On Sat, Jan 29, 2005 at 05:26:45PM +0530, USM Bish wrote: > On Sat, Jan 29, 2005 at 01:07:06AM +0000, Thomas Beale wrote: > > I think it's a given that we assume that "age" is not literally > recorded in the db - the question is whether date of birth is > good enough. >
If the EHR is designed is to be developed for a 'patient centric' database where data is appended from the first registration onwards to ad-infinetum till his/ her death, the only thing needed is DOB. If the objective of the EHR is institution or episode centric, then ofcourse amendments as per the need may be thought of as per the setting. > > Clearly for many paediatric cases it is not, since birth can > come at a nearly arbitrary time these days (20 weeks?). > Prematurity and postmaturity are concepts in relation to gestational age (being one of the component factors) and not chronological 'age' per se (viz. 'age' as we percieve in common medical parliance). > To avoid working with negative ages, the one proper point of > reference we have is (estimated) date of conception, but for > most patients we probabl dont' need this. I suspect an > application level type is needed that generates age_since_birth > and age_since_conception from recorded expected date of > delivery, which should presumably be estimated date of > conception + 38 weeks (Sam tells me that actually recording the > date of conception can get people into trouble!).. I am of the view, that things like 'age since conception' is too variable a thing to be included in an objective database. In cases of conception within the period of gestational amenorrhoea, or worse still, spotting after conception, more often than not, gestatonal age is determined from ultrasound findings and other methods. It is best to leave these to the discretion of the practitioner. > > In the case of neonatal work (as I understand it from the > physicians) there are certain rules of thumb they use based on > the (estimated) date of conception compared with the due date > and again compared with the actual date of birth, modified by > factors such as IVF, AI, multiple births etc......to determine > level of prematurity. > There is actually little guess work here. If the last menstural period is known, the calculations are quite simple (irrespective of the method of conception). Even without accurate LMP, a fairly good estimation of the development process can be obtained (while the baby is in the womb) with invesigation methods available today. Normally, in medical practice, the term 'age' is chronological age in years as on last birthday (except in paed practice, where it may be in days, weeks or months). If credence is to be given to gestational age, mental age and other ages used in various sub-disciplines of medicine, the implementation would go into all sorts of tangents and unnecessary complexities. Yes, alternate age definitions may find a place in specialised scenerios, but not in a generic medical database setting. I would suggest, to clearly define 'age' as chronological age, and proceed accordingly. Dr USM Bish Bangalore - If you have any questions about using this list, please send a message to d.lloyd at openehr.org
