archetype (adl_version=1.4; uid=0638a5d4-4012-43a5-a97d-cf379a960f99)
	openEHR-EHR-OBSERVATION.alvarado_score.v0

concept
	[at0000]	-- Alvarado score
language
	original_language = <[ISO_639-1::en]>
	translations = <
		["sv"] = <
			language = <[ISO_639-1::sv]>
			author = <
				["name"] = <"Dennis Forslund">
				["organisation"] = <"Cambio Healthcare Systems">
			>
		>
	>
description
	original_author = <
		["name"] = <"Syeeda S Farruque">
		["organisation"] = <"Cambio Healthcare Systems">
		["email"] = <"models@cambiocds.com">
		["date"] = <"2016-12-28">
	>
	details = <
		["sv"] = <
			language = <[ISO_639-1::sv]>
			purpose = <"Alvarado score utvecklades för att understödja diagnostik vid misstänkt akut appendicit.">
			use = <"Använd för att understödja diagnostik vid misstänkt akut appendicit. Totala poängen uppgår till maximalt 10p och utgörs av summan av följande faktorer:

+2 poäng - Ömhet höger fossa
+1 poäng - Förhöjd temperatur (>37.3°C eller 99.1°F)
+1 poäng - Släppömhet
+1 poäng - Smärtvandring till höger fossa
+1 poäng - Anorexi/aptitlöshet
+1 poäng - Illamående eller kräkning
+2 poäng - LPK > 10,000
+1 poäng - Vänsterförskjuten diff

- Poäng om ≤3p anses vara låg risk utan behov av vidare utredning med DT
- DT rekommenderas om 4-6p
- Poäng om ≥7p bör föranleda kontakt med kirurg. ">
			keywords = <"alvarado", "appendicit">
			misuse = <"Ej att anse som diagnostisk utan är endast till för att understödja klinisk bedömning.">
			copyright = <"© Cambio Healthcare Systems, openEHR Foundation">
		>
		["en"] = <
			language = <[ISO_639-1::en]>
			purpose = <"To determine the likelihood of appendicitis based on symptoms, signs and laboratory test results.">
			use = <"Use to determine the likelihood of appendicitis based on symptoms, signs and laboratory test results.

The total score, derived by adding up the individual scores for each of the 8 items ranges from 0 to 10 with score weights allocated thus:

+2 points - Right lower quadrant tenderness
+1 point - Elevated temperature (>37.3°C or 99.1°F)
+1 point - Rebound tenderness
+1 point - Migration of pain to the right lower quadrant
+1 point - Anorexia
+1 point - Nausea or vomiting
+2 point - Leukocytosis > 10,000
+1 point - Leukocyte left shift 

- A CT scan is recommended for scores 4-6 
- A surgical consultation for scores  ≥ 7. 
- For scores  ≤ 3: a CT scan is not needed due to the low probability of appendicitis.">
			keywords = <"acute appendicitis", "appendicitis">
			misuse = <"">
			copyright = <"© Cambio Healthcare Systems, openEHR Foundation">
		>
	>
	lifecycle_state = <"in_development">
	other_contributors = <"Heather Leslie, Atomica Informatics, Australia", ...>
	other_details = <
		["licence"] = <"This work is licensed under the Creative Commons Attribution-ShareAlike 3.0 License. To view a copy of this license, visit http://creativecommons.org/licenses/by-sa/3.0/.">
		["custodian_organisation"] = <"openEHR Foundation">
		["references"] = <"Alvarado A. A practical score for the early diagnosis of acute appendicitis. Ann Emerg Med. 1986 May;15(5):557-64. PubMed PMID: 3963537.

McKay R, Shepherd J. The use of the clinical scoring system by Alvarado in the decision to perform computed tomography for acute appendicitis in the ED. Am J Emerg Med. 2007 Jun;25(5):489-93. doi: 10.1016/j.ajem.2006.08.020. PubMed PMID: 17543650.">
		["current_contact"] = <"Heather Leslie, Atomica Informatics<heather.leslie@atomicainformatics.com>">
		["original_namespace"] = <"org.openehr">
		["original_publisher"] = <"openEHR Foundation">
		["custodian_namespace"] = <"org.openehr">
		["MD5-CAM-1.0.1"] = <"040354CC247D57E2E8569F37700C5478">
		["build_uid"] = <"40c42695-658c-445d-8da8-4e3526ba3880">
		["revision"] = <"0.0.1-alpha">
	>

