archetype (adl_version=1.4; uid=677a2484-3ebd-49c9-81fc-b8341fae7a33)
	openEHR-EHR-OBSERVATION.hscore.v0

concept
	[at0000]	-- HScore
language
	original_language = <[ISO_639-1::en]>
	translations = <
		["nb"] = <
			language = <[ISO_639-1::nb]>
			author = <
				["name"] = <"Marit Alice Venheim">
				["organisation"] = <"Helse Vest IKT">
				["email"] = <"marit.alice.venheim@helse-vest-ikt.no">
			>
		>
	>
description
	original_author = <
		["name"] = <"Liv Laugen">
		["organisation"] = <"Oslo universitetssykehus">
		["email"] = <"liv.laugen@ous-hf.no">
		["date"] = <"2020-03-30">
	>
	details = <
		["nb"] = <
			language = <[ISO_639-1::nb]>
			purpose = <"For å registrere et estimat av ett individs risiko for å ha sekundær hemofagocytisk lymfohistiocytose.">
			use = <"Brukes for å registrere et estimat av ett individs risiko for å ha sekundær hemofagocytisk lymfohistiocytose.">
			keywords = <"HLH, sHLH, sekundær Hemofagisk lymfohistocytose, COVID-19, infeksjon, Reaktiv Heomfagocytisksyndrom, RAS, Makrofag Aktiveringsyndrom, MAS, Sekundær/reaktiv HLH", ...>
			misuse = <"">
		>
		["en"] = <
			language = <[ISO_639-1::en]>
			purpose = <"To record an estimation of an individual's risk of having reactive hemophagocytic syndrome.">
			use = <"Use to record an estimation of an individual's risk of having reactive hemophagocytic syndrome.">
			keywords = <"HLH, Hemophagocytic lymphohistiocytosis, COVID-19, infection,", ...>
			misuse = <"">
		>
	>
	lifecycle_state = <"in_development">
	other_contributors = <"Heather Leslie, Atomica Informatics, Australia (openEHR Editor)", "Vebjørn Arntzen, Oslo university hospital, Norway", "Silje Ljosland Bakke, Helse Vest IKT AS, Norway", "Marit Alice Venheim, Helse Vest IKT AS, Norway">
	other_details = <
		["licence"] = <"This work is licensed under the Creative Commons Attribution-ShareAlike 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by-sa/4.0/.">
		["custodian_organisation"] = <"openEHR Foundation">
		["references"] = <"Fardet L, Galicier L, Lambotte O, Marzac C, Aumont C, Chahwan D, Coppo P, Hejblum G. Development and validation of the HScore, a score for the diagnosis of reactive hemophagocytic syndrome. Arthritis Rheumatol. 2014 Sep;66(9):2613-20. doi: 10.1002/art.38690. PubMed PMID: 24782338.

