archetype (adl_version=1.4; uid=d23b3c39-c9f9-45d7-989d-83001ac525a6)
	openEHR-EHR-OBSERVATION.grace_acs_risk.v0

concept
	[at0000]	-- Grace acs risk 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 Farruque">
		["organisation"] = <"Cambio Healthcare Systems">
		["email"] = <"models@cambiocds.com">
		["date"] = <"2017-02-18">
	>
	details = <
		["sv"] = <
			language = <[ISO_639-1::sv]>
			purpose = <"Att uppskatta 6-månadersmortalitet hos nyligen mottagna patienter med akut koronart syndrom.">
			use = <"Använd för att uppskatta 6-månadersmortalitet hos nyligen mottagna patienter med akut koronart syndrom. Instrumentet baseras på följande åtta faktorer:

Ålder
Hjärtfrekvens
Systoliskt blodtryck
Kreatininvärde, angivet i mg/dl
Hjärtstopp vid ankomst till sjukhus
Patologiska ST-förändringar på EKG
Förhöjda/avvikande hjärtmarkörer
Killip-klassificering (Klass I - ingen hjärtsvikt, klass II - rassel och/eller halsvenstas, klass III - lungödem, klass IV - kardiogen chock)

Resultatet uppgår till maximalt 372p - för detaljerad beskrivning av poängsystemet vänligen se (1). Resultatet tolkas enligt:

Non-STEMI inlagd på sjukhus:
1-108p - låg risk (<1% risk att avlida på sjukhuset)
109-140p - mellanrisk (1-3% risk att avlida på sjukhuset)
141-372p - hög risk (>3% risk att avlida på sjukhuset)

För detaljerad beskrivning av denna tolkning, vänligen se (2).">
			keywords = <"GRACE ACS Risk Score", "GRACE", "STEMI", "NSTEMI", "akut koronart syndrom", "akut kranskärlssjukdom", "kardiologi">
			misuse = <"Instrumentet är ej avsett för att identifiera patienter med akut koronart syndrom och ska endast användas i samråd med utförlig klinisk utredning.">
			copyright = <"© Apperta Foundation / Wales Cardiac Network">
		>
		["en"] = <
			language = <[ISO_639-1::en]>
			purpose = <"Identified patients will have a known STEMI (ST Elevation Myocardial Infarction) or NSTEMI (Non-ST Elevation Myocardial Infarction).">
			use = <"Determining the mortality of these patients can be achieved with these 8 variables:

Age in years 
Heart Rate
Systolic Blood Pressure
Creatinine (mg/dL)
Cardiac arrest at admission
ST segment deviation on EKG
Elevated/abnormal cardiac enzymes

Killip class (signs/symptoms):
	No CHF - Class I
	Rales and/or JVD - Class II
	Pulmonary edema - Class III
	Cardiogenic shock - Class IV

The sum total of all the individual scores ranges from 0 to 372 with discretized buckets to score for continuous variables such as Age and Heart rate for example. 
The full details can be seen on (1) with details on scoring and more scoring interpretations beyond that below, in (2).

Score interpretations:

Non-STE ACS in-hospital mortality: 
Low: score 1-108 (<1% probablility of death in hospital)
Intermediate: score 109-140 (1-3%)
High: score 141-372 (>3%)">
			keywords = <"GRACE ACS Risk score", "STEMI", "NSTEMI", "Acute Coronary Syndrome", "cardiology">
			misuse = <"The score was not designed to assess which patients’ anginal symptoms are due to ACS and should not be used out of context without a more thorough clinical examination.">
			copyright = <"© Apperta Foundation / Wales Cardiac Network">
		>
	>
	lifecycle_state = <"in_development">
	other_contributors = <>
	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"] = <"Apperta UK">
		["references"] = <"Ref. 1: Fox KA, Dabbous OH, Goldberg RJ, Pieper KS, Eagle KA, Van de Werf F, Avezum A,Goodman SG, Flather MD, Anderson FA Jr, Granger CB. Prediction of risk of death and myocardial infarction in the six months after presentation with acute coronary syndrome: prospective multinational observational study (GRACE). BMJ. 2006 Nov 25;333(7578):1091. Epub 2006 Oct 10. PubMed PMID: 17032691; PubMed Central PMCID: PMC1661748.

