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).'
package_name: de.medizininformatikinitiative.kerndatensatz.icu
derivation: constraint
name: MII_PR_ICU_Score_CAM_ICU
type: Observation
elements:
  code:
    elements:
      coding:
        index: 0
        slicing:
          slices:
            loinc:
              match: {}
              schema:
                pattern:
                  type: Coding
                  value: {code: 99844-5, system: 'http://loinc.org', display: Confusion Assessment Method for the ICU}
                _required: true
                index: 1
              min: 1
            sct:
              match: {}
              schema:
                pattern:
                  type: Coding
                  value: {code: '450740000', system: 'http://snomed.info/sct', display: Confusion Assessment Method for the intensive care unit score}
                index: 2
    required: [coding]
  value:
    choices: []
    index: 4
    slicing:
      rules: open
      ordered: false
      discriminator:
      - {path: $this, type: type}
      min: 1
      slices:
        valueCodeableConcept:
          match: {}
          schema:
            choices: [valueCodeableConcept]
            _required: true
            index: 6
          min: 1
          max: 1
  valueCodeableConcept:
    type: CodeableConcept
    choiceOf: value
    index: 7
    slicing:
      slices:
        valueCodeableConcept:
          match: {}
          schema: {type: CodeableConcept, choiceOf: value, _required: true, index: 7}
          min: 1
          max: 1
  interpretation:
    short: Delirium status
    binding: {strength: extensible, valueSet: 'https://www.medizininformatik-initiative.de/fhir/ext/modul-icu/ValueSet/delirium-interpretation'}
    index: 8
  component:
    array: true
    max: 4
    index: 9
    slicing:
      rules: open
      discriminator:
      - {path: code, type: pattern}
      min: null
      max: 4
      slices:
        feature1-acute-change:
          match: {code: null}
          schema:
            short: Acute change or fluctuating mental status
            mustSupport: true
            index: 10
            elements:
              code:
                elements:
                  text:
                    pattern: {type: String, value: 'Acute change from mental status baseline or Fluctuation in mental status in past 24 hours [CAM.ICU]'}
                    index: 11
              value:
                choices: []
                index: 13
                slicing:
                  rules: open
                  ordered: false
                  discriminator:
                  - {path: $this, type: type}
                  min: 1
                  slices:
                    valueCodeableConcept:
                      match: {}
                      schema:
                        choices: [valueCodeableConcept]
                        _required: true
                        index: 15
                      min: 1
                      max: 1
              valueCodeableConcept:
                type: CodeableConcept
                choiceOf: value
                index: 16
                slicing:
                  slices:
                    valueCodeableConcept:
                      match: {}
                      schema: {type: CodeableConcept, choiceOf: value, _required: true, index: 16}
                      min: 1
                      max: 1
            required: [value, valueCodeableConcept]
        feature2-inattention:
          match: {code: null}
          schema:
            short: Inattention present
            mustSupport: true
            index: 17
            elements:
              code:
                elements:
                  text:
                    pattern: {type: String, value: 'Feature 2: Inattention'}
                    index: 18
              value:
                choices: []
                index: 20
                slicing:
                  rules: open
                  ordered: false
                  discriminator:
                  - {path: $this, type: type}
                  min: 1
                  slices:
                    valueCodeableConcept:
                      match: {}
                      schema:
                        choices: [valueCodeableConcept]
                        _required: true
                        index: 22
                      min: 1
                      max: 1
              valueCodeableConcept:
                type: CodeableConcept
                choiceOf: value
                index: 23
                slicing:
                  slices:
                    valueCodeableConcept:
                      match: {}
                      schema: {type: CodeableConcept, choiceOf: value, _required: true, index: 23}
                      min: 1
                      max: 1
            required: [value, valueCodeableConcept]
        feature3-altered-loc:
          match: {code: null}
          schema:
            short: Current level of consciousness
            mustSupport: true
            index: 24
            elements:
              code:
                elements:
                  text:
                    pattern: {type: String, value: 'Feature 3: Altered level of consciousness'}
                    index: 25
              value:
                choices: []
                index: 27
                slicing:
                  rules: open
                  ordered: false
                  discriminator:
                  - {path: $this, type: type}
                  min: 1
                  slices:
                    valueCodeableConcept:
                      match: {}
                      schema:
                        choices: [valueCodeableConcept]
                        _required: true
                        index: 29
                      min: 1
                      max: 1
              valueCodeableConcept:
                type: CodeableConcept
                choiceOf: value
                index: 30
                slicing:
                  slices:
                    valueCodeableConcept:
                      match: {}
                      schema: {type: CodeableConcept, choiceOf: value, _required: true, index: 30}
                      min: 1
                      max: 1
            required: [value, valueCodeableConcept]
        feature4-disorganized-thinking:
          match: {code: null}
          schema:
            short: Disorganized thinking present
            mustSupport: true
            index: 31
            elements:
              code:
                elements:
                  text:
                    pattern: {type: String, value: 'Feature 4: Disorganized thinking'}
                    index: 32
              value:
                choices: []
                index: 34
                slicing:
                  rules: open
                  ordered: false
                  discriminator:
                  - {path: $this, type: type}
                  min: 1
                  slices:
                    valueCodeableConcept:
                      match: {}
                      schema:
                        choices: [valueCodeableConcept]
                        _required: true
                        index: 36
                      min: 1
                      max: 1
              valueCodeableConcept:
                type: CodeableConcept
                choiceOf: value
                index: 37
                slicing:
                  slices:
                    valueCodeableConcept:
                      match: {}
                      schema: {type: CodeableConcept, choiceOf: value, _required: true, index: 37}
                      min: 1
                      max: 1
            required: [value, valueCodeableConcept]
package_version: 2027.0.0-ballot.3
class: profile
kind: resource
url: https://www.medizininformatik-initiative.de/fhir/ext/modul-icu/StructureDefinition/mii-pr-icu-score-cam-icu
base: https://www.medizininformatik-initiative.de/fhir/ext/modul-icu/StructureDefinition/mii-pr-icu-score
version: 2027.0.0-ballot.3
required: [value, valueCodeableConcept]