Mehta P, McAuley DF, Brown M, Sanchez E, Tattersall RS, Manson JJ. COVID-19: consider cytokine storm syndromes and immunosuppression. Lancet. 2020 Mar 16;. doi: 10.1016/S0140-6736(20)30628-0. [Epub ahead of print] PubMed PMID: 32192578. ">
		["original_namespace"] = <"org.openehr">
		["original_publisher"] = <"openEHR Foundation">
		["custodian_namespace"] = <"org.openehr">
		["MD5-CAM-1.0.1"] = <"2F7A9970BE5A959CEFD5211DB1907494">
		["build_uid"] = <"b0a5f2b4-f7a1-43fd-ac35-a3a392df19f8">
		["revision"] = <"0.0.1-alpha">
	>

definition
	OBSERVATION[at0000] matches {    -- HScore
		data matches {
			HISTORY[at0001] matches {    -- History
				events cardinality matches {0..*; 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 {    -- Temperature
										value matches {
											0|[local::at0005],
											33|[local::at0006],
											49|[local::at0007]
										}
									}
									ELEMENT[at0008] occurrences matches {0..1} matches {    -- Organomegaly
										value matches {
											0|[local::at0009],
											23|[local::at0010],
											38|[local::at0011]
										}
									}
									ELEMENT[at0012] occurrences matches {0..1} matches {    -- Number of cytopenias
										value matches {
											0|[local::at0013],
											24|[local::at0014],
											34|[local::at0015]
										}
									}
									ELEMENT[at0016] occurrences matches {0..1} matches {    -- Triglycerides
										value matches {
											0|[local::at0024],
											44|[local::at0025],
											64|[local::at0026]
										}
									}
									ELEMENT[at0017] occurrences matches {0..1} matches {    -- Fibrinogen
										value matches {
											0|[local::at0027],
											30|[local::at0028]
										}
									}
									ELEMENT[at0018] occurrences matches {0..1} matches {    -- Ferritin
										value matches {
											0|[local::at0029],
											35|[local::at0030],
											50|[local::at0031]
										}
									}
									ELEMENT[at0019] occurrences matches {0..1} matches {    -- Aspartate aminotransferase
										value matches {
											0|[local::at0032],
											19|[local::at0033]
										}
									}
									ELEMENT[at0020] occurrences matches {0..1} matches {    -- Haemophagocytosis on bone marrow aspirate
										value matches {
											0|[local::at0034],
											35|[local::at0035]
										}
									}
									ELEMENT[at0021] occurrences matches {0..1} matches {    -- Known immunosuppression
										value matches {
											0|[local::at0022],
											18|[local::at0023]
										}
									}
									ELEMENT[at0036] occurrences matches {0..1} matches {    -- Total HScore
										value matches {
											DV_COUNT matches {
												magnitude matches {|0..337|}
											}
										}
									}
									ELEMENT[at0037] occurrences matches {0..1} matches {    -- Probability of HS
										value matches {
											DV_PROPORTION matches {
												numerator matches {|0.0..100.0|}
												type matches {2}
											}
										}
									}
								}
							}
						}
					}
				}
			}
		}
		protocol matches {
			ITEM_TREE[at0038] matches {    -- Item tree
				items cardinality matches {0..*; unordered} matches {
					allow_archetype CLUSTER[at0039] occurrences matches {0..*} matches {    -- Extension
						include
							archetype_id/value matches {/.*/}
					}
				}
			}
		}
	}


ontology
	term_definitions = <
		["en"] = <
			items = <
				["at0000"] = <
					text = <"HScore">
					description = <"Estimate an individual's risk of having reactive hemophagocytic syndrome.
">
				>
				["at0001"] = <
					text = <"History">
					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 = <"Temperature">
					description = <"Range category for the body temperature measurement.">
				>
				["at0005"] = <
					text = <"<38.4°C">
					description = <"The body temperature of the individual is less than 38.4°C.">
				>
				["at0006"] = <
					text = <"38.4-39.4°C">
					description = <"The body temperature of the individual is between 38.4 and 39.4°C.">
				>
				["at0007"] = <
					text = <">39.4°C">
					description = <"The body temperature of the individual is greater than 39.4°C.">
				>
				["at0008"] = <
					text = <"Organomegaly">
					description = <"Findings of any enlargement of the liver or/and spleen in the individual.">
				>
				["at0009"] = <
					text = <"None">
					description = <"No enlargement of the liver or the spleen.">
				>
				["at0010"] = <
					text = <"Hepatomegaly or splenomegaly">
					description = <"Enlargment of the liver or the spleen.">
				>
				["at0011"] = <
					text = <"Hepatomegaly and splenomegaly">
					description = <"Enlargement of both the liver and the spleen.">
				>
				["at0012"] = <
					text = <"Number of cytopenias">
					description = <"Number of cytopenias present - in red cells, white cells and/or platelets.">
					comment = <"Defined as either haemoglobin concentration of 9.2 g/dL or less (≤5.71 mmol/L), a white blood cell count of 5000 white blood cells per mm³ (5,0 x 10E9/L) or less, or platelet count of 110 000 platelets per mm³ (110 x 10E9/L) or less, or all of these criteria combined.
