Wikipedia:Articles for deletion/Collapse (medical)

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The following discussion is an archived debate of the proposed deletion of the article below. Please do not modify it. Subsequent comments should be made on the appropriate discussion page (such as the article's talk page or in a deletion review). No further edits should be made to this page.

The result was delete. Clear conclusion that as a medical article this isn’t helpful or appropriate but where or how we do this (if at all) we can leave editors to discuss and agree what kind of redirect, replacement or other solution is best. Spartaz Humbug! 20:20, 27 March 2021 (UTC)[reply]

Collapse (medical)

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Collapse (medical) (edit | talk | history | protect | delete | links | watch | logs | views) – (View log)
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(Responding to a call for attention from an expert in Cardiology, pending from 2019). 'Collapse' is a colloquial rather than a medical term, that seems to be used in medical literature with various meanings:

This may explain why this stub has only been relying on a single source for a number of years (other sources give different definitions). Being devoid of any standard medical meaning, the very existence of this article may be unwarranted. Moreover, given the above, I cannot see how this article is of high importance in Cardiology. It could be replaced by mentioning in Collapse (disambiguation) that, 'in medicine, collapse may refer to syncope or loss of pustural muscle tone', in a style similar to blackout (disambiguation); or perhaps some more refined restructuring of the disambiguation page (which could also include circulatory collapse). NikosGouliaros (talk) 22:37, 20 February 2021 (UTC)[reply]

Note: This discussion has been included in the list of Medicine-related deletion discussions. NikosGouliaros (talk) 22:42, 20 February 2021 (UTC)[reply]
  • Comment' you are probably right, but can't we just list & link out such medical meanings as can be well-sourced? At the least there should be a redirect, I suppose to syncope. Johnbod (talk) 03:09, 21 February 2021 (UTC)[reply]
    Although the above definitions may be cited from single articles, and the colloquial term 'collapse' seems to be broader than the medical term syncope, in medical literature it is generally used as a synonym of syncope. ICD-10 itself lists syncope and collapse together, with no other disambiguation. In my mind, a new 'Medicine' section in collapse (disambiguation) may be the right place to redirect via link to syncope, and also mention circulatory collapse (which, by the way, may warranty merging with Shock (circulatory)) and lung collapse. This is what it could look like. (Syncope itself is not an easy term to define, and more problems arise as the broader but valid term loss of consciousness redirects to unconsciousness, no page as postural tone exists, and posture redirects to good posture. Luckily, Syncope (medicine) contains information on what conditions mimic but don't qualify as syncope.) NikosGouliaros (talk) 08:24, 21 February 2021 (UTC)[reply]
  • Keep as creator. The term is very widely used, although imprecise. It cannot always be determine whether someone lands on the floor as a result of a simple fall versus transient loss of consciousness (in the UK "collapse query cause"). Matters are much harder still in the absence of a clear recollection from the patients and the lack of an eyewitness account. I think there is some merit in keeping this article. It would need to be expanded to explain to the reader how one would go about distinguishing between the various causes. JFW | T@lk 13:21, 21 February 2021 (UTC)[reply]
    Distinguishing between various types of 'dropping in the floor' is a tough clinical problem and an interesting subject. However, I wonder if 'collapse' could be generally accepted as an appropriate term to discuss the above. For example, in the source the current article is based on, 'collapse' does not presuppose loss of consciousness, and explicitly excludes simple falling. I think an article on (transient?) loss of consciousness might be more appropriate; it seems to be much more widely used as a chapter heading in medical textbooks. NikosGouliaros (talk) 13:42, 21 February 2021 (UTC)[reply]
  • Redirect to Syncope_(medicine), barring an improvement in the references that clearly indicates this should be a standalone, I think a simple redirect is the best course. But I don't have strong objections to the suggestions by NikosGouliaros I think the keep arguments by the creator, are clear indications of why it should not be kept. Jeepday (talk) 19:08, 26 February 2021 (UTC)[reply]
Relisted to generate a more thorough discussion and clearer consensus.
