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Risk Stratification for Athletes and Adventurers in High-Altitude Environments: Recommendations for Preparticipation Evaluation

Campbell, Aaron D. MD, MHS*; McIntosh, Scott E. MD, MPH; Nyberg, Andy MD; Powell, Amy P. MD; Schoene, Robert B. MD§; Hackett, Peter MD

Clinical Journal of Sport Medicine: September 2015 - Volume 25 - Issue 5 - p 404–411
doi: 10.1097/JSM.0000000000000231
Care of the Wilderness Athlete

Abstract: High-altitude athletes and adventurers face a number of environmental and medical risks. Clinicians often advise participants or guiding agencies before or during these experiences. Preparticipation evaluation (PPE) has the potential to reduce risk of high-altitude illnesses in athletes and adventurers. Specific conditions susceptible to high-altitude exacerbation also important to evaluate include cardiovascular and lung diseases. Recommendations by which to counsel individuals before participation in altitude sports and adventures are few and of limited focus. We reviewed the literature, collected expert opinion, and augmented principles of a traditional sport PPE to accommodate the high-altitude wilderness athlete/adventurer. We present our findings with specific recommendations on risk stratification during a PPE for the high-altitude athlete/adventurer.

*Family and Sports Medicine, University of Utah Health Care, Salt Lake City, Utah;

Division of Emergency Medicine, University of Utah Health Care, Salt Lake City, Utah;

Department of Orthopedics, University of Utah, Salt Lake City, Utah;

§Bay Area Pulmonary/Critical Care Medical Associates, Berkeley/Oakland, California; and

Institute for Altitude Medicine, Telluride, Colorado.

Corresponding Author: Aaron D. Campbell, MD, MHS, (

The authors report no conflicts of interest.

This article appears in a “Care of the Wilderness and Adventure Athlete” special issue, jointly published by Clinical Journal of Sport Medicine and Wilderness & Environmental Medicine.

Received April 15, 2015

Accepted June 15, 2015

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