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  1. We have received an enquiry regarding these two concepts as to whether they are duplicate. Would you please consider and advise on the following:

    287439000|Emergency tracheostomy (procedure)|
    55622001|Tracheostomy, emergency procedure by transtracheal approach (procedure)|

    All comments appreciated. Thank you for your attention to this matter. Monica

  2. Hello Monica,

    55622001 is the same as 287439000 in an emergency setting. Does this help?


    1. Yes but I think we may need to make this an agenda item for discussion:

      I have looked into this a bit further and the issue is that both concepts are defined using the same attributes and values so the reasoner classifies them similarly i.e. as: 

      Exteriorization of the trachea via transtracheal approach

      • Is this considered a bypass as one concept is modelled as such
      • Is it correct to make this a subtype of 75506009 |Construction of stoma (procedure)|
      • Is there an approach other than Transtracheal 

      • Then we have as well: 307007002 |Percutaneous tracheostomy (procedure)|

      If transtreacheal is the approach for all, how are they different?

      Note: Steven has sent me an article in an email which I will review separately. 

      thanks, Monica

  3. Monica, James, Steven

    Agree it would be useful to discuss this area at the next Anesthesia CRG meeting - it is scheduled for Tuesday 26th November.  

    As in the review article that Steven kindly provided, there are basically two fundamental techniques of performing a tracheostomy: open surgical and percutaneous, of which there are a number of variants of each.  I suppose (perhaps incorrectly) I have presumed the "transtracheal" to reference primarily open tracheostomy, although I suppose thinking about it more logically, the approach for both principle techniques could be regarded as transtracheal.

    Think that we may have also have to give some thought to 307007002 |Percutaneous tracheostomy (procedure)|

    As currently classified the approach attribute is "percutaneous approach" which seems fine, and the method attribute is "bypass - action", but this does result in the parents of the concept being 48537004 Bypass graft (procedure) and 367439007 Repair of trachea (procedure), the latter does have tracheostomy terms as descendants, but one would probably also want to classify percutaneous tracheostomy as an exteriorization of trachea like the other surgical tracheostomy terms.

    Best wishes


  4. On the face of it not, since one includes the transtracheal approach.  I can see where Andrew Norton is going with bypass - action but it appears there is implicit vascular bypass if it is being subsumed by bypass graft.  I would expect to see them related as below; however whether Emergency tracheostomy is enough to be clinically useful I will ask anaesthetic colleagues to comment.

    287439000|Emergency tracheostomy (procedure)|

    55622001|Tracheostomy, emergency procedure by transtracheal approach (procedure)|

    Apart from a number of potential additional concepts, I am not convinced a number of the descriptions meet the requirements for an FSN even if OK for preferred terms.  Much of the technique and approach can be implicit in the term and therefore not sufficiently helpful for modelling.  There may well be a number of approaches missing, not just in this area but particularly when one considers the less surgical healthcare activities.