Please add new comments below this notice. Thanks, — MarkH21talk 04:54, 2 March 2021 (UTC)[reply]
Relisted to generate a more thorough discussion and clearer consensus.
Relisting comment: There seems to be an emerging consensus towards redirection, but given that this is a medical article where implications of usability are on the table, I'd like to leave this open to give editors one more go at ironing out the best solution.
Please add new comments below this notice. Thanks, Go Phightins! 12:01, 10 March 2021 (UTC)[reply]
  • Keep Syncope is not a common name and a collapse might have other causes such as intoxication. As it is a significant and common symptom, we should have a clear entry covering the various possibilities. Andrew🐉(talk) 12:53, 10 March 2021 (UTC)[reply]
    Note: I left a request for input at Wikipedia talk:WikiProject Medicine. NikosGouliaros (talk) 04:30, 11 March 2021 (UTC)[reply]
  • Keep as per Andrew. It is a significant and common symptom. A prose article with links to longer articles is a better way to handle this than having items listed on a disambiguation page. Bondegezou (talk) 14:21, 10 March 2021 (UTC)[reply]
  • Delete Too ambiguous. There are multiple problems here. First, we have one single source, and while it is a review article and thus meets MEDRS, it technically talks about "Transient Loss of Consciousness", although it does note that this is colloquially sometimes referred to as "collapse". At best, we could have "collapse" redirect and call this article Transient Loss of Consciousness. But even that would really require us to expand the article and get many more sources to do an article on TLOC.
But this brings us to a second problem, which is that the one RS we have is about how TLOC is a nonspecific clinical sign, and it then discusses a proper differential diagnosis and the various issues surrounding that. Wikipedia is really not the place for what would essentially become clinical practice guidelines. I see no real way to have a page about how to differentiate between several causes of TLOC (including a few not mentioned in the abstract) without crossing the line into WP:OR and providing medical advice. Even a disambiguation page would be risky because the very creation of such a page requires more RS than we have here, along with predictable debates about which conditions really belong on that disambiguation page.
I cannot see the use of a page for the colloquial term for a common sign that might indicate one of a number of different medical conditions, and that would be even if I had a hypothetical load of MEDRS sources to work with, which we don't in this case. None of the options seem appealing, some may prove unworkable, and I'm not sure how any of it improves the encyclopedia. The concept, while understandable, is too ambiguous to be properly encyclopedic. Hyperion35 (talk) 00:26, 11 March 2021 (UTC)[reply]
  • keep per Andrew rationale--Ozzie10aaaa (talk) 00:33, 12 March 2021 (UTC)[reply]
  • Maybe amend. Still, I think Hyperion35 has made a strong case for deletion. — Preceding unsigned comment added by ApproximateLand (talk • contribs) 01:23, 12 March 2021 (UTC)[reply]
  • Comment: This is not a topic. That is to say, this article does not have a well-defined scope. I am thoroughly unconvinced by the argument that it should be kept because It is a significant and common symptom., because it's not—it's an ambiguous term which could refer to one of several things. As the nomination notes it is devoid of any standard medical meaning, and what it refers in any particular context may range from loss of postural tone without loss of consciousness to presyncope (for anyone who cannot access https://pubmed.ncbi.nlm.nih.gov/27107684/, it says Collapse or synonymous presyncope were defined as transient alteration of consciousness, but without complete loss of consciousness)—in other words, it might refer to a loss of postural tone without altered consciousness or conversely altered consciousness without loss of postural tone. That means that from a medical point of view, two cases of "collapse" may not have any characteristics whatsoever in common.
