) were less frequent (2.6% to 0.8%, P=0.007). The negative predictive value of the decision tree based was 81%, suggesting that the procedure is efficient to detect subjects who will not suffer from SHAI, therefore limiting the use of ACZ. The maximal daily altitude gain that limits the occurrence of SHAI was established at 400 m. The occurrence of SHAI was reduced from 27% to 12% when the recommendations for ACZ use and 400 m daily altitude gain were respected (P
- Published
- 2021
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