{
  "description": "Intensive Care Delirium Screening Checklist (ICDSC) for delirium assessment. Evaluates 8 items over a shift (usually 8-12 hours). Each item scores 0 (absent) or 1 (present). Total score ranges from 0-8. A score of 0: no delirium, 1-3: subsyndromal delirium, ≥4: delirium.",
  "_filename": "StructureDefinition-mii-pr-icu-score-icdsc.json",
  "package_name": "de.medizininformatikinitiative.kerndatensatz.icu",
  "date": null,
  "derivation": "constraint",
  "publisher": "Medizininformatik Initiative",
  "fhirVersion": "4.0.1",
  "name": "MII_PR_ICU_Score_ICDSC",
  "abstract": false,
  "type": "Observation",
  "experimental": null,
  "resourceType": "StructureDefinition",
  "title": "MII PR ICU Score ICDSC",
  "package_version": "2026.0.0",
  "status": "draft",
  "id": "cd9e6e2f-ee55-4f28-8f21-c6ad9540d523",
  "kind": "resource",
  "url": "https://www.medizininformatik-initiative.de/fhir/ext/modul-icu/StructureDefinition/mii-pr-icu-score-icdsc",
  "version": "2026.0.0",
  "differential": {
    "element": [ {
      "id": "Observation.code.coding:sct",
      "path": "Observation.code.coding",
      "sliceName": "sct",
      "patternCoding": {
        "code": "1351995008",
        "system": "http://snomed.info/sct",
        "display": "Intensive Care Delirium Screening Checklist score (observable entity)"
      }
    }, {
      "id": "Observation.value[x]",
      "min": 1,
      "path": "Observation.value[x]",
      "slicing": {
        "rules": "open",
        "ordered": false,
        "discriminator": [ {
          "path": "$this",
          "type": "type"
        } ]
      }
    }, {
      "id": "Observation.value[x]:valueInteger",
      "max": "1",
      "min": 1,
      "path": "Observation.value[x]",
      "type": [ {
        "code": "integer"
      } ],
      "sliceName": "valueInteger",
      "constraint": [ {
        "key": "icdsc-score-range",
        "human": "ICDSC total score must be between 0 and 8",
        "source": "https://www.medizininformatik-initiative.de/fhir/ext/modul-icu/StructureDefinition/mii-pr-icu-score-icdsc",
        "severity": "error",
        "expression": "value >= 0 and value <= 8"
      } ]
    }, {
      "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"
      },
      "definition": "No delirium (0), subsyndromal delirium (1-3), delirium (≥4)"
    }, {
      "id": "Observation.component",
      "max": "8",
      "min": 8,
      "path": "Observation.component",
      "slicing": {
        "rules": "closed",
        "discriminator": [ {
          "path": "code",
          "type": "pattern"
        } ]
      }
    }, {
      "id": "Observation.component:altered-consciousness",
      "max": "1",
      "min": 1,
      "path": "Observation.component",
      "short": "Altered consciousness",
      "sliceName": "altered-consciousness",
      "definition": "No response (5 points in GCS), need for vigorous stimulation to obtain any response (1 point), or spontaneously drowsy (RASS -1 to -3) but easy to arouse (1 point)",
      "mustSupport": true
    }, {
      "id": "Observation.component:altered-consciousness.code.text",
      "path": "Observation.component.code.text",
      "patternString": "Altered level of consciousness"
    }, {
      "id": "Observation.component:altered-consciousness.value[x]",
      "min": 1,
      "path": "Observation.component.value[x]",
      "slicing": {
        "rules": "open",
        "ordered": false,
        "discriminator": [ {
          "path": "$this",
          "type": "type"
        } ]
      }
    }, {
      "id": "Observation.component:altered-consciousness.value[x]:valueInteger",
      "max": "1",
      "min": 1,
      "path": "Observation.component.value[x]",
      "type": [ {
        "code": "integer"
      } ],
      "sliceName": "valueInteger",
      "constraint": [ {
        "key": "icdsc-item-range",
        "human": "ICDSC item score must be 0 or 1",
        "source": "https://www.medizininformatik-initiative.de/fhir/ext/modul-icu/StructureDefinition/mii-pr-icu-score-icdsc",
        "severity": "error",
        "expression": "value = 0 or value = 1"
      } ]
    }, {
      "id": "Observation.component:inattention",
      "max": "1",
      "min": 1,
      "path": "Observation.component",
      "short": "Inattention",
      "sliceName": "inattention",
      "definition": "Difficulty following conversation or instructions, easily distracted by external stimuli, difficulty shifting focus",
      "mustSupport": true
    }, {
      "id": "Observation.component:inattention.code.text",
      "path": "Observation.component.code.text",
      "patternString": "Inattention"
    }, {
      "id": "Observation.component:inattention.value[x]",
      "min": 1,