    I think the comparison made with blackout is particularly apt–vastly dissimilar conditions that may be referred to with the same inexact/ambiguous term. The idea that A prose article with links to longer articles is a better way to handle this than having items listed on a disambiguation page. seems misguided to me, not to mention contrary to WP:NOTDIC (In Wikipedia, things are grouped into articles based on what they are, not what they are called by.)—I don't think anyone would propose creating a prose article called blackout (medical) to replace blackout#Medicine. For that matter, elevated body temperature is a significant and common symptom (well, technically it's a sign), and some of the other arguments that have been presented in favour of retaining this article could equally well be adapted to argue in favour of creating elevated body temperature, but medically we distinguish between fever and hyperthermia and those are the appropriate articles to have, not elevated body temperature. Likewise, reddening of the skin is a common and significant feature of a variety of clinical conditions, caused by a variety of different mechanisms, and these can be distinguished by other indicators (such as the presence or absence of macroscopic skin defects along with the characteristics of those defects, whether applying pressure makes the redness recede, and so on). It would be preposterous to propose creating a prose article called red skin (medical) on the grounds that "erythema is not a common name and red skin might have other causes such as hematoma" (to paraphrase an argument advanced above). Put simply, it is a bad idea to have medical articles for these kinds of vague, inexact, imprecise, ambiguous, and/or ill-defined terms.
    I don't think redirecting to Syncope (medicine) is appropriate, for two reasons. Firstly because it is a poor match for the stand-alone term "collapse" in medical contexts (as noted above), and secondly because when the term "collapse" is used in medical contexts, it is usually a specified type of collapse (which should have some kind of modifier, but the modifier may be omitted if context makes it clear what is meant) such as circulatory/hemodynamic/cardiovascular collapse, airway collapse, or vertebral collapse rather than the general "collapse". These factors combine to make it an inappropriate redirect inasmuch as it makes it more difficult to find the content one is looking for.
    I see three valid options here: (1) delete this article without changing collapse, (2) delete this article and change collapse per NikosGouliaros's suggestion, or (3), change collapse per the suggestion at User:NikosGouliaros/sandbox2 and redirect collapse (medical) to collapse#Medicine. I don't have any strong opinions as to which of the three options would be the most appropriate. TompaDompa (talk) 02:21, 16 March 2021 (UTC)[reply]
  • Comment This is a somewhat non-Wikipedian comment, but I believe it may be useful, coming from my own background in healthcare policy. A search of the ICD-10 lists multiple entries that involve the word collapse, including Collapse NOS Following a Procedure, but most forms of "collapse" reference an actual (if sometimes vague or suspected) cause, even where the cause is suspected to be psychogenic. A CMS-1500 with the comment "well, the patient there just collapsed" with no further documentation is going to be returned with a request for clarification, at best, and some questions from investigators at worst. It is clear that a physician or other clinician is expected to make an attempt to diagnose the cause of the collapse, and provide appropriate treatment. At the very least, to use a proper ICD code, the provider had better distinguish between cardiovascular, cardiopulmonary, heat, or syncope as a cause, and that's just for codes with the word "collapse". Realistically, that provider had better also make an effort to investigate and consider epilepsy, cataplexy, narcolepsy, hypoglycemia, simple dehydration, hyponaetremia, exhaustion, intoxication, and the list goes on for the various ICD codes that might be described by someone collapsing with or without a loss of consciousness.
My point is, there is no acceptable manner for a healthcare provider to bill for treating a patient who has "just collapsed", not without being much more specific. In the USA, at least, in my experience you simply will not find adequate sources for something that cannot be billed, because billing documentation is essentially how everything in medicine is defined. So you will find sources discussing differential diagnosis, sources discussing treatment for specific conditions, but you're just not going to find sources that just discuss "collapse" because the language and terminology has no need for this word or term on its own without reference to anything else. Hyperion35 (talk) 22:41, 16 March 2021 (UTC)[reply]
  • The idea that our medical coverage should be determined by US billing procedures seems quite bizarre. Note that this is an international project and other countries have different methods. For example, I'm in the UK which has a National Health Service. Anyway, here's a few counter-examples which discuss some common types of collapse:
  1. Collapse in the Endurance Athlete