definition
	OBSERVATION[at0000] matches {	-- Alvarado score
		data matches {
			HISTORY[at0001] matches {	-- Event Series
				events cardinality matches {1..*; unordered} matches {
					EVENT[at0002] occurrences matches {0..*} matches {	-- Any event
						data matches {
							ITEM_TREE[at0003] matches {	-- Tree
								items cardinality matches {0..*; unordered} matches {
									ELEMENT[at0004] occurrences matches {0..1} matches {	-- Right lower quadrant tenderness?
										value matches {
											0|[local::at0014], 	-- No
											2|[local::at0015]  	-- Yes
										}
									}
									ELEMENT[at0005] occurrences matches {0..1} matches {	-- Elevated temperature (>37.3°C or 99.1°F)?
										value matches {
											0|[local::at0016], 	-- No
											1|[local::at0017]  	-- Yes
										}
									}
									ELEMENT[at0006] occurrences matches {0..1} matches {	-- Rebound tenderness?
										value matches {
											0|[local::at0018], 	-- No
											1|[local::at0019]  	-- Yes
										}
									}
									ELEMENT[at0007] occurrences matches {0..1} matches {	-- Migration of pain to the right lower quadrant?
										value matches {
											0|[local::at0020], 	-- No
											1|[local::at0021]  	-- Yes
										}
									}
									ELEMENT[at0008] occurrences matches {0..1} matches {	-- Anorexia?
										value matches {
											0|[local::at0022], 	-- No
											1|[local::at0023]  	-- Yes
										}
									}
									ELEMENT[at0009] occurrences matches {0..1} matches {	-- Nausea or vomiting?
										value matches {
											0|[local::at0024], 	-- No
											1|[local::at0025]  	-- Yes
										}
									}
									ELEMENT[at0010] occurrences matches {0..1} matches {	-- Leukocytosis > 10,000?
										value matches {
											0|[local::at0026], 	-- No
											2|[local::at0027]  	-- Yes
										}
									}
									ELEMENT[at0011] occurrences matches {0..1} matches {	-- Leukocyte left shift
										value matches {
											0|[local::at0028], 	-- No
											1|[local::at0029]  	-- Yes
										}
									}
									ELEMENT[at0012] occurrences matches {0..1} matches {	-- Total score
										value matches {
											DV_COUNT matches {
												magnitude matches {|0..10|}
											}
										}
									}
								}
							}
						}
					}
				}
			}
		}
		protocol matches {
			ITEM_TREE[at0030] matches {	-- Tree
				items cardinality matches {0..*; unordered} matches {
					allow_archetype CLUSTER[at0031] occurrences matches {0..*} matches {	-- Extension
						include
							archetype_id/value matches {/.*/}
					}
				}
			}
		}
	}


