Acute mountain sickness (AMS) prevention requires prioritizing multiple interrelated determinants in pre-travel counseling. Conventional syntheses often focus on statistical significance of single factors and rarely integrate evidence strength (E*), effect magnitude (M*), and controllability (C*) into actionable priorities. We mapped factors into an E–M–C space and computed a Priority Index (PI = E* × M* × C* × kweight), with down-weighting for sparsely studied factors (kweight = 0.5 for k<5; 0.33 for k<3). Pooled effects were synthesized using conservative random-effects inference with prespecified robustness checks (heterogeneity assessment and influence/leave-one-out analyses). Across 81 variable-level syntheses, heterogeneity was common but the principal signals remained stable under conservative inference and influence checks. High-priority risk signals were dominated by the ascent process (ascent speed, ascent mode—especially direct air travel—and attained/sleeping altitude), while acetazolamide prophylaxis remained the leading protective option. We identified an action-ready set (i.e., directly modifiable levers suitable for routine counseling) for immediate implementation. A small set of factors with greater uncertainty were classified as confirm-before-adopt (i.e., plausible but currently insufficient to drive routine advice), warranting standardized exposure contexts and multi-centre prospective validation. The E–M–C framework and PI provide a quantitative, reproducible basis for prioritizing AMS prevention actions in pre-travel counseling. Despite common heterogeneity, the principal signals support high-yield, actionable counseling priorities.. Managing the ascent process and considering acetazolamide when indicated remain the most immediate, controllable risk-reduction options; importantly, the framework adds a structured way to rank competing determinants and communicate uncertainty to guide future evidence-building and iterative updates.
Hu et al. (Wed,) studied this question.