{
  "description": "Confusion Assessment Method for the ICU (CAM-ICU) for delirium assessment. A two-step process: first assess arousal using RASS (Feature 1), then evaluate four features if RASS ≥ -3. Delirium is present if Features 1 and 2 are present, plus either Feature 3 or 4. The result is a binary outcome: positive (delirium present) or negative (delirium absent).",
  "_filename": "StructureDefinition-mii-pr-icu-score-cam-icu.json",
  "package_name": "de.medizininformatikinitiative.kerndatensatz.icu",
  "date": null,
  "derivation": "constraint",
  "publisher": "Medizininformatik Initiative",
  "fhirVersion": "4.0.1",
  "name": "MII_PR_ICU_Score_CAM_ICU",
  "abstract": false,
  "type": "Observation",
  "experimental": null,
  "resourceType": "StructureDefinition",
  "title": "MII PR ICU Score CAM-ICU",
  "package_version": "2026.0.0",
  "status": "draft",
  "id": "5808b833-04d6-401d-8b9d-34e1ee985470",
  "kind": "resource",
  "url": "https://www.medizininformatik-initiative.de/fhir/ext/modul-icu/StructureDefinition/mii-pr-icu-score-cam-icu",
  "version": "2026.0.0",
  "differential": {
    "element": [ {
      "id": "Observation.code.coding",
      "min": 1,
      "path": "Observation.code.coding"
    }, {
      "id": "Observation.code.coding:sct",
      "path": "Observation.code.coding",
      "sliceName": "sct",
      "patternCoding": {
        "code": "450740000",
        "system": "http://snomed.info/sct",
        "display": "Confusion Assessment Method for the intensive care unit score"
      }
    }, {
      "id": "Observation.code.coding:loinc",
      "min": 1,
      "path": "Observation.code.coding",
      "sliceName": "loinc",
      "patternCoding": {
        "code": "99844-5",
        "system": "http://loinc.org",
        "display": "Confusion Assessment Method for the ICU"
      }
    }, {
      "id": "Observation.value[x]",
      "min": 1,
      "path": "Observation.value[x]",
      "slicing": {
        "rules": "open",
        "ordered": false,
        "discriminator": [ {
          "path": "$this",
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    }, {
      "id": "Observation.value[x]:valueCodeableConcept",
      "max": "1",
      "min": 1,
      "path": "Observation.value[x]",
      "type": [ {
        "code": "CodeableConcept"
      } ],
      "binding": {
        "strength": "required",
        "valueSet": "https://www.medizininformatik-initiative.de/fhir/ext/modul-icu/ValueSet/cam-icu-result"
      },
      "sliceName": "valueCodeableConcept"
    }, {
      "id": "Observation.interpretation",
      "path": "Observation.interpretation",
      "short": "Delirium status",
      "binding": {
        "strength": "extensible",
        "valueSet": "https://www.medizininformatik-initiative.de/fhir/ext/modul-icu/ValueSet/delirium-interpretation"
      }
    }, {
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        "rules": "open",
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      }
    }, {
      "id": "Observation.component:feature1-acute-change",
      "max": "1",
      "min": 0,
      "path": "Observation.component",
      "short": "Acute change or fluctuating mental status",
      "sliceName": "feature1-acute-change",
      "definition": "Is there an acute change from mental status baseline? Or has the patient's mental status fluctuated during the past 24 hours?",
      "mustSupport": true
    }, {
      "id": "Observation.component:feature1-acute-change.code.text",
      "path": "Observation.component.code.text",
      "patternString": "Acute change from mental status baseline or Fluctuation in mental status in past 24 hours [CAM.ICU]"
    }, {
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      "path": "Observation.component.value[x]",
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    }, {
      "id": "Observation.component:feature2-inattention",
      "max": "1",
      "min": 0,
      "path": "Observation.component",
      "short": "Inattention present",
      "sliceName": "feature2-inattention",
      "definition": "Does the patient have difficulty focusing attention (e.g., easily distracted, difficulty keeping track of conversation)?",
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    }, {
      "id": "Observation.component:feature2-inattention.code.text",
      "path": "Observation.component.code.text",
      "patternString": "Feature 2: Inattention"
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      "id": "Observation.component:feature2-inattention.value[x]",
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    }, {
      "id": "Observation.component:feature3-altered-loc",
      "max": "1",
      "min": 0,
      "path": "Observation.component",
      "short": "Current level of consciousness",
      "sliceName": "feature3-altered-loc",
      "definition": "Is the patient's level of consciousness anything other than alert (e.g., vigilant, lethargic, stupor, coma)?",
      "mustSupport": true
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      "id": "Observation.component:feature3-altered-loc.code.text",
      "path": "Observation.component.code.text",
      "patternString": "Feature 3: Altered level of consciousness"
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    }, {
      "id": "Observation.component:feature4-disorganized-thinking",
      "max": "1",
      "min": 0,
      "path": "Observation.component",
      "short": "Disorganized thinking present",
      "sliceName": "feature4-disorganized-thinking",
      "definition": "Is there evidence of disorganized or incoherent thinking (e.g., rambling, irrelevant conversation, unclear flow of ideas, illogical thinking)?",
      "mustSupport": true
    }, {
      "id": "Observation.component:feature4-disorganized-thinking.code.text",
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  },
  "contact": [ {
    "telecom": [ {
      "value": "https://www.medizininformatik-initiative.de",
      "system": "url"
    } ]
  } ],
  "baseDefinition": "https://www.medizininformatik-initiative.de/fhir/ext/modul-icu/StructureDefinition/mii-pr-icu-score"
}