  2. Rhabdomyolysis in elderly people after collapse
  3. Maternal collapse
  4. Rate of recurrent collapse after vaccination with whole cell pertussis vaccine
Andrew🐉(talk) 18:00, 17 March 2021 (UTC)[reply]
All four articles use "collapse" differently: "inability to walk unassisted, with or without exhaustion, nausea, vomiting, or cramps" [1]; any reason for falling and staying on the floor is implied [2]; "an acute event involving the cardiorespiratory systems and/or brain, resulting in a reduced or absent conscious level" [3]; "a hypotonic-hyporesponsive episode or shock-like syndrome" [4]. As a set, these articles clearly point to a wide spectrum of medical conditions, mostly affecting circulation, consciousness, and muscular tone (wider than loss of consciousness or postural tone but including them); so wide a spectrum that I cannot imagine how it could be discussed in an encyclopedic article, which must begin by some short of definition. More than an encyclopedic article, it points to a dictionary entry for "collapse": the word is used in the above sources in the loose, ill-defined way it would be used in everyday speech. It therefore reminds of the way it is used in the examples of User:Hyperion35. On the other hand, being an inexperienced editor, I may be mistaken and I'm open to any suggestion on how a "Collapse (medical)" article could be written. Hoping I'm not bludgeoning: NikosGouliaros (talk) 19:23, 17 March 2021 (UTC)[reply]
Those four different definitions make me think that a WP:SETINDEX would be appropriate. WhatamIdoing (talk) 22:40, 17 March 2021 (UTC)[reply]
Andrew Davidson, I apologize, the reason I mentioned medical billing is both because it is an area I am professionally familiar with, but also because in the USA, our health system is highly decentralized and so billing is one of the few areas where government regulations and thus standardizations focus. Clinical practice is generally guided by the specialty and subspecialty societies and (God help us) physician experience. Various boards handle licensing. But it's only when it comes to billing that you generally find true oversight over the practice of medicine in the USA. This is important to this topic, because as User:NikosGouliaros correctly points out, "collapse" is a sign that could indicate a wide range of problems. So cardiologists are going to have an entirely different set of guidelines than neurologists, for example. It is possible that the American Academy of Family Physicians (potential COI: I once worked for a subspecialty society that worked with AAFP on issues unrelated to this article) might have broader guidelines that may be useful. But at the end of the day, American sources at least are unlikely to spend much time on "collapse" as a broad category, because physician documentation is going to have to be more specific, otherwise CMS or the state Medicaid agency or the insurer is going to send it back with the equivalent of those Wikipedia tags that say "more information is needed" (and without any payment). I cannot speak for NHS or HealthCanada or other English language healthcare systems, although I have little doubt that they are likely better organized. Hyperion35 (talk) 21:10, 17 March 2021 (UTC)[reply]
Of course, a collapse may have a variety of causes and outcomes. But this just means that it's a broad topic, not that we should delete it. In this, it is like numerous other broad conditions or concepts such as injury, disease, rash and ageing. And notice that these are all articles. Andrew🐉(talk) 22:50, 17 March 2021 (UTC)[reply]
Being referred to broad topics gave me an "a-ha" moment, and I tried imagining what such an article would be like. It seems it gets too confusing, in the sense Blackout#Mecicine would be if discussed as a broad topic, instead of a disambiguation page. You can check out what I mean here. I don't know where it could go from here; for instance, what short of Differential diagnosis section could include prostration and syncope? If anyone has anything specific to suggest, I'm willing to give it another try. NikosGouliaros (talk) 10:42, 18 March 2021 (UTC)[reply]
Indeed. The difference between this and injury, disease, and so on is that each of those actually is a broad concept, and not disparate topics sharing a term. Of course, it's not always immediately obvious whether medical concepts belong to the former or latter category; cardiogenic shock, hypovolemic shock, neurogenic shock, and anaphylactic shock are all part of the WP:BROADCONCEPT circulatory shock, but circulatory shock, shell shock, and spinal shock are not part of a broad concept that could be called shock (medical) (put another way, the first group consists of different types of shock, whereas the latter consists of different senses of "shock"). To give a more everyday example, "sex" as in sex chromosome or sexual dimorphism is not the same "sex" as in oral sex or sexual intercourse. Likewise, the different meanings of "collapse" in medical contexts here result in what is essentially an equivocation. Medically, the inability to walk unassisted (Sallis 2004), presyncope (Keller et al. 2016) and non-traumatic transient loss of consciousness (Thijs et al. 2005) are not part of a single, broad topic.
