Statement of the Third International Exercise-Associated Hyponatremia Consensus Development Conference, Carlsbad, California, 2015.

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Grading strength of recommendations and quality of evidence in clinical guidelines: report from an american college of chest physicians task force.

Gordon Guyatt, David Gutterman, Michael H Baumann … (2006)

While grading the strength of recommendations and the quality of underlying evidence enhances the usefulness of clinical guidelines, the profusion of guideline grading systems undermines the value of the grading exercise. An American College of Chest Physicians (ACCP) task force formulated the criteria for a grading system to be utilized in all ACCP guidelines that included simplicity and transparency, explicitness of methodology, and consistency with current methodological approaches to the grading process. The working group examined currently available systems, and ultimately modified an approach formulated by the international GRADE group. The grading scheme classifies recommendations as strong (grade 1) or weak (grade 2), according to the balance among benefits, risks, burdens, and possibly cost, and the degree of confidence in estimates of benefits, risks, and burdens. The system classifies quality of evidence as high (grade A), moderate (grade B), or low (grade C) according to factors that include the study design, the consistency of the results, and the directness of the evidence. For all future ACCP guidelines, The College has adopted a simple, transparent approach to grading recommendations that is consistent with current developments in the field. The trend toward uniformity of approaches to grading will enhance the usefulness of practice guidelines for clinicians.

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Hyponatremia among runners in the Boston Marathon.

Christopher Almond, Andrew Y Shin, Elizabeth Fortescue … (2005)

Hyponatremia has emerged as an important cause of race-related death and life-threatening illness among marathon runners. We studied a cohort of marathon runners to estimate the incidence of hyponatremia and to identify the principal risk factors. Participants in the 2002 Boston Marathon were recruited one or two days before the race. Subjects completed a survey describing demographic information and training history. After the race, runners provided a blood sample and completed a questionnaire detailing their fluid consumption and urine output during the race. Prerace and postrace weights were recorded. Multivariate regression analyses were performed to identify risk factors associated with hyponatremia. Of 766 runners enrolled, 488 runners (64 percent) provided a usable blood sample at the finish line. Thirteen percent had hyponatremia (a serum sodium concentration of 135 mmol per liter or less); 0.6 percent had critical hyponatremia (120 mmol per liter or less). On univariate analyses, hyponatremia was associated with substantial weight gain, consumption of more than 3 liters of fluids during the race, consumption of fluids every mile, a racing time of >4:00 hours, female sex, and low body-mass index. On multivariate analysis, hyponatremia was associated with weight gain (odds ratio, 4.2; 95 percent confidence interval, 2.2 to 8.2), a racing time of >4:00 hours (odds ratio for the comparison with a time of <3:30 hours, 7.4; 95 percent confidence interval, 2.9 to 23.1), and body-mass-index extremes. Hyponatremia occurs in a substantial fraction of nonelite marathon runners and can be severe. Considerable weight gain while running, a long racing time, and body-mass-index extremes were associated with hyponatremia, whereas female sex, composition of fluids ingested, and use of nonsteroidal antiinflammatory drugs were not. Copyright 2005 Massachusetts Medical Society.

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Interrelations between serum sodium concentration, serum osmolarity and total exchangeable sodium, total exchangeable potassium and total body water.

Andreas Birkenfeld, J LEIBMAN, M. O'Meara … (1958)

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Journal

Journal ID (iso-abbrev): Clin J Sport Med

Title: Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine

ISSN (Electronic): 1536-3724

ISSN (Print): 1050-642X

Publication date (Electronic): Jul 2015

Volume: 25

Issue: 4

Affiliations

[1 ] *Exercise Science Program, Oakland University, Rochester, Michigan; †Division of Nephrology, University of Virginia Health System, Charlottesville, Virginia; ‡Department of Sports Medicine, West Chester University, West Chester, Pennsylvania; §The Vitality Group, Chicago, Illinois; ¶Department of Physical Medicine and Rehabilitation, VA Northern California Health Care System and University of California Davis, Sacramento, California; ‖Family Medicine Residency Program, Via Christi Hospitals Wichita, Inc, Wichita, Kansas; **Department of Sport and Exercise Nutrition, Loughborough University, Leicestershire, United Kingdom; ††Athletic Training Program, Central Michigan University, Mount Pleasant, Michigan; ‡‡Military Nutrition Division, United States Army Research Institute of Environmental Medicine, Natick, Massachusetts; §§School of Physical Education, Sport and Exercise Science, University of Otago, Dunedin, New Zealand; ¶¶Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, Minnesota; ‖‖Department of Emergency Medicine, St John of God Murdoch Hospital and University of Notre Dame, Perth, Western Australia; ***Department of Internal Medicine, Harvard Medical School, Boston, Massachusetts; †††Health Sciences Department, Gettysburg College, Gettysburg, Pennsylvania; ‡‡‡Department of Family Medicine, Loyola University Chicago Stritch School of Medicine, Chicago, Illinois; and §§§Department of Endocrinology and Metabolism, Georgetown University Medical Center, Washington, District of Columbia.

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Publisher Item ID: 00042752-201507000-00002

DOI: 10.1097/JSM.0000000000000221

PubMed ID: 26102445

SO-VID: cd7bd2c8-f4aa-4d69-a595-60d384e29871

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Statement of the Third International Exercise-Associated Hyponatremia Consensus Development Conference, Carlsbad, California, 2015.

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Most cited references 132

Grading strength of recommendations and quality of evidence in clinical guidelines: report from an american college of chest physicians task force.

Hyponatremia among runners in the Boston Marathon.

Interrelations between serum sodium concentration, serum osmolarity and total exchangeable sodium, total exchangeable potassium and total body water.

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