New Zealand ICP Implementation Guide
1.0.0 - draft
New Zealand ICP Implementation Guide
1.0.0 - draft
New Zealand ICP Implementation Guide, published by Accident Compensation Corporation. This guide is not an authorized publication; it is the continuous build for version 1.0.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/acc-fhir-publisher/icp/ and changes regularly. See the Directory of published versions
| Official URL: http://hl7.org.nz/fhir/Questionnaire/acc-bist | Version: 1.0.0 | |||
| Draft as of 2024-11-10 | Computable Name: ACCBist | |||
Usage:Clinical Focus: BIST |
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Represents the Brain Injury Screening Tool (BIST) for ACC.
Generated Narrative: Questionnaire acc-bist
| LinkID | Text | Cardinality | Type | Description & Constraints |
|---|---|---|---|---|
  ACCBist | Represents the Brain Injury Screening Tool (BIST) for ACC. | Questionnaire | http://hl7.org.nz/fhir/Questionnaire/acc-bist#1.0.0 | |
  0 | null | 0..1 | group | |
  0.1 | Date of injury | 1..1 | date | |
 0.2 | Time of injury | 1..1 | string | |
| 0.3 | Date of consultation | 1..1 | date | |
  0.4 | Injury occurred within past 24 hours | 1..1 | choice | Value Set: BIST Answer Option ( no | yes ) |
| 1 | null | 0..1 | group | |
 1.1 | Please tell me about what happened | 1..1 | text | |
| 1.2 | Are there high risk indicators such as suspicion of skull fracture, focal neurological deficit, high speed, focal blunt trauma, or fall from height (e.g., > 5 stairs) | 1..1 | choice | Value Set: BIST Answer Option ( no | yes ) |
 1.2.1 | **If high risk indicators present, consider referral to Emergency Department or Concussion Service** | 0..1 | display | Enable When: 1.2 = |
| 1.3 | Did the incident occur in traumatic circumstances which could result in emotional or psychological reactions (e.g., assault, domestic violence, fatalities in a car accident) | 1..1 | choice | Value Set: BIST Answer Option ( no | yes ) |
| 1.3.1 | **If psychological trauma likely, consider referral to Concussion Service** | 0..1 | display | Enable When: 1.4 = |
| 1.4 | Did anyone with you at the time of injury say anything else about what happened | 1..1 | choice | Value Set: BIST Answer Option ( no | yes ) |
| 1.4.1 | Please give details | 0..1 | text | Enable When: 1.4 = |
| 1.5 | Were you sick or did you vomit | 1..1 | choice | Value Set: BIST Answer Option ( no | yes ) |
| 1.5.1 | How many times | 1..1 | string | Enable When: 1.5 = |
| 1.5.1.1 | **If > 1 vomiting episode, consider referral to the Emergency Department or Concussion Service** | 0..1 | display | |
| 1.6 | Were you knocked out (or did you lose consciousness) | 1..1 | choice | Value Set: BIST Answer Option ( no | yes ) |
| 1.6.1 | How long for (hours/mins) | 0..1 | string | Enable When: 1.6 = |
| 1.6.1.1 | **If loss of consciousness > brief, consider referral to Emergency Department or Concussion Service** | 0..1 | display | |
| 1.7 | Did you have a fit or seizure straight afterwards (i.e., go stiff or shake violently) | 1..1 | choice | Value Set: BIST Answer Option ( no | yes | unknown) |
| 1.7.1 | **If seizure is within a few days of the injury, consider referral to Emergency Department or Concussion Service** | 0..1 | display | Enable When: 1.7 = |
| 1.8 | Are you feeling better, worse, or about the same since the injury | 1..1 | choice | Value Set: BIST Answer Option ( Better | Worse | About the same ) |
| 1.8.1 | **If symptoms have worsened within the first few days of injury, consider referral to the Emergency Department or Concussion Service** | 0..1 | display | Enable When: 1.8 = |
| 1.9 | Have you had a concussion or brain injury before | 1..1 | choice | Value Set: BIST Answer Option ( no | yes ) |
| 1.9.1 | How many times | 1..1 | string | Enable When: 1.9 = |
| 1.9.2 | When was the last injury | 1..1 | date | Enable When: 1.9 = |
| 1.9.3 | Was it a prolonged recovery (> 3 months to recover) | 1..1 | choice | Enable When: 1.9 = Value Set: BIST Answer Option ( no | yes ) |
| 1.9.4 | **If multiple, recent or unrecovered previous injury, refer to Emergency Department or Concussion Service** | 0..1 | display | Enable When: 1.9 = |
| 1.10 | Are you currently taking any medications that thin the blood e.g., anticoagulants | 1..1 | choice | Value Set: BIST Answer Option ( no | yes ) |
| 1.10.1 | **Consider referral to Emergency Department if injury recently sustained (within past few days)** | 0..1 | display | Enable When: 1.10 = |
| 1.11 | Have you ever experienced difficulties with your mental health | 1..1 | choice | Value Set: BIST Answer Option ( no | yes ) |
| 1.11.1 | **The person may be at moderate risk of poor recovery and early specialist input may be required. If not recovered by 7-10 days, consider referral to Concussion Service** | 0..1 | display | Enable When: 1.11 = |
| 1.12 | Do you have a history of migraine (severe headache with vomiting or extreme sensitivity to light and sound) | 1..1 | choice | Value Set: BIST Answer Option ( no | yes ) |
