AQI NACOR Outcome Terms Map To SNOMED CT

New kidney damage or a sudden decrease in kidney function. Criteria include:

1. Increase in serum creatinine (Cr) > 0.3 mg/dl within 48 hours
2. Increase in Cr to > 1.5 times baseline, which is known or presumed to have occurred within the prior 7 days

An acute respiratory dysfunction that produces reduced airflow into the alveoli and an arterial oxygen saturation less than 90% and that results in bradycardia or other clinical signs of hypoxia; the obstruction can be anatomically localized (e.g., tumor, stricture, foreign body, laryngospasm) or generalized (e.g., bronchospasm, asthma)

An injury to any of the structures or tissues of the mouth, nasopharynx, oropharynx, or larynx resulting from the use of any airway device such as laryngoscope, oral or nasal airway, endotracheal tube, or stylet

Clarifying statement: The most common injury is to the teeth, but airway trauma includes other injuries such as mucosal tears or tongue lacerations. 

A severe, life-threatening allergic response, which is rapid in onset and characterized by a sudden drop in blood pressure and/or respiratory insufficiency

Note: Elevated serum tryptase level may be used to confirm the diagnosis. Although anaphylaxis is a lifethreatening allergic reaction, there may be other manifestations such as urticaria, bronchospasm, and edema. Epinephrine is often required as part of the treatment.

New onset of an abnormality of the cardiac rhythm; a cardiac rhythm other than normal sinus rhythm, including atrial fibrillation, atrial flutter, ventricular tachycardia, ventricular fibrillation, 2nd or 3rd degree heart block

Synonym: irregular heartbeat

Clarifying statement: A disorder in which there is abnormal electrical activity in the heart.

A scenario in which a patient becomes conscious during a procedure performed under general anesthesia and subsequently has recall of these events

Synonym: Intraoperative awareness, awareness under anesthesia, recall of intraoperative events

Clarifying statement: Awareness should be limited to explicit memory and should not include the time before general anesthesia is fully induced or the time of emergence from general anesthesia or during an intraoperative "wake-up test", when arousal and return of consciousness are intended.

Should we create a synonym "Recall of intraoperative events"?

Significant slowness of the heart rate that poses a threat to the patient and requires treatment.

Note: The heart rate that is considered bradycardic depends on the patient’s age and coexisting medical conditions.

Inability to force oxygen into the trachea and alveoli for the purpose of oxygenating the blood in the pulmonary capillaries and removing carbon dioxide

Clarifying statement: Inability to generate an adequate tidal volume or produce active movement of oxygen into the trachea and alveoli despite multiple attempts despite instituting corrective actions such as changing head and neck positions, use of jaw thrust or airway devices such as oral or nasal airways or placement of a laryngeal mask airway or other supraglottic airway device. CANNOT VENTILATE may occur in patients with a tracheostomy when positive pressure does not produce active movement of oxygen into the trachea and alveoli.

The unplanned cessation of the mechanical activity of the heart as confirmed by the absence of signs of effective circulation. Cardiac compression and/or defibrillation may be required for treatment.

Synonym: perioperative cardiac arrest, cardiopulmonary arrest, circulatory arrest

A scheduled procedure that is not performed on the scheduled procedure day and the decision not to perform the procedure takes place before Anesthesia Start Time.

Synonym: surgery cancellation; cancelled operative procedure

A scheduled procedure that is not performed on the scheduled procedure day and the decision not to perform the procedure takes place after Anesthesia Start Time but before Anesthesia Induction Time. 

Synonym: Aborted surgery, surgery cancellation; cancelled operative procedure 

A scheduled procedure that is not performed on the scheduled procedure day and the decision not to perform the procedure takes place after Anesthesia Induction Time but before Procedure/Surgery Start Time.

Synonym: Aborted surgery, surgery cancellation; cancelled operative procedure

The Surgery/Procedure Start Time occurs significantly later than expected in the context of institutional norms.

Note: Case delays may be due to patient issues (e.g., late arrival, insurance problems, abnormal lab values), system issues (e.g., test results unavailable, blood unavailable, equipment malfunction or unavailable, transport delay), or practitioner issues (e.g., no consent obtained, surgery, nursing or anesthesia personnel arrived late).

A primary bloodstream infection that develops in a patient with a central line in place within the 48-hour period prior to the infection onset. Criteria for diagnosis include any of the following:

• Criteria 1: Patient has a recognized pathogen cultured from one or more blood cultures AND organism cultured from blood is NOT related to an infection at another site.
• Criteria 2: Patient has at least one of the following signs or symptoms: fever (>38 degrees C), chills or hypotension AND signs and symptoms and positive laboratory results (two or more positive blood cultures drawn on separate occasions) are NOT related to an infection at another site
• Criteria 3:  Patient < 1 year of age has at least one of the following signs or symptoms: fever (> 38 degrees C core), hypothermia (<36 degrees core), apnea, or bradycardia AND signs and symptoms and positive laboratory results (two or more positive blood cultures drawn on separate occasions) are NOT related to an infection at another site 

Should add new concept.

Harmonize these concepts and have new concept relate to one or both

The impairment, inability or incapacity of the blood to form clots and is associated with clinical bleeding.

Clarifying statement: Coagulopathy is a disorder involving the elements of blood coagulation, including platelets, coagulation factors and inhibitors, and the fibrinolytic system and may be confirmed by abnormal tests of clotting (PT, INR, PTT) or decreased platelet count.

A state of profound unconsciousness, not present prior to the initiation of anesthetic care, in which the individual cannot be awakened, fails to respond normally to external stimuli, and does not initiate voluntary actions.   Exclude coma due to prolonged anesthetic effect or hypothermia (temp <34 degrees C).

Clarifying statement: Scenarios include profound unconsciousness following anoxic or ischemic events such as cardiac arrest; metabolic encephalopathy; thromboembolic event; or cerebral hemorrhage. 

A corneal injury is either a corneal abrasion (a scratch or scrape on the cornea, the clear front window of the eye that transmits and focuses light into the eye) or exposure keratitis (inflammation of the cornea fromdrying of the corneal tear film).

Synonyms: Exposure keratitis, exposure keratopathy

Clarifying statement and criteria: Includes both exposure keratitis and corneal abrasion (diagnosed in any manner including with fluorescein examination of the cornea under ultraviolet light). Also includes any new symptom of eye pain treated with topical antibiotic (e.g., erythromycin) while in the post-anesthesia care unit/recovery area. Other causes of eye pain (e.g., acute angle-closure glaucoma) can be excluded by instilling one drop of local anesthetic (e.g., proparacaine) into the eye. If the pain is immediately and completely relieved, corneal injury is confirmed and acute angle-closure glaucoma is excluded.