ontology
	term_definitions = <
		["en"] = <
			items = <
				["at0000"] = <
					text = <"Alvarado score">
					description = <"Clinical scoring system used to determine the likelihood of appendicitis based on symptoms, signs and laboratory test results.">
				>
				["at0001"] = <
					text = <"Event Series">
					description = <"@ internal @">
				>
				["at0002"] = <
					text = <"Any event">
					description = <"Default, unspecified point in time or interval event which may be explicitly defined in a template or at run-time.">
				>
				["at0003"] = <
					text = <"Tree">
					description = <"@ internal @">
				>
				["at0004"] = <
					text = <"Right lower quadrant tenderness?">
					description = <"Score 2 if positive.">
				>
				["at0005"] = <
					text = <"Elevated temperature (>37.3°C or 99.1°F)?">
					description = <"Score 1 if positive.">
				>
				["at0006"] = <
					text = <"Rebound tenderness?">
					description = <"Score 1 if positive.">
				>
				["at0007"] = <
					text = <"Migration of pain to the right lower quadrant?">
					description = <"Score 1 if positive.">
				>
				["at0008"] = <
					text = <"Anorexia?">
					description = <"Score 1 if positive.">
				>
				["at0009"] = <
					text = <"Nausea or vomiting?">
					description = <"Score 1 if positive.">
				>
				["at0010"] = <
					text = <"Leukocytosis > 10,000?">
					description = <"Score 2 if positive.">
				>
				["at0011"] = <
					text = <"Leukocyte left shift">
					description = <"Score 1 if positive.">
				>
				["at0012"] = <
					text = <"Total score">
					description = <"The sum of each ordinal score recorded for each of the eight component responses.">
				>
				["at0014"] = <
					text = <"No">
					description = <"*">
				>
				["at0015"] = <
					text = <"Yes">
					description = <"*">
				>
				["at0016"] = <
					text = <"No">
					description = <"*">
				>
				["at0017"] = <
					text = <"Yes">
					description = <"*">
				>
				["at0018"] = <
					text = <"No">
					description = <"*">
				>
				["at0019"] = <
					text = <"Yes">
					description = <"*">
				>
				["at0020"] = <
					text = <"No">
					description = <"*">
				>
				["at0021"] = <
					text = <"Yes">
					description = <"*">
				>
				["at0022"] = <
					text = <"No">
					description = <"*">
				>
				["at0023"] = <
					text = <"Yes">
					description = <"*">
				>
				["at0024"] = <
					text = <"No">
					description = <"*">
				>
				["at0025"] = <
					text = <"Yes">
					description = <"*">
				>
				["at0026"] = <
					text = <"No">
					description = <"*">
				>
				["at0027"] = <
					text = <"Yes">
					description = <"*">
				>
				["at0028"] = <
					text = <"No">
					description = <"*">
				>
				["at0029"] = <
					text = <"Yes">
					description = <"*">
				>
				["at0030"] = <
					text = <"Tree">
					description = <"@ internal @">
				>
				["at0031"] = <
					text = <"Extension">
					description = <"Additional information required to capture local content or to align with other reference models/formalisms.">
					comment = <"For example: local information requirements or additional metadata to align with FHIR or CIMI equivalents.">
				>
			>
		>
		["sv"] = <
			items = <
				["at0000"] = <
					text = <"Alvarado appendicitis score">
					description = <"Alvarado score utvecklades för att understödja diagnostik vid misstänkt akut appendicit.">
				>
				["at0001"] = <
					text = <"*Event Series(en)">
					description = <"*@ internal @(en)">
				>
				["at0002"] = <
					text = <"*Any event(en)">
					description = <"**(en)">
				>
				["at0003"] = <
					text = <"*Tree(en)">
					description = <"*@ internal @(en)">
				>
				["at0004"] = <
					text = <"Ömhet höger fossa?">
					description = <"2p om föreliggande.">
				>
				["at0005"] = <
					text = <"Förhöjd temperatur (>37.3°C eller 99.1°F)?">
					description = <"1p om föreliggande.">
				>
				["at0006"] = <
					text = <"Släppömhet?">
					description = <"1p om föreliggande.">
				>
				["at0007"] = <
					text = <"Smärtvandring till höger fossa?">
					description = <"1p om föreliggande.">
				>
				["at0008"] = <
					text = <"Anorexi eller aptitlöshet?">
					description = <"1p om föreliggande.">
				>
				["at0009"] = <
					text = <"Illamående eller kräkning?">
					description = <"1p om föreliggande.">
				>
				["at0010"] = <
					text = <"LPK > 10,000?">
					description = <"2p om föreliggande.">
				>
				["at0011"] = <
					text = <"Vänsterförskjuten diff?">
					description = <"1p om föreliggande.">
				>
				["at0012"] = <
					text = <"Total poäng">
					description = <"Summan av samtliga faktorer">
				>
				["at0014"] = <
					text = <"Nej">
					description = <"*">
				>
				["at0015"] = <
					text = <"Ja">
					description = <"*">
				>
				["at0016"] = <
					text = <"Nej">
					description = <"*">
				>
				["at0017"] = <
					text = <"Ja">
					description = <"*">
				>
				["at0018"] = <
					text = <"Nej">
					description = <"*">
				>
				["at0019"] = <
					text = <"Ja">
					description = <"*">
				>
				["at0020"] = <
					text = <"Nej">
					description = <"*">
				>
				["at0021"] = <
					text = <"Ja">
					description = <"*">
				>
				["at0022"] = <
					text = <"Nej">
					description = <"*">
				>
				["at0023"] = <
					text = <"Ja">
					description = <"*">
				>
				["at0024"] = <
					text = <"Nej">
					description = <"*">
				>
				["at0025"] = <
					text = <"Ja">
					description = <"*">
				>
				["at0026"] = <
					text = <"Nej">
					description = <"*">
				>
				["at0027"] = <
					text = <"Ja">
					description = <"*">
				>
				["at0028"] = <
					text = <"Nej">
					description = <"*">
				>
				["at0029"] = <
					text = <"Ja">
					description = <"*">
				>
				["at0030"] = <
					text = <"*Tree(en)">
					description = <"*@ internal @(en)">
				>
				["at0031"] = <
					text = <"*Extension(en)">
					description = <"*Additional information required to capture local content or to align with other reference models/formalisms.(en)">
					comment = <"*For example: local information requirements or additional metadata to align with FHIR or CIMI equivalents.(en)">
				>
			>
		>
	>