">
				>
				["at0013"] = <
					text = <"One lineage">
					description = <"Cytopenia in only one cell lineage.">
				>
				["at0014"] = <
					text = <"Two lineages">
					description = <"Cytopenia in two cell lineages.">
				>
				["at0015"] = <
					text = <"Three lineages">
					description = <"Cytopenia in three cell lineages.">
				>
				["at0016"] = <
					text = <"Triglycerides">
					description = <"The triglycerides category, measured in mmol/L or mg/dL.">
				>
				["at0017"] = <
					text = <"Fibrinogen">
					description = <"The fibrinogen category, measured in g/L or mg/dL.">
				>
				["at0018"] = <
					text = <"Ferritin">
					description = <"The ferritin category, measured in ng/mL or μg/L.">
				>
				["at0019"] = <
					text = <"Aspartate aminotransferase">
					description = <"An individvals serum aspartate aminotransferase level measured in U/L.">
					comment = <"This is also known as AST, AspAT, ASAT, AAT or SGOT.">
				>
				["at0020"] = <
					text = <"Haemophagocytosis on bone marrow aspirate">
					description = <"Presence of hemophagocytosis features in bone marrow aspirate.">
				>
				["at0021"] = <
					text = <"Known immunosuppression">
					description = <"Presence of known underlying immunosuppression.">
					comment = <"For example HIV positive or receiving long-term immunosuppressive therapy.">
				>
				["at0022"] = <
					text = <"No">
					description = <"No known underlying immunosuppression.">
				>
				["at0023"] = <
					text = <"Yes">
					description = <"Known underlying immunosuppression.">
				>
				["at0024"] = <
					text = <"<1.5 mmol/L">
					description = <"The Triglyceride level is less than 1.5 mmol/L or 132.7 mg/dL.">
				>
				["at0025"] = <
					text = <"1.5-4.0 mmol/L">
					description = <"The Triglyceride level is 1.5-4.0 mmol/L or 132.7-354 mg/dL.">
				>
				["at0026"] = <
					text = <">4.0 mmol/L">
					description = <"The Triglyceride level is greater than 4.0 mmol/L or 354 mg/dL.">
				>
				["at0027"] = <
					text = <">2.5 g/L">
					description = <"The fibinogen level is greater than 2.5 g/L or 250 mg/dL.">
				>
				["at0028"] = <
					text = <"≤2.5 g/L">
					description = <"The fibinogen level is less than or equal to 2.5 g/L 250 mg/dL.">
				>
				["at0029"] = <
					text = <"<2000 ng/ml">
					description = <"The ferritin level is less than 2000 ng/ml or 2000 μg/L.">
				>
				["at0030"] = <
					text = <"2000–6000 ng/ml">
					description = <"The ferritin level is 2000-6000 ng/ml or 2000-6000 μg/L.">
				>
				["at0031"] = <
					text = <">6000 ng/ml">
					description = <"The ferritin level is greater than 6000 ng/ml or 6000 μg/L.">
				>
				["at0032"] = <
					text = <"<30 U/L">
					description = <"The aspartate aminotransferase level is less than 30 U/L.">
				>
				["at0033"] = <
					text = <"≥30 U/L">
					description = <"The aspartate aminotransferase level is greater than or equal to 30 U/L.">
				>
				["at0034"] = <
					text = <"No">
					description = <"No hemophagocytosis features are present in bone marrow aspirate.">
				>
				["at0035"] = <
					text = <"Yes">
					description = <"Hemophagocytosis features are present in bone marrow aspirate.">
				>
				["at0036"] = <
					text = <"Total HScore">
					description = <"The total sum for each component variable for the HScore.">
				>
				["at0037"] = <
					text = <"Probability of HS">
					description = <"Probability of an individual having reactive hemophagocytic syndrome.">
					comment = <"According to table 5 in the original original paper by Fardet et al, https://doi.org/10.1002/art.38690.">
				>
				["at0038"] = <
					text = <"Item tree">
					description = <"@ internal @">
				>
				["at0039"] = <
					text = <"Extension">
					description = <"Additional information required to extend the model with local content or to align with other reference models or formalisms.
