SNOMED CT Templates

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StatusIn PROD
Version

1.0

Latest version2.0

Descriptions:

Termdescription typeLanguage/acceptabilityLanguage/acceptabilityCase significance
[Physical object] [Wound morphology] of [body structure] due to [event] (disorder)FSNus:Pgb:Pci

[Physical object] [Wound morphology] of [body structure] due to [event]

SYNus:Pgb:Pci


Concept model:

Attribute

Cardinality

AttributeValuerole group numberRole Group Cardinality
1..1

116680003 |Is a (attribute)|

64572001 |Disease (disorder)|

0

N/A

0..1

42752001 |Due to (attribute)|

<< 272379006 |Event (event)|

0
1..1

116676008 |Associated morphology (attribute)|

<< 13924000 |Wound (morphologic abnormality)|

1


1..1

0..1

363698007 |Finding site (attribute)|

[body structure] << 123037004 |Body structure (body structure)|

1
0..1

246075003 |Causative agent (attribute)|

1
0..1

370135005 |Pathological process (attribute)|

<<  441862004 |Infectious process (qualifier value)|

1

Definition status:  


900000000000073002 |Defined|

Applies To:

<<  416462003 |Wound (disorder)|

Template Language


64572001 |Disease (disorder)| : [[~0..1]] {[[~0..1]]  42752001 |Due to (attribute)|  =  [[ +id (<<  272379006 |Event (event)| ) @event]]}, [[~1..1]]{ [[~1..1]]  116676008 |Associated morphology (attribute)|  = [[ +id ( <<  13924000 |Wound (morphologic abnormality)| ) @morphology]], [[~0..1]]  363698007 |Finding site (attribute)|  = [[ +id( <  123037004 |Body structure (body structure)|  ) @site]], [[~0..1]]  246075003 |Causative agent (attribute)|  =  [[ +id (<<  260787004 |Physical object (physical object)|  OR <<  78621006 |Physical force (physical force)|  OR <<  105590001 |Substance (substance)| ) @object ]], [[~0..1]]  370135005 |Pathological process (attribute)|  = [[ +id ( <<  441862004 |Infectious process (qualifier value)|  ) @proc]] }

Rules for description generation:

  1. Apply General rules for generating descriptions for templates;
  2. If description of event is part of description of associated morphology, the description of event can be omitted to avoid redundancy, e.g. Open bite wound of thigh (disorder) is modelled by due to = bite (event) and associated morphology = Open bite wound (morphologic abnormality);
  3. If description of associated morphology is part of description of event, the description of associated morphology can be omitted to avoid redundancy, e.g. Dog bite of forehead (disorder) is modelled by due to = Dog bite (event) and associated morphology = bite (morphologic abnormality).

JIRA Ticket:

QI-57 - Getting issue details... STATUS

INFRA-3054 - Getting issue details... STATUS


39 Comments

  1. Monica Harry

    We have many wound concepts which do not have finding site e.g. 416462003 |Wound (disorder)| with no attributes but 2 stated parents. 

    275461003 |Wound of toenail (disorder)|

    283669004 |Nail wound of hip (disorder)|

    210361004 |Open wound of gum (disorder)|

  2. Yongsheng Gao

    This template could be merged with the template '[Morphology] of [ site ] due to [bite event] (disorder)' if there are other events that can cause wound.

  3. Monica Harry

    Did consider separate template for Puncture wounds however decided not required. 

  4. Monica Harry

    Would separate template for Iatrogenic disorders be of use? We are running into Qs around the accidental injury during procedure concepts. 

  5. Bruce Goldberg

    We did talk about iatrogenic disorders in ECE. Philip Brown created a document which I can provide on request (I can't upload a file here). I have summarized the pproposal below:

    Proposal

     

    • Iatrogenic is not available as a value of pathogenesis
    • Iatrogenic disorder to remain as a primitive concept and as a subordinate of Complication
    • Concepts currently sub-ordinate to Iatrogenic disorder but who’s FSNs do not contain the word ‘iatrogenic’ should be re-modelled and their IS_A relationship with Iatrogenic disorder be removed
    • The modelling of concepts containing the word ‘iatrogenic’ should include an IS_A relationship with Iatrogenic disorder and to the underlying disorder itself
    • Further population of the Iatrogenic disorder hierarchy should be discouraged

    Bruce

    1. Monica Harry

      Jim CaseBruce Goldberg - Ok, if I add these notes about Iatrogenic disorder, which Bruce has summarised here, to the Ed. guide?