This is not like dizziness, an imprecise term used by laypeople which still has a clearly understood meaning as a collective term for what medical professionals more precisely refer to as vertigo, presyncope, and so on. What we have here is a term without any established, generally-understood medical meaning which is variously defined in contradictory (though sometimes overlapping) ways. Attempting to combine these different definitions into a single broad concept does not result in a quality medical article, it results in a WP:SYNTH nightmare. If this actually were a single, broad concept we would see sources discussing that broad concept.
We could by all means create a transient loss of consciousness article (and we probably should) which would include syncope, epileptic seizures, and possibly loss of consciousness due to blunt force trauma to the head (some definitions of TLOC exclude loss consciousness that is traumatic in origin)—but that's quite a different article than the one under discussion. It could say something along the lines of Transient loss of consciousness (TLOC) is a brief period of unconsciousness which resolves spontaneously. It may be traumatic—as in a concussion—or non-traumatic in origin. Common causes of non-traumatic TLOC include syncope and epileptic seizures. If we want a medical perspective as to why someone ended up on the floor or ground, we can expand falling (accident)#Causes. I suppose I wouldn't be opposed to reworking this article entirely to be about TLOC and moving it to the title transient loss of consciousness, but that would functionally be the same as deleting this article and creating that one from scratch (except the edit history would be retained). TompaDompa (talk) 16:30, 19 March 2021 (UTC)[reply]
Yes, why don't you do that - I think that would satisfy both keepers and deleters. Obviously "collapse" should redirect, if a new article is started. Johnbod (talk) 17:38, 19 March 2021 (UTC)[reply]
Relisted to generate a more thorough discussion and clearer consensus.
Relisting comment: Third relist as it seems the discussion is ongoing and a clearer consensus may yet be reached
Please add new comments below this notice. Thanks, Eddie891 Talk Work 16:59, 17 March 2021 (UTC)[reply]
Note: I left a new neutral request for input at Wikipedia talk:WikiProject Medicine.NikosGouliaros (talk) 17:08, 17 March 2021 (UTC)[reply]

* Strong Keep. Easily passes WP:GNG. Syncope is a very specific cause of collapse, but collapses have many other possible medical causes and therefore a redirect is not advisable or appropriate as collapse is the parent article and not the other way around. Collapse is a notable term in medical literature that’s widely used in medical RS. There are a multiplicity of sources available. I would suggest reaching out to WP:WikiProject Medicine to help develop the article further. AFD is not cleanup and it’s not prejudicial against notable stubs. Any arguments for deletion or redirect are not based in policy but are WP:IDONTLIKEIT opinions.4meter4 (talk) 05:11, 26 March 2021 (UTC)[reply]

Question The RS suggested so far all indicate that "collapse" is a non-specific sign that could be caused by a large number of different causes. A search of the ICD-10 does not show any single code for "collapse" but rather records many different codes that might involve some sort of collapse. Also, with all due respect, the nominating editor and I are both members of Wikiproject Medicine as well as being medical professionals. You are certainly entitled to your opinion, and I would welcome more participation from Wikiproject Medicine, however your suggestion that votes for delete are based on WP:IDONTLIKEIT is simply not true. Several votes, such as my own, have pointed out significant problems with having this article, specifically concern that as a non-specific sign, the article could turn into what is essentially clinical guidance on a differential diagnosis, in violation of multiple Wikipedia policies. This isn't "I don't like it" so much as "here are the challenges, and I can't see how to solve them." Rather than dismissing those concerns, could you please elaborate on how this article would avoid those problems? And what RS are you considering using? Hyperion35 (talk) 19:19, 26 March 2021 (UTC)[reply]
You have successfully changed my mind. Delete per Hyperion35. Oppose redirect. The disambiguation page for collapse should be all that is needed.4meter4 (talk) 00:35, 27 March 2021 (UTC)[reply]
The above discussion is preserved as an archive of the debate. Please do not modify it. Subsequent comments should be made on the appropriate discussion page (such as the article's talk page or in a deletion review). No further edits should be made to this page.
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