| 1.12.1 | **If not recovered by 7-10 days, consider referral to Concussion Service** | 0..1 | display | Enable When: 1.12 = |
| 2 | Patient questions | 0..1 | group | |
| 2.0 | Compared with before the accident, please rate how much you experience the following symptoms: | 0..1 | display | |
| 2.1 | **Physical:** | 0..1 | group | |
| 2.1.1 | Headache (my head hurts) | 0..1 | choice | Value Set: BIST Options Range 0-10 ( 0 | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 ) |
| 2.1.2 | My neck hurts | 0..1 | choice | Value Set: BIST Options Range 0-10 ( 0 | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 ) |
| 2.1.3 | I don't like bright lights | 0..1 | choice | Value Set: BIST Options Range 0-10 ( 0 | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 ) |
| 2.1.4 | I don't like loud noises | 0..1 | choice | Value Set: BIST Options Range 0-10 ( 0 | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 ) |
 2.1.0 | Total physical score (out of 40) score | 0..1 | decimal | Initial Value: decimal = 0 |
| 2.2 | **Vestibular-ocular:** | 0..1 | group | |
| 2.2.1 | I fell dizzy or like I could be sick | 0..1 | choice | Value Set: BIST Options Range 0-10 ( 0 | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 ) |
| 2.2.2 | If I close my eyes, I feel like I am sea | 0..1 | choice | Value Set: BIST Options Range 0-10 ( 0 | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 ) |
| 2.2.3 | I have trouble with my eyesight (vision) | 0..1 | choice | Value Set: BIST Options Range 0-10 ( 0 | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 ) |
| 2.2.4 | I feel clumsy (bumping into or dropping things more than usual) | 0..1 | choice | Value Set: BIST Options Range 0-10 ( 0 | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 ) |
| 2.2.0 | Total vestibular score (out of 40) | 0..1 | decimal | Initial Value: decimal = 0 |
| 2.3 | **Cognitive:** | 0..1 | group | |
| 2.3.1 | It takes me longer to think | 0..1 | choice | Value Set: BIST Options Range 0-10 ( 0 | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 ) |
| 2.3.2 | I forget things | 0..1 | choice | Value Set: BIST Options Range 0-10 ( 0 | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 ) |
| 2.3.3 | I get confused easily | 0..1 | choice | Value Set: BIST Options Range 0-10 ( 0 | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 ) |
| 2.3.4 | I have trouble concentrating | 0..1 | choice | Value Set: BIST Options Range 0-10 ( 0 | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 ) |
| 2.3.0 | Total cognitive score (out of 40) | 0..1 | decimal | Initial Value: decimal = 0 |
| 2.4 | **If more than 24 hours post-injury, please also rate these physical symptoms:** | 0..1 | group | |
 2.4.1 | I get angry or irritated easily | 0..1 | choice | Value Set: BIST Options Range 0-10 ( 0 | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 ) |
| 2.4.2 | I feel restless | 0..1 | choice | Value Set: BIST Options Range 0-10 ( 0 | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 ) |
| 2.4.3 | I feel tired during the day | 0..1 | choice | Value Set: BIST Options Range 0-10 ( 0 | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 ) |
| 2.4.4 | I need to sleep a lot more or find it hard to sleep at night | 0..1 | choice | Value Set: BIST Options Range 0-10 ( 0 | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 ) |
| 3 | null | 0..1 | group | |
| 3.1 | Total symptom severity score within 24 hours (out of 120) | 0..1 | decimal | Initial Value: decimal = 0 |
| 3.1.1 | **If score is 50 or more, consider referral to Concussion Service as this person is likely to be at moderate risk of poor recovery** | 0..1 | display | Enable When: 3.1 > |
| 3.1.2 | **If < 50, this person is at low risk, monitor and follow up in 7 - 10 days** | 0..1 | display | Enable When: 3.1 <= |
| 3.2 | Total symptom severity score > 24 hours (out of 160) | 0..1 | decimal | Initial Value: decimal = 0 |
| 3.2.1 | **If score is 66 or more, consider referral to Concussion Service as this person is likely to be at moderate risk of poor recovery** | 0..1 | display | Enable When: 3.2 >= |
| 3.2.2 | **If < 66, this person is at low risk, monitor and follow up in 7 - 10 days. If minimal improvement in scores since previous visit, consider referral to Concussion Service** | 0..1 | display | Enable When: 3.2 < |
| 3.3 | **Injuries to the brain can affect how a person feels, behaves, thinks, and how able they are to do everyday tasks** On a scale of 0 to 10, where 0 means that you do not feel the injury has had any impact on you at all, and 10 means you feel that the injury stops you from doing anything, how much do you feel your injury is impacting on you at this point in time: | 0..1 | group | |
| 3.3.1.0 | Impact of injury | 0..1 | choice | Value Set: BIST Options Range 0-10 ( 0 | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 ) |
| Documentation for this format | ||||