Ref. 2: http://www.outcomes-umassmed.org/GRACE/grace_risk_table.aspx ; University Court of the University of Edinburgh and the University of Massachusetts Centres for Outcomes Research (COR)">
		["original_namespace"] = <"uk.org.clinicalmodels">
		["original_publisher"] = <"Apperta UK">
		["custodian_namespace"] = <"uk.org.clinicalmodels">
		["MD5-CAM-1.0.1"] = <"3AB23EB711125878E60143CE90787592">
		["build_uid"] = <"33bc3c8e-9cc4-4eb8-87a9-6f04d9328ddc">
		["revision"] = <"0.0.1-alpha">
	>

definition
	OBSERVATION[at0000] matches {    -- Grace acs risk score
		data matches {
			HISTORY[at0001] matches {    -- Event Series
				events cardinality matches {1..*; unordered} matches {
					EVENT[at0002] occurrences matches {0..1} matches {    -- Any event
						data matches {
							ITEM_TREE[at0003] matches {    -- Tree
								items cardinality matches {0..*; unordered} matches {
									ELEMENT[at0004] occurrences matches {0..1} matches {    -- Age score
										value matches {
											0|[local::at0014],
											8|[local::at0015],
											25|[local::at0016],
											41|[local::at0017],
											58|[local::at0018],
											75|[local::at0019],
											91|[local::at0020],
											100|[local::at0021]
										}
									}
									ELEMENT[at0005] occurrences matches {0..1} matches {    -- Heart Rate score
										value matches {
											0|[local::at0022],
											3|[local::at0023],
											9|[local::at0024],
											15|[local::at0025],
											24|[local::at0026],
											38|[local::at0027],
											46|[local::at0028]
										}
									}
									ELEMENT[at0006] occurrences matches {0..1} matches {    -- Systolic Blood Pressure score
										value matches {
											0|[local::at0029],
											10|[local::at0030],
											24|[local::at0031],
											34|[local::at0032],
											43|[local::at0033],
											53|[local::at0034],
											58|[local::at0035]
										}
									}
									ELEMENT[at0007] occurrences matches {0..1} matches {    -- Creatinine score
										value matches {
											0|[local::at0036],
											1|[local::at0037],
											4|[local::at0038],
											7|[local::at0039],
											10|[local::at0040],
											13|[local::at0041],
											21|[local::at0042],
											28|[local::at0043]
										}
									}
									ELEMENT[at0008] occurrences matches {0..1} matches {    -- Cardiac Arrest at admission
										value matches {
											0|[local::at0044],
											39|[local::at0045]
										}
									}
									ELEMENT[at0009] occurrences matches {0..1} matches {    -- ST segment Deviation on EKG
										value matches {
											0|[local::at0046],
											28|[local::at0047]
										}
									}
									ELEMENT[at0010] occurrences matches {0..1} matches {    -- Elevated/Abnormal Cardiac Enzymes
										value matches {
											0|[local::at0048],
											14|[local::at0049]
										}
									}
									ELEMENT[at0011] occurrences matches {0..1} matches {    -- Killip Class score
										value matches {
											0|[local::at0050],
											20|[local::at0051],
											39|[local::at0052],
											59|[local::at0053]
										}
									}
									ELEMENT[at0012] occurrences matches {0..1} matches {    -- Total score
										value matches {
											DV_COUNT matches {
												magnitude matches {|0..372|}
											}
										}
									}
									ELEMENT[at0013] occurrences matches {0..1} matches {    -- Comment
										value matches {
											DV_TEXT matches {*}
										}
									}
								}
							}
						}
					}
				}
			}
		}
		protocol matches {
			ITEM_TREE[at0054] matches {*}    -- Item tree
		}
	}


