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RASS score to CDM Measurement

(Shantha Bethusamy) #1

Hi all,

Unsure if this is the right forum, please route me to the appropriate.

We have a requirement to convert one of the vitals, Richmond Agitation Sedation Scale (RASS) score to CDM ending in measurement table. The actual score can range from -5 to +5.

The measurement table field, value_as_number has the convention to not store negative values rather store null with some exceptions @ https://ohdsi.github.io/CommonDataModel/cdm531.html#MEASUREMENT

a) Is the solution then to store the value into value_source_value field ?
b) We also thought about leveraging the vaue_as_concept_id field by finding LOINC codes for the scores, but they seem too generic for this recognized standard scale.

e.g. RASS score +1 --> restless - concept ID 45881739

Appreciate your feedback,
Shantha B

(Dmytry Dymshyts) #2

a)

Then we probably need to enrich the list of exceptions.

b) RASS +1 Restless =“Anxious or apprehensive but movements not aggressive or vigorous”
LOINC concept seems to be appropriate. We can’t store the whole definition as a concept. We don’t store diabetes as “disorder of glucose metabolism with insulin dificiency and stuff”, we just have “diabetes mellitus”.
Same here - just Restless.

(Rimma Belenkaya) #3

@Dymshyts, @Christian_Reich

This problem generalizes representation of various scales.

RASS is a medical scale used to measure the agitation or sedation level of a person. It is mostly used in mechanically ventilated patients in order to avoid over and under-sedation (https://en.wikipedia.org/wiki/Richmond_Agitation-Sedation_Scale)

Problem space

  1. Concepts representing RASS scale grades are not fully available in the vocabulary: +3 (Very agitation), -2 (Light Sedation), -3 (Moderate Sedation) are unavailable, -4 (Deep Sedation)

  2. Those concepts that look suitable are not linked to the RASS scale concept which makes them out of context.
    For example, +1 (Restless) can be mapped to the LOINC concept https://athena.ohdsi.org/search-terms/terms/45881739 (LA16474-1) isn’t linked to RASS scale concept.

  3. Those concepts that look suitable are linked to their original scale, and, may not mean the same within the RASS scale.
    For example, “+1 (Restless)” (https://athena.ohdsi.org/search-terms/terms/45881739) is “Answer Of” “Mental Status”(https://athena.ohdsi.org/search-terms/terms/3018668).

  4. There is no designated relationship between scale and its scores.

  5. If scores are a combination of text and numbers or text and numeric ranges, how should they be represented? For example, LOINC 82227-0 “Pain intensity”:

  • 0: I have no pain at the moment.
  • 1: The pain is very mild at the moment.
  • 2:The pain is moderate at the moment.
  • 3: The pain is fairly severe at the moment.
  • 4: The pain is very severe at the moment.
  • 5: The pain is the worst imaginable at the moment.

Thank you.

t