Is previous history a reliable predictor for acute mountain sickness susceptibility? A meta-analysis of diagnostic accuracy

Purpose: The goal of this meta-analysis was to determine the clinical utility of acute mountain sickness (AMS) history to predict future incidents of AMS. Method: 17 studies (n=7921 participants) were included following a systematic review of the literature. A bivariate random-effects model was used to calculate the summary sensitivity and specificity of the diagnostic test, and moderator variables were tested to explain the heterogeneity across studies. The Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) method was used to assess concerns for bias and applicability for the included studies. Results: The history of AMS had a low diagnostic accuracy for the prediction of future AMS incidents: the summary sensitivity was 0.50 (95% CI (0.40 to 0.59)) and the summary specificity was 0.72 (95% CI (0.66 to 0.78)). There was significant heterogeneity in the sensitivity and specificity across studies, which we modelled using moderator analysis. Studies that restricted the use of acetazolamide and dexamethasone had not only a higher sensitivity (0.66) relative to those that did not (0.44; p=0.03) but also an increased falsepositive rate (0.39 vs 0.23, p=0.03). The QUADAS-2 analysis showed that AMS histories were insufficiently detailed, and few studies controlled for prophylactic medication use or recent altitude exposure, leading to high risks of bias and concerns for applicability. Conclusions: The use of AMS history to guide prophylactic strategies for high-altitude ascent is not supported by the literature; however, the low sensitivity and specificity of this diagnostic test could reflect the quality of the available studies. Ensuring that the characteristics of the history and future ascents are similar may improve the clinical utility of AMS history.