ontology
	term_definitions = <
		["en"] = <
			items = <
				["at0000"] = <
					text = <"Grace acs risk score">
					description = <"GRACE [Global Registry of Acute Coronary Events] acute coronary syndrome (ACS) risk:
Estimates admission-6-month mortality for patients with ACS">
				>
				["at0001"] = <
					text = <"Event Series">
					description = <"@ internal @">
				>
				["at0002"] = <
					text = <"Any event">
					description = <"*">
				>
				["at0003"] = <
					text = <"Tree">
					description = <"@ internal @">
				>
				["at0004"] = <
					text = <"Age score">
					description = <"Discretized values for Age in years">
				>
				["at0005"] = <
					text = <"Heart Rate score">
					description = <"Discretized values for Heart rate in BPM">
				>
				["at0006"] = <
					text = <"Systolic Blood Pressure score">
					description = <"Discretized values for Systolic Blood Pressure (mmHg)">
				>
				["at0007"] = <
					text = <"Creatinine score">
					description = <"Discretized values for Creatinine (mg/dL)">
				>
				["at0008"] = <
					text = <"Cardiac Arrest at admission">
					description = <"Yes or No values are 39 and 0 respectively">
				>
				["at0009"] = <
					text = <"ST segment Deviation on EKG">
					description = <"Yes and No values are 28 and 0 respectively">
				>
				["at0010"] = <
					text = <"Elevated/Abnormal Cardiac Enzymes">
					description = <"Yes and No scores are 14 and 0 respectively">
				>
				["at0011"] = <
					text = <"Killip Class score">
					description = <"Killip Classification (Signs and Symptoms)">
				>
				["at0012"] = <
					text = <"Total score">
					description = <"Sum of all the individual scores">
				>
				["at0013"] = <
					text = <"Comment">
					description = <"Any comments regarding the score">
				>
				["at0014"] = <
					text = <"≤ 30 years">
					description = <"≤ 30 years">
				>
				["at0015"] = <
					text = <"30-39 years">
					description = <"30-39 years">
				>
				["at0016"] = <
					text = <"40-49 years">
					description = <"40-49 years">
				>
				["at0017"] = <
					text = <"50-59 years">
					description = <"50-59 years">
				>
				["at0018"] = <
					text = <"60-69 years">
					description = <"60-69 years">
				>
				["at0019"] = <
					text = <"70-79 years">
					description = <"70-79 years">
				>
				["at0020"] = <
					text = <"80-89 years">
					description = <"80-89 years">
				>
				["at0021"] = <
					text = <"≥ 90 years">
					description = <"≥ 90 years">
				>
				["at0022"] = <
					text = <"≤ 50 bpm">
					description = <"*">
				>
				["at0023"] = <
					text = <"50-69 bpm">
					description = <"*">
				>
				["at0024"] = <
					text = <"70-89 bpm">
					description = <"*">
				>
				["at0025"] = <
					text = <"90-109 bpm">
					description = <"*">
				>
				["at0026"] = <
					text = <"110-149 bpm">
					description = <"*">
				>
				["at0027"] = <
					text = <"150-199 bpm">
					description = <"*">
				>
				["at0028"] = <
					text = <"≥ 200 bpm">
					description = <"*">
				>
				["at0029"] = <
					text = <"≥ 200 mmHg">
					description = <"*">
				>
				["at0030"] = <
					text = <"160-199 mmHg">
					description = <"*">
				>
				["at0031"] = <
					text = <"140-159 mmHg">
					description = <"*">
				>
				["at0032"] = <
					text = <"120-139 mmHg">
					description = <"*">
				>
				["at0033"] = <
					text = <"100-119 mmHg">
					description = <"*">
				>
				["at0034"] = <
					text = <"80-99 mmHg">
					description = <"*">
				>
				["at0035"] = <
					text = <"≤ 80 mmHg">
					description = <"*">
				>
				["at0036"] = <
					text = <"NA">
					description = <"*">
				>
				["at0037"] = <
					text = <"0-0.39 mg/dL">
					description = <"*">
				>
				["at0038"] = <
					text = <"0.4-0.79 mg/dL">
					description = <"*">
				>
				["at0039"] = <
					text = <"0.8-1.19 mg/dL">
					description = <"*">
				>
				["at0040"] = <
					text = <"1.20-1.59 mg/dL">
					description = <"*">
				>
				["at0041"] = <
					text = <"1.60-1.99 mg/dL">
					description = <"*">
				>
				["at0042"] = <
					text = <"2.0-3.99 mg/dL">
					description = <"*">
				>
				["at0043"] = <
					text = <"> 4.0 mg/dL">
					description = <"*">
				>
				["at0044"] = <
					text = <"No">
					description = <"*">
				>
				["at0045"] = <
					text = <"Yes">
					description = <"*">
				>
				["at0046"] = <
					text = <"No">
					description = <"*">
				>
				["at0047"] = <
					text = <"Yes">
					description = <"*">
				>
				["at0048"] = <
					text = <"No">
					description = <"*">
				>
				["at0049"] = <
					text = <"Yes">
					description = <"*">
				>
				["at0050"] = <
					text = <"Class 1">
					description = <"*">
				>
				["at0051"] = <
					text = <"Class 2">
					description = <"*">
				>
				["at0052"] = <
					text = <"Class 3">
					description = <"*">
				>
				["at0053"] = <
					text = <"Class 4">
					description = <"*">
				>
				["at0054"] = <
					text = <"Item tree">