      "path": "Observation.component.value[x]",
      "slicing": {
        "rules": "open",
        "ordered": false,
        "discriminator": [ {
          "path": "$this",
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    }, {
      "id": "Observation.component:inattention.value[x]:valueInteger",
      "max": "1",
      "min": 1,
      "path": "Observation.component.value[x]",
      "type": [ {
        "code": "integer"
      } ],
      "sliceName": "valueInteger",
      "constraint": [ {
        "key": "icdsc-item-range",
        "human": "ICDSC item score must be 0 or 1",
        "source": "https://www.medizininformatik-initiative.de/fhir/ext/modul-icu/StructureDefinition/mii-pr-icu-score-icdsc",
        "severity": "error",
        "expression": "value = 0 or value = 1"
      } ]
    }, {
      "id": "Observation.component:disorientation",
      "max": "1",
      "min": 1,
      "path": "Observation.component",
      "short": "Disorientation",
      "sliceName": "disorientation",
      "definition": "Manifest disorientation to time, place, or person (≥ 1 error)",
      "mustSupport": true
    }, {
      "id": "Observation.component:disorientation.code.text",
      "path": "Observation.component.code.text",
      "patternString": "Disorientation"
    }, {
      "id": "Observation.component:disorientation.value[x]",
      "min": 1,
      "path": "Observation.component.value[x]",
      "slicing": {
        "rules": "open",
        "ordered": false,
        "discriminator": [ {
          "path": "$this",
          "type": "type"
        } ]
      }
    }, {
      "id": "Observation.component:disorientation.value[x]:valueInteger",
      "max": "1",
      "min": 1,
      "path": "Observation.component.value[x]",
      "type": [ {
        "code": "integer"
      } ],
      "sliceName": "valueInteger",
      "constraint": [ {
        "key": "icdsc-item-range",
        "human": "ICDSC item score must be 0 or 1",
        "source": "https://www.medizininformatik-initiative.de/fhir/ext/modul-icu/StructureDefinition/mii-pr-icu-score-icdsc",
        "severity": "error",
        "expression": "value = 0 or value = 1"
      } ]
    }, {
      "id": "Observation.component:hallucination-delusion",
      "max": "1",
      "min": 1,
      "path": "Observation.component",
      "short": "Hallucination, delusion, or psychosis",
      "sliceName": "hallucination-delusion",
      "definition": "Clinical manifestation of hallucination or behavior suggestive of hallucination, gross distortion or misrepresentation of reality",
      "mustSupport": true
    }, {
      "id": "Observation.component:hallucination-delusion.code.text",
      "path": "Observation.component.code.text",
      "patternString": "Hallucination, delusion, or psychosis"
    }, {
      "id": "Observation.component:hallucination-delusion.value[x]",
      "min": 1,
      "path": "Observation.component.value[x]",
      "slicing": {
        "rules": "open",
        "ordered": false,
        "discriminator": [ {
          "path": "$this",
          "type": "type"
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      }
    }, {
      "id": "Observation.component:hallucination-delusion.value[x]:valueInteger",
      "max": "1",
      "min": 1,
      "path": "Observation.component.value[x]",
      "type": [ {
        "code": "integer"
      } ],
      "sliceName": "valueInteger",
      "constraint": [ {
        "key": "icdsc-item-range",
        "human": "ICDSC item score must be 0 or 1",
        "source": "https://www.medizininformatik-initiative.de/fhir/ext/modul-icu/StructureDefinition/mii-pr-icu-score-icdsc",
        "severity": "error",
        "expression": "value = 0 or value = 1"
      } ]
    }, {
      "id": "Observation.component:psychomotor-agitation-retardation",
      "max": "1",
      "min": 1,
      "path": "Observation.component",
      "short": "Psychomotor agitation or retardation",
      "sliceName": "psychomotor-agitation-retardation",
      "definition": "Hyperactivity requiring sedation or restraints, hypoactivity or clinically noticeable psychomotor slowing",
      "mustSupport": true
    }, {
      "id": "Observation.component:psychomotor-agitation-retardation.code.text",
      "path": "Observation.component.code.text",
      "patternString": "Psychomotor agitation or retardation"
    }, {
      "id": "Observation.component:psychomotor-agitation-retardation.value[x]",
      "min": 1,
      "path": "Observation.component.value[x]",
      "slicing": {
        "rules": "open",
        "ordered": false,
        "discriminator": [ {
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      }
    }, {
      "id": "Observation.component:psychomotor-agitation-retardation.value[x]:valueInteger",