">
					comment = <"For example: local information requirements; or additional metadata to align with FHIR.">
				>
			>
		>
		["nb"] = <
			items = <
				["at0000"] = <
					text = <"HScore">
					description = <"Estimerer ett individs risiko for å ha sekundær hemofagocytisk lymfohistiocytose.">
				>
				["at0001"] = <
					text = <"History">
					description = <"@ internal @">
				>
				["at0002"] = <
					text = <"Uspesifisert hendelse">
					description = <"Standard, uspesifisert tidspunkt eller tidsintervall som kan defineres mer eksplisitt i et templat eller i en applikasjon.">
				>
				["at0003"] = <
					text = <"Tree">
					description = <"@ internal @">
				>
				["at0004"] = <
					text = <"Tempratur">
					description = <"Måling av kroppstemperatur.">
				>
				["at0005"] = <
					text = <"<38,4°C">
					description = <"Kroppstemperaturen til individet er mindre enn 38,4°C.">
				>
				["at0006"] = <
					text = <"38,4-39,4°C">
					description = <"Kroppstemperaturen til individet er mellom 38,4 og 39,4°C.">
				>
				["at0007"] = <
					text = <">39.4°C">
					description = <"Kroppstemperaturen til individet er større enn 39,4°C.">
				>
				["at0008"] = <
					text = <"Organomegali">
					description = <"Funn av forstørret lever og/eller milt hos individet.">
				>
				["at0009"] = <
					text = <"Ingen">
					description = <"Ingen forstørret lever og/eller milt hos individet.">
				>
				["at0010"] = <
					text = <"Hepatomegali eller splenomegali">
					description = <"Forstørret lever eller milt.">
				>
				["at0011"] = <
					text = <"Hepatomegali og splenomegali">
					description = <"Forstørret lever og milt.">
				>
				["at0012"] = <
					text = <"Antall cytopenier">
					description = <"Antall cytopenier til stede - i den røde cellelinjen, hvite cellelinjen og/eller blodplatelinjen.">
					comment = <"Definert som enten hemoglobinkonsentrasjon på 9,2 g/dL eller mindre (≤5,71 mmol/L), et antall hvite blodlegemer på 5000 hvite blodlegemer per mm³ (5,0 x 10E9/L) eller mindre, eller antall blodplater på 110 000 blodplater per mm³ (110 x 10E9/L) eller mindre, eller alle disse kriteriene kombinert.">
				>
				["at0013"] = <
					text = <"En linje">
					description = <"Cytopeni i kun en cellelinje.">
				>
				["at0014"] = <
					text = <"To linjer">
					description = <"Cytopeni i to cellelinjer.">
				>
				["at0015"] = <
					text = <"Tre linjer">
					description = <"Cytopeni i tre cellelinjer.">
				>
				["at0016"] = <
					text = <"Triglyserider">
					description = <"Triglyseridkonsentrasjonen målt i mmol/L eller mg/dL.">
				>
				["at0017"] = <
					text = <"Fibrinogen">
					description = <"Fibrinogenkonsentrasjonen målt i g/L eller mg/dL.">
				>
				["at0018"] = <
					text = <"Ferritin">
					description = <"Ferritinkonsentrasjonen mål i ng/mL or μg/L.">
				>
				["at0019"] = <
					text = <"Aspartataminotransferase">
					description = <"Ett individs aspartataminotransferasekonsentrasjon målt i U/L.">
					comment = <"Dette er også kjent som AST, AspAT, ASAT, AAT eller SGOT.">
				>
