Stream: Cancer Interoperability
Topic: Grade, Stage, Severity and Criticality
Mark Kramer (Jun 21 2017 at 20:40):
I'm trying to sort out Grade and Stage in relation to Condition.severity and the concept of Criticality that appears in AllergyIntolerance. Working definitions:
- Severity is the degree of harshness or extent of a symptom, disorder, or problem.
- Criticality is potential clinical harm associated with a condition. (Some conditions may be relatively severe, but not critical, such as severe hot flashes.)
- Stage is the relative advancement in the course of an disease.
- Grade represents the clinical significance (e.g., 1 = mild not requiring intervention; 2 = moderate, typically requiring non-invasive intervention, 3 = severe but not life-threatening, indicating hospitalization and impacting activities of daily living, 4 is life-threatening requiring immediate intervention, 5 is death)
My question is, is Grade synonymous with Severity or Criticality? For hot flashes, CTCAE lists Grade 1, 2, and 3, but not 4 or 5, since people don't die from hot flashes. Grade 3 cites "severe [hot flash] symptoms". Therefore, I conclude Grade aligns more with Criticality, not Severity. Is that correct?
Stefan Lang (Jun 22 2017 at 05:51):
I don't think that's an exact synonym.
Severity is "how bad it is", criticality is "how bad it might become". CTCAE grades mix that up. E.g., a non-invasive intervention may be indicated because the condition itself requires it, or to avoid some other condition that will typically come up at some point in the future
Stefan Lang (Jun 22 2017 at 06:01):
It's similar with TNM/UICC/AJCC. They, too, describe the current state (severity) as well as a prognosis for outcome (criticality)
Stefan Lang (Jun 22 2017 at 06:04):
Still, that's called a stage ;)
Mark Kramer (Jun 28 2017 at 12:02):
@Stefan Lang if you are right that Grade is neither severity nor criticality, then that implies the need for making an extension on Condition, if you regard Grade as a property of the cancer condition. OR - we might say that Grade is an independent observation (although it is an assessment really, not an observation). @Lloyd McKenzie how would you suggest modeling Grade?
Stefan Lang (Jun 28 2017 at 12:37):
@Mark Kramer There also is Condition.stage, defined as "Stage/grade, usually assessed formally".
I think that would cover CTCAE grades.
Mark Kramer (Jun 28 2017 at 12:58):
I think I have unintentionally created confusion. There are two different grades in play here: One is the histological grade “… the description of a tumor based on how abnormal the tumor cells and the tumor tissue look under a microscope", and the second is the AdverseEvent grade, CTCAE, which is more like a severity.
Stefan Lang (Jun 28 2017 at 13:21):
These are definitely different ;-)
The pathological "G" may well be represented as an Observation with code="pathological grading" and valueCodeableConcept holding "G1".
The definition of grade you gave above points straight to side effects/adverse events.
Richard Esmond (Jun 28 2017 at 14:21):
I once sat through a lengthy conversation within the Vocab group and the differences between Severity and Criticality, and if I remember correctly the 'best' explanation pivoted around 'how bad is it if it happens vs. how likely is it to happen'. If a person on vacation to Guatemala was bitten by a Guatemalan Spider and found they were severely allergic to it but they vowed to never enter Guatemala ever again, then the issue could be considered of low Criticality.
Last updated: Apr 12 2022 at 19:14 UTC