					description = <"@ internal @">
				>
			>
		>
		["sv"] = <
			items = <
				["at0000"] = <
					text = <"Grace ACS Risk Score">
					description = <"Global Registry of Acute Coronary Events (GRACE) Acute Coronary Syndrome (ACS) Risk Score används för att uppskatta 6-månadersmortalitet hos nyligen mottagna patienter med akut koronart syndrom.">
				>
				["at0001"] = <
					text = <"*Event Series(en)">
					description = <"*@ internal @(en)">
				>
				["at0002"] = <
					text = <"*Any event(en)">
					description = <"**(en)">
				>
				["at0003"] = <
					text = <"*Tree(en)">
					description = <"*@ internal @(en)">
				>
				["at0004"] = <
					text = <"Ålder">
					description = <"Poäng baserat på ålder.">
				>
				["at0005"] = <
					text = <"Hjärtfrekvens">
					description = <"Poäng baserat på hjärtfrekvens angiven i slag per minut.">
				>
				["at0006"] = <
					text = <"Systoliskt blodtryck">
					description = <"Poäng baserat på systoliskt blodtryck.">
				>
				["at0007"] = <
					text = <"Kreatinin">
					description = <"Poäng baserat på kreatininvärde, angivet i mg/dl.">
				>
				["at0008"] = <
					text = <"Hjärtstopp vid ankomst">
					description = <"Hjärtstopp vid ankomst till sjukhus.">
				>
				["at0009"] = <
					text = <"Patologiska ST-förändringar på EKG">
					description = <"Patologiska ST-förändringar på elektrokardiografi (EKG).">
				>
				["at0010"] = <
					text = <"Förhöjda/avvikande hjärtmarkörer">
					description = <"Provsvar - förhöjda/avvikande hjärtmarkörer.">
				>
				["at0011"] = <
					text = <"Killip-klassificering">
					description = <"Killip-klassificering baserat på fynd och symtom.">
				>
				["at0012"] = <
					text = <"Resultat">
					description = <"Summan av samtliga faktorer.">
				>
				["at0013"] = <
					text = <"Kommentar">
					description = <"Ev tillägg.">
				>
				["at0014"] = <
					text = <"≤ 30 år">
					description = <"*">
				>
				["at0015"] = <
					text = <"30-39 år">
					description = <"*">
				>
				["at0016"] = <
					text = <"40-49 år">
					description = <"*">
				>
				["at0017"] = <
					text = <"50-59 år">
					description = <"*">
				>
				["at0018"] = <
					text = <"60-69 år">
					description = <"*">
				>
				["at0019"] = <
					text = <"70-79 år">
					description = <"*">
				>
				["at0020"] = <
					text = <"80-89 år">
					description = <"*">
				>
				["at0021"] = <
					text = <"≥ 90 år">
					description = <"*">
				>
				["at0022"] = <
					text = <"≤ 50">
					description = <"*">
				>
				["at0023"] = <
					text = <"50-69">
					description = <"*">
				>
				["at0024"] = <
					text = <"70-89">
					description = <"*">
				>
				["at0025"] = <
					text = <"90-109">
					description = <"*">
				>
				["at0026"] = <
					text = <"110-149">
					description = <"*">
				>
				["at0027"] = <
					text = <"150-199">
					description = <"*">
				>
				["at0028"] = <
					text = <"≥ 200">
					description = <"*">
				>
				["at0029"] = <
					text = <"≥ 200 mmHg">
					description = <"*">
				>
				["at0030"] = <
					text = <"160-199 mmHg">
					description = <"*">
				>
				["at0031"] = <
					text = <"140-159 mmHg">
					description = <"*">
				>
				["at0032"] = <
					text = <"120-139 mmHg">
					description = <"*">
				>
				["at0033"] = <
					text = <"100-119 mmHg">
					description = <"*">
				>
				["at0034"] = <
					text = <"80-99 mmHg">
					description = <"*">
				>
				["at0035"] = <
					text = <"≤ 80 mmHg">
					description = <"*">
				>
				["at0036"] = <
					text = <"NA">
					description = <"*">
				>
				["at0037"] = <
					text = <"0-0.39 mg/dl">
					description = <"*">
				>
				["at0038"] = <
					text = <"0.4-0.79 mg/dl">
					description = <"*">
				>
				["at0039"] = <
					text = <"0.8-1.19 mg/dl">
					description = <"*">
				>
				["at0040"] = <
					text = <"1.20-1.59 mg/dl">
					description = <"*">
				>
				["at0041"] = <
					text = <"1.60-1.99 mg/dl">
					description = <"*">
				>
				["at0042"] = <
					text = <"2.0-3.99 mg/dl">
					description = <"*">
				>
				["at0043"] = <
					text = <"> 4.0 mg/dl">
					description = <"*">
				>
				["at0044"] = <
					text = <"Nej">
					description = <"*">
				>
				["at0045"] = <
					text = <"Ja">
					description = <"*">
				>
				["at0046"] = <
					text = <"Nej">
					description = <"*">
				>
				["at0047"] = <
					text = <"Ja">
					description = <"*">
				>
				["at0048"] = <
					text = <"Nej">
					description = <"*">
				>
				["at0049"] = <
					text = <"Ja">
					description = <"*">
				>
				["at0050"] = <
					text = <"Klass 1">
					description = <"*">
				>
				["at0051"] = <
					text = <"Klass 2">
					description = <"*">
				>
				["at0052"] = <
					text = <"Klass 3">
					description = <"*">
				>
				["at0053"] = <
					text = <"Klass 4">
					description = <"*">
				>
				["at0054"] = <
					text = <"*Item tree (en)">
					description = <"@ internal @">
				>
			>
		>
	>