      "max": "1",
      "min": 1,
      "path": "Observation.component.value[x]",
      "type": [ {
        "code": "integer"
      } ],
      "sliceName": "valueInteger",
      "constraint": [ {
        "key": "icdsc-item-range",
        "human": "ICDSC item score must be 0 or 1",
        "source": "https://www.medizininformatik-initiative.de/fhir/ext/modul-icu/StructureDefinition/mii-pr-icu-score-icdsc",
        "severity": "error",
        "expression": "value = 0 or value = 1"
      } ]
    }, {
      "id": "Observation.component:inappropriate-speech-mood",
      "max": "1",
      "min": 1,
      "path": "Observation.component",
      "short": "Inappropriate speech or mood",
      "sliceName": "inappropriate-speech-mood",
      "definition": "Inappropriate, disorganized, or incoherent speech, inappropriate display of emotion",
      "mustSupport": true
    }, {
      "id": "Observation.component:inappropriate-speech-mood.code.text",
      "path": "Observation.component.code.text",
      "patternString": "Inappropriate speech or mood"
    }, {
      "id": "Observation.component:inappropriate-speech-mood.value[x]",
      "min": 1,
      "path": "Observation.component.value[x]",
      "slicing": {
        "rules": "open",
        "ordered": false,
        "discriminator": [ {
          "path": "$this",
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    }, {
      "id": "Observation.component:inappropriate-speech-mood.value[x]:valueInteger",
      "max": "1",
      "min": 1,
      "path": "Observation.component.value[x]",
      "type": [ {
        "code": "integer"
      } ],
      "sliceName": "valueInteger",
      "constraint": [ {
        "key": "icdsc-item-range",
        "human": "ICDSC item score must be 0 or 1",
        "source": "https://www.medizininformatik-initiative.de/fhir/ext/modul-icu/StructureDefinition/mii-pr-icu-score-icdsc",
        "severity": "error",
        "expression": "value = 0 or value = 1"
      } ]
    }, {
      "id": "Observation.component:sleep-wake-disturbance",
      "max": "1",
      "min": 1,
      "path": "Observation.component",
      "short": "Sleep/wake cycle disturbance",
      "sliceName": "sleep-wake-disturbance",
      "definition": "Sleeping less than 4 hours or frequent awakening at night, sleeping most of the day",
      "mustSupport": true
    }, {
      "id": "Observation.component:sleep-wake-disturbance.code.text",
      "path": "Observation.component.code.text",
      "patternString": "Sleep/wake cycle disturbance"
    }, {
      "id": "Observation.component:sleep-wake-disturbance.value[x]",
      "min": 1,
      "path": "Observation.component.value[x]",
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      "id": "Observation.component:sleep-wake-disturbance.value[x]:valueInteger",
      "max": "1",
      "min": 1,
      "path": "Observation.component.value[x]",
      "type": [ {
        "code": "integer"
      } ],
      "sliceName": "valueInteger",
      "constraint": [ {
        "key": "icdsc-item-range",
        "human": "ICDSC item score must be 0 or 1",
        "source": "https://www.medizininformatik-initiative.de/fhir/ext/modul-icu/StructureDefinition/mii-pr-icu-score-icdsc",
        "severity": "error",
        "expression": "value = 0 or value = 1"
      } ]
    }, {
      "id": "Observation.component:symptom-fluctuation",
      "max": "1",
      "min": 1,
      "path": "Observation.component",
      "short": "Symptom fluctuation",
      "sliceName": "symptom-fluctuation",
      "definition": "Fluctuation of manifestation of any item or symptom over 24 hours",
      "mustSupport": true
    }, {
      "id": "Observation.component:symptom-fluctuation.code.text",
      "path": "Observation.component.code.text",
      "patternString": "Symptom fluctuation"
    }, {
      "id": "Observation.component:symptom-fluctuation.value[x]",
      "min": 1,
      "path": "Observation.component.value[x]",
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      "id": "Observation.component:symptom-fluctuation.value[x]:valueInteger",
      "max": "1",
      "min": 1,
      "path": "Observation.component.value[x]",
      "type": [ {
        "code": "integer"
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      "sliceName": "valueInteger",
      "constraint": [ {
        "key": "icdsc-item-range",
        "human": "ICDSC item score must be 0 or 1",
        "source": "https://www.medizininformatik-initiative.de/fhir/ext/modul-icu/StructureDefinition/mii-pr-icu-score-icdsc",
        "severity": "error",
        "expression": "value = 0 or value = 1"
      } ]
    } ]
  },
  "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"
}