# Representation of scales total score meaning **Category:** [Clinical](https://discourse.openehr.org/c/clinical/5) **Created:** 2022-09-21 09:57 UTC **Views:** 511 **Replies:** 3 **URL:** https://discourse.openehr.org/t/representation-of-scales-total-score-meaning/3007 --- ## Post #1 by @damoca Hello, We are working with the [International prostate symptom score (IPSS)](https://ckm.openehr.org/ckm/archetypes/1013.1.2361) archetype from CKM. We have been asked to add the interpretation for the total score, which ranges from 0 to 35 and that is currently represented as a DV_COUNT: * 0-7: Mild * 8-19: Moderate * 20-35: Severe We have several options here. * **Option 1**. Maintain the total score as a DV_COUNT and just add the interpretation a part of the comment of that element. This has been seen in [Moddified Barthel index](https://ckm.openehr.org/ckm/archetypes/1013.1.128) ![image|690x83](upload://kftnIkAokceYEEG0NUL4TwLTCtC.png) This approach also follows the [recommendation of not adding additional elements to scores](https://discourse.openehr.org/t/extra-data-elements-in-archetypes-representing-clinical-scores-and-scales/299) The problem with this approach is that we lose the formalization of that knowledge. * **Option 2**. Maintain the total score as a DV_COUNT and add a new element for the interpretation. This has been seen in [Waterlow score](https://ckm.openehr.org/ckm/archetypes/1013.1.1036) ![image|690x176](upload://dwNfGeV9st3YAnPGsX0dUQ8OsVv.png) In this specific example we see a problem with relying on an ad hoc interpretation of those ordinal values, as it defines a kind of ranges but not explicitly (it only includes an option for 10, 15 and 20). The alternative here would be to explicitly define a DV_ORDINAL for each of the possible values (for example, from 0 to 35 in the IPSS score), but this seems difficult to maintain. * **Option 3**. Is defining the value of a total score as a DV_COUNT mandatory in current modelling patterns? If not, would it possible to define a total score directly as a DV_ORDINAL/DV_SCALE? As an additional note, technically it would be possible to define a range as the constraint of the DV_ORDINAL value, as it is just an integer. We can do this in LinkEHR but I can't see that possibility in the Archetype Editor. Something like this: ![image|657x426](upload://wzrlzYbzuu4K5C7wzSIm4ypP0lt.png) --- ## Post #2 by @ian.mcnicoll Hi David, The inclusion of a coded interpretation or grade in addition to the raw total count is quite a common pattern. My current approach would be 1. Keep the Total Score as a Count 2 Add a Grade/Interpretation as a DV_CODED_TEXT (not an Ordinal/Scale).with internal codeList Mild, Moderate , Severe. The algorithm for calculating the Intepretation can be descriped in the description, or better still add From what I can see, that Interpretation is part of the original score I was the original author of the Waterlow scale and would not use an ordinal it that way now. Originally there quite a few places where 'artificial' ordinals were created but I think that approach is not used exactly for the reasons you have given. --- ## Post #3 by @ian.mcnicoll Aslo - I'd suggest you make a change request on CKM for the Interpretation to be added. --- ## Post #4 by @damoca I can also see the benefits of that new approach using a DV_CODED_TEXT. Thus, we do not need to replicate the value of the total score as it happens when using a DV_ORDINAL, which is safer from a data perspective. --- **Canonical:** https://discourse.openehr.org/t/representation-of-scales-total-score-meaning/3007 **Original content:** https://discourse.openehr.org/t/representation-of-scales-total-score-meaning/3007