				["at0020"] = <
					text = <"Hemofagocytose i benmargsaspirat">
					description = <"Funn av fagocytose i benmargsaspiratet.">
				>
				["at0021"] = <
					text = <"Kjent immunsuppresjon">
					description = <"Tilstedeværelse av kjent immunsuppresjon.">
					comment = <"For eksempel HIV-positiv eller pågående langvarig immunsuppressiv behandling.">
				>
				["at0022"] = <
					text = <"Nei">
					description = <"Ingen kjent immunsuppresjon.">
				>
				["at0023"] = <
					text = <"Ja">
					description = <"Kjent immunsuppresjon.">
				>
				["at0024"] = <
					text = <"<1,5 mmol/L">
					description = <"Triglyseridkonsentrasjonen er mindre enn 1,5 mmol/L eller 132,7 mg/dL.">
				>
				["at0025"] = <
					text = <"1,5-4,0 mmol/L">
					description = <"Triglyseridkonsentrasjonen er 1,5-4,0 mmol/L eller 132,7-354 mg/dL.">
				>
				["at0026"] = <
					text = <">4,0 mmol/L">
					description = <"Triglyseridkonsentrasjonen er større enn 4,0 mmol/L eller 354 mg/dL.">
				>
				["at0027"] = <
					text = <">2,5 g/L">
					description = <"Fibrinogenkonsentrasjonen er større enn 2,5 g/L eller 250 mg/dL.">
				>
				["at0028"] = <
					text = <"≤2,5 g/L">
					description = <"Fibrinogenkonsentrasjonen er mindre enn eller er lik 2,5 g/L eller 250 mg/dL.">
				>
				["at0029"] = <
					text = <"<2000 ng/ml">
					description = <"Ferritinkonsentrasjonen er mindre enn 2000 ng/ml eller 2000 μg/L.">
				>
				["at0030"] = <
					text = <"2000–6000 ng/ml">
					description = <"Ferritinkonsentrasjonen er 2000-6000 ng/ml eller 2000-6000 μg/L.">
				>
				["at0031"] = <
					text = <">6000 ng/ml">
					description = <"Ferritin nivået er større enn 6000 ng/ml eller 6000 μg/L.">
				>
				["at0032"] = <
					text = <"<30 U/L">
					description = <"Aspartataminotransferasekonsentrasjonen er mindre enn 30 U/L.">
				>
				["at0033"] = <
					text = <"≥30 U/L">
					description = <"Aspartataminotransferasekonsentrasjonen er mer enn eller er lik 30 U/L.">
				>
				["at0034"] = <
					text = <"Nei">
					description = <"Det er ikke funnet hemofagocytose i benmargsaspiratet.">
				>
				["at0035"] = <
					text = <"Ja">
					description = <"Det er funnet hemofagocytose i benmargsaspiratet.">
				>
				["at0036"] = <
					text = <"Total HScore">
					description = <"Summen av skår av hver enkelt kategori.">
				>
				["at0037"] = <
					text = <"Sannsynligheten for sekundær HLH">
					description = <"Sannsynligheten for at ett individ har sekundær hemofagocytisk lymfohistiocytose.">
					comment = <"I følge tabell 5 i originalstudien av Fardet et al, https://doi.org/10.1002/art.38690.">
				>
				["at0038"] = <
					text = <"Item tree">
					description = <"@ internal @">
				>
				["at0039"] = <
					text = <"Tilleggsinformasjon">
					description = <"Ytterligere informasjon som trengs for å kunne registrere lokalt definert innhold eller for å tilpasse til andre referansemodeller/formalismer.">
					comment = <"For eksempel lokale informasjonsbehov eller ytterligere metadata for å kunne tilpasse til tilsvarende konsepter i FHIR eller CIMI.">
				>
			>
		>
	>