      1. Jim Case

        That would be fine.  Hopefully we can resolve this in the near future

  6. Monica Harry

    I am looking at 733041001 |Accidental wound during procedure (disorder) 216878005 |Accidental cut, puncture, perforation or hemorrhage during kidney dialysis (disorder)| - I have to remodel as complications and will do manually then.

  7. Bruce Goldberg

    Agree. May want to use both during and due to relationships to procedure if appropriate.

  8. Jim Case

    The focus of the disorder concept is the resulting wound, as a result of the event, so they still need to be disorders (you don't treat an event, events are not actionable, but the result of the event may be). If we take the literal approach to the definition we have accepted for a Complication as being an unexpected outcome of a condition or a procedure, then, yes, all accidental wounds during a procedure would be complications. So Bruce's suggestion that we use DUE TO = Event; DURING= Procedure, makes sense. 

    I would not make all of the the Accidental wound subtype complications.  They are just accidents.     

  9. Monica Harry

    Yes, agree about the during and due to and yes, will not make all "accidents" complications, only those where appropriate as you state. thank you.

  10. Monica Harry

    Jim Case - I see what looks like a duplicate of this template further up this list here: Wound morphology - Shall I delete this one on this page here?

  11. Jim Case

    We do not need two templates.  The one above was created a few months ago to support the "bite wound" changes, so if this one has not been reviewed and approved (and it looks to be a proper duplicate) then we can delete it. We could make the one above even more generic if we made the DUE TO optional. But I think we need to verify with Peter whether making templates with so many optional components more of a problem.  We do need a generic "Wound of site".  We may also need "Wound due to procedure", but I have not seen a specific use case for that yet (it happens all the time in vet med, e.g. "wound of skin during grooming (accidental cut with scissors)"

  12. Yongsheng Gao

    I have changed the wound to [wound morphology] as a variable in description. Should causative agent also include substance? Please see examples in the comments. The causative agent needs to be included in the description template. 

    1. Jim Case

      I would need some examples of where substance would be the causative agent (chemical spill?),  we might even need to expand it to include "Physical force" such as wound due to explosion 

      1. Yongsheng Gao

        Jim Case  

        << 105590001|Substance (substance)|, such as 

        Causative agent (attribute) = Bee venom (substance) for Bee sting (disorder),

        241818005 |Poisoning caused by tick bite (disorder)|

  13. Bruce Goldberg

    I don't think bee venom is the cause of the wound.

    1. Yongsheng Gao

      I agree that venom is not the cause of wound. It looks like that all insect sting has modelled with causative agent to insect venom. The venom causes most of the itching and pain associated with the sting. The second example is classified under both poisoning and insect bite wound. 

  14. Bruce Goldberg

    The second example of poisoning due to tick bite seems to be modeled incorrectly. The focus is the poisoning which is due to the tick bite event. IMO it should not be modeled as a kind of insect bite wound. The examples which Jim sites of chemical spill and explosion seem more appropriate for this modeling pattern.


    Bruce

  15. Yongsheng Gao

    Following Bruce's feedback, I think model and descriptions need to be changed. The description should include word 'wound' to distinguish it from the bite events. The causative agent to venom should be removed. Poisoning caused by bite should not have parent concept of wound. The template is marked as ready for implementation now.

  16. Peter G. Williams

    I'm just going to tweak the title of this template because in fact the FSN template does make it clear that this template will handle other types of Wound morphology, so I'll make it more obvious that that's a slot rather than a fixed value and then we can re-use this template (in fact I already am) for abrasions and lacerations.

