description: Parent profile for ICU scoring systems. Scores are represented as Observations with the total score in value[x] and subscores as components. This profile defines common constraints for all ICU scores including sedation scores (RASS), pain scores (NRS, BPS), delirium assessments (CAM-ICU, ICDSC), and severity scores (SOFA, qSOFA).
package_name: de.medizininformatikinitiative.kerndatensatz.icu
derivation: constraint
name: MII_PR_ICU_Score
abstract: true
type: Observation
elements:
  category:
    mustSupport: true
    array: true
    min: 2
    index: 1
    slicing:
      rules: open
      discriminator:
      - {path: $this, type: pattern}
      min: 2
      slices:
        survey:
          match:
            coding:
            - {code: survey, system: 'http://terminology.hl7.org/CodeSystem/observation-category'}
          schema:
            short: Survey category
            mustSupport: true
            pattern:
              type: CodeableConcept
              value:
                coding:
                - {code: survey, system: 'http://terminology.hl7.org/CodeSystem/observation-category'}
            _required: true
            index: 2
            elements:
              coding:
                mustSupport: true
                index: 3
                elements:
                  system: {mustSupport: true, index: 4}
                  code: {mustSupport: true, index: 5}
                required: [system, code]
            required: [coding]
        assessment-scale:
          match:
            coding:
            - {code: '273249006', system: 'http://snomed.info/sct', display: Assessment scales (assessment scale)}
          schema:
            short: Assessment scale category
            mustSupport: true
            pattern:
              type: CodeableConcept
              value:
                coding:
                - {code: '273249006', system: 'http://snomed.info/sct', display: Assessment scales (assessment scale)}
            _required: true
            index: 6
            elements:
              coding:
                mustSupport: true
                index: 7
                elements:
                  system: {mustSupport: true, index: 8}
                  code: {mustSupport: true, index: 9}
                required: [system, code]
            required: [coding]
  referenceRange: {short: Reference range for score interpretation, mustSupport: true, index: 36}
  hasMember: {short: 'Related observations (e.g., individual assessment items)', mustSupport: true, index: 37}
  derivedFrom: {short: Source observations used to calculate score, mustSupport: true, index: 38}
  interpretation: {short: Clinical interpretation of the score, mustSupport: true, index: 31}
  encounter: {short: Encounter during which score was assessed, mustSupport: true, index: 19}
  specimen: {index: 34}
  valueQuantity: {type: Quantity, short: Total score value, mustSupport: true, choiceOf: value, index: 27}
  value:
    short: Total score value
    mustSupport: true
    choices: [valueQuantity, valueCodeableConcept, valueInteger]
    index: 26
  component:
    short: Subscore components
    mustSupport: true
    index: 39
    elements:
      code: {short: Type of component/subscore, mustSupport: true, index: 40}
      value:
        short: Subscore value
        mustSupport: true
        choices: [valueQuantity, valueCodeableConcept, valueInteger]
        index: 42
      valueQuantity: {type: Quantity, short: Subscore value, mustSupport: true, choiceOf: value, index: 43}
      valueCodeableConcept: {type: CodeableConcept, short: Subscore value, mustSupport: true, choiceOf: value, index: 44}
      valueInteger: {type: integer, short: Subscore value, mustSupport: true, choiceOf: value, index: 45}
      dataAbsentReason: {mustSupport: true, index: 46}
      interpretation: {mustSupport: true, index: 47}
  note: {short: Comments about the score, mustSupport: true, index: 32}
  effectiveDateTime: {type: dateTime, short: Time of score assessment, mustSupport: true, choiceOf: effective, index: 22}
  status: {short: Status of the observation, mustSupport: true, index: 0}
  effective:
    short: Time of score assessment
    mustSupport: true
    choices: [effectiveDateTime]
    index: 21
  code:
    short: Type of score
    constraint:
      obs-loinc-sct: {human: Es muss mindestens ein LOINC oder SnomedCT Code vorhanden sein, source: 'https://www.medizininformatik-initiative.de/fhir/ext/modul-icu/StructureDefinition/mii-pr-icu-score', severity: error, expression: 'coding.where(system=''http://loinc.org'').exists().not() implies coding.where(system=''http://snomed.info/sct'').exists()'}
    mustSupport: true
    index: 10
    elements:
      coding:
        mustSupport: true
        index: 11
        slicing:
          rules: open
          discriminator:
          - {path: $this, type: pattern}
          min: null
          slices:
            sct:
              match: {system: 'http://snomed.info/sct'}
              schema:
                short: SNOMED CT code for the score
                mustSupport: true
                binding: {strength: extensible, valueSet: 'https://www.medizininformatik-initiative.de/fhir/ext/modul-icu/ValueSet/score-snomed'}
                pattern:
                  type: Coding
                  value: {system: 'http://snomed.info/sct'}
                index: 12
                elements:
                  system: {mustSupport: true, index: 13}
                  code: {mustSupport: true, index: 14}
                required: [system, code]
            loinc:
              match: {system: 'http://loinc.org'}
              schema:
                short: LOINC code for the score
                mustSupport: true
                binding: {strength: extensible, valueSet: 'https://www.medizininformatik-initiative.de/fhir/ext/modul-icu/ValueSet/score-loinc'}
                pattern:
                  type: Coding
                  value: {system: 'http://loinc.org'}
                index: 15
                elements:
                  system: {mustSupport: true, index: 16}
                  code: {mustSupport: true, index: 17}
                required: [system, code]
  valueCodeableConcept: {type: CodeableConcept, short: Total score value, mustSupport: true, choiceOf: value, index: 28}
  bodySite: {index: 33}
  issued: {short: Date/Time this observation was made available, mustSupport: true, index: 23}
  device: {short: Device used for automated score calculation (if applicable), mustSupport: true, index: 35}
  valueInteger: {type: integer, short: Total score value, mustSupport: true, choiceOf: value, index: 29}
  subject:
    type: Reference
    short: Patient being assessed
    mustSupport: true
    refers: ['http://hl7.org/fhir/StructureDefinition/Patient']
    index: 18
  performer: {short: Who performed the score assessment, mustSupport: true, index: 24}
  dataAbsentReason: {short: Why the score value is missing, mustSupport: true, index: 30}
package_version: 2026.0.0
class: profile
kind: resource
url: https://www.medizininformatik-initiative.de/fhir/ext/modul-icu/StructureDefinition/mii-pr-icu-score
base: http://hl7.org/fhir/StructureDefinition/Observation
version: 2026.0.0
required: [effectiveDateTime, encounter, subject, effective]