  17. Monica Harry

    Peter G. Williams It seems we need to add Substance as a possible value for causative agent as we have 424765000 |Penetrating injury due to glass (disorder)| for example. 

  18. Peter G. Williams

    OK.  That will also sort out the Animal Venom cases we're seeing although I do take Bruce Goldberg's point that the venom is not the cause of the wound.    Is that discussion ongoing?

  19. Monica Harry

    Jim Case

    Bruce Goldberg For ECE  please - I have run into Traumatic injuries in trying to close out the Wound ticket.

    If I follow the Wound template here then all the Traumatic injury subtypes would have a DUE TO = Traumatic Event, does this make sense?

  20. Bruce Goldberg

    Monica Harry Can you give me some examples?


    Thanks,

    Bruce

    1. Monica Harry

       For example: 

      371052003 |Traumatic wound dehiscence (disorder)| how different from 225553008 |Wound dehiscence (finding)|?

      262985005 |Traumatic division of long flexor tendon of forearm, wrist or hand (disorder)|

      262983003 |Traumatic division of tendon (disorder)|

      If not trauma, would it be spontaneous? 

      Then there are concepts which use Traumatic abnormality as Ass. morphology so are subtypes of Traumatic injury e.g. 721177006 |Injury complicating pregnancy (disorder)| but don't think this is meant to be due to traumatic event. 

      1. Jim Case

        Monica Harry , my interpretation of 371052003 |Traumatic wound dehiscence (disorder)| is a dehiscence of a traumatic wound, not a traumatic dehiscence, so there wouldbe no DUE TO event here.  My interpretation of traumatic divisions is that there is an associated traumatic event.  While a division can occur from a weakened tendon, I am not sure that i what is intended here, i.e. the implication is that there is a traumatic event beyond normal stresses placed on a tendon. Some friends of mine from church suffer from Ehler-Danlos and have tendon ruptures from walking down the street.  IMHO that is not a traumatic event. 

  21. Bruce Goldberg

     |Traumatic division of tendon (disorder)|. If a division of tendon is just a transverse rupture then possibly it can arise from non-traumatic causes such as fluoroquinolone use.

    721177006 |Injury complicating pregnancy (disorder)|  decision from last ECE call:

    X complicating pregnancy, childbirth and the puerperium 

    1. Model as simple co-occurrence

    For other types of traumatic injury, need final consensus on changing model from associated morphology Traumatic abnormality to Pathological process traumatic.



    1. Monica Harry

      Thanks Bruce, very often the morphology is e.g. Complete traumatic transverse disruption (morphologic abnormality) 

      We have plain 52183003 |Division of tendon sheath (procedure)| I will raise on the call on Monday.

      1. Monica Harry

        To add to this we have subtypes of Traumatic injury (disorder), concepts such as:

        212986009 |Effects of vibration (disorder)|

        212985008 |Effects of high-pressure fluids (disorder)|

        238533000 |Coral injury (disorder)| 

        The first two are outcomes not the injury itself. 

  22. Jim Case

    I am not sure I find value in: 

    212986009 |Effects of vibration (disorder)|  (only one subtype, can inactivate)

    212985008 |Effects of high-pressure fluids (disorder)|  (no subtype, vague, can inactivate)

    238533000 |Coral injury (disorder)| is Injury due to coral, seems OK to me.

    We really need to get resolution on the traumatic/non-traumatic issue, if Bruce and I can come to a consensus so we can apply the pathological process changes to clean up this sizeable area of SNOMED.  

    1. Bruce Goldberg

      My current view on non-traumatic injuries is that we should concentrate on the most common use of this term which is non-traumatic brain injury which can be represented using GCIs. There are 6 other nontraumatic morphologies  and 65 nontraumatic disorders. The latter can either remain primitive (although many are fully defined using using one of the 6 nontraumatic morphologies) or inactivated and just point to X injury (traumatic or nontraumatic). Another option is to define these nontraumatic disorders by their known causes using GCIs as for nontraumatic brain injury.

      Bruce

  23. Jim Case

    Yongsheng Gao,

    According to the template mismatch report, the DUE TO relationship is still coming up as non-conformant.  Many of the other issues relate to the presence of multiple RGs, which this template does not allow, but is s frequent occurrence (e.g. 269167000 Open wound of larynx and trachea (disorder)).  I see you have requested a template language update, but why could we not just make the  RG cardinality 1..*?


    1. Yongsheng Gao

      Hi Jim Case I looked into the report. You are right many are failed because of multiple RGs. The number reduced from 600 to 400 after allowing the multiple RGs in the template. These are having different morphology from 'wound', e.g. 209768007 |Mallet thumb with closed tendon injury (disorder)|, 722638005 |Laceration of neck with foreign body (disorder)|. This would require combination with different templates, e.g. traumatic injury, foreign body. If we allow the second role group to be any morphology or run the report with the generic disease template, it is likely we get a good all pass. However, it might miss potential issues in additional role groups. We will need to discuss this for a solution. Peter G. Williams

      1. Jim Case

        Thank Yongsheng Gao, but how do we explain that the DUE TO relationship is still showing up as a non-conformance in this template?


        1. Yongsheng Gao

          Hi Jim Case, you are right. The report should not include 'due to' anymore because it is self-grouped in the template language. 

          Hi Peter G. Williams  The following is an example. It looks like that the STL missed comma ',' after the role group for 'due to' in the process of template language. I guess this is the cause of 'due to' in the report.  Thought?

          735864001 Laceration of foot with foreign body (disorder)

          "Cardinality mismatch: N/A
          Relationship Group mismatches:
          { [I1] 42752001 |Due to (attribute)| -> 773760007 |Traumatic event (event)| }
          A{ [I2] 116676008 |Associated morphology (attribute)| -> 19227008 |Foreign body (morphologic abnormality)|, [I2] 363698007 |Finding site (attribute)| -> 56459004 |Foot structure (body structure)| }
          { [I3] 116676008 |Associated morphology (attribute)| -> 35933005 |Laceration (morphologic abnormality)|, [I3] 363698007 |Finding site (attribute)| -> 56459004 |Foot structure (body structure)| }"


          " STL: ""64572001 |Disease (disorder)|: [[~0..1]] { [[~0..1]] 42752001 |Due to (attribute)| = [[+id(<<272379006 |Event (event)|) @event]] }[[~1..*]] { [[~1..1]] 116676008 |Associated morphology (attribute)| = [[+id( <<13924000 |Wound (morphologic abnormality)|) @morphology]], [[~0..1]] 363698007 |Finding site (attribute)| = [[+id( <123037004 |Body structure (body structure)| ) @site]], [[~0..1]] 246075003 |Causative agent (attribute)| = [[+id(<<260787004 |Physical object (physical object)| OR <<78621006 |Physical force (physical force)| OR <<105590001 |Substance (substance)|) @object]], [[~0..1]] 370135005 |Pathological process (attribute)| = [[+id( <<441862004 |Infectious process (qualifier value)| ) @proc]] }"""


          1. Peter G. Williams

            Hi Yong.   Yes I agree that there is a comma missing in the STL but it doesn't seem to have prevented the template from parsing OK.     In this case the "A" on the 2nd role group I2] is indicating where the problem lies and I'd say because 19227008 |Foreign body (morphologic abnormality) is not a type of 13924000 |Wound (morphologic abnormality)|.    Role group 1 with the Due To is not indicating a problem in this example - it's self grouped in the concept and self grouped in the STL so no problem there, so there's no "A" preceding that group.

  24. Jim Case

    We have 4 concepts that have a CAUSATIVE AGENT that is a subtype of <<410607006 |Organism (organism)|.  So we need to extension the range for this template.  Can we update the template language?


    1. Yongsheng Gao

      Hi Jim Case, this template has been implemented in the PROD. So, we cannot make changes directly anymore. I made a copy of your change for inclusion of organism in range with the update of template language at [Wound morphology] of [body structure] due to [event] (disorder) - v2.0

      Cheers,

      Yong