Descriptions:
| Term | description type | Language/acceptability | Language/acceptability | Case significance |
|---|---|---|---|---|
| [Morphology] of [ site ] due to birth trauma (disorder) | FSN | us:P | gb:P | ci |
| [Morphology] of [ site ] due to birth trauma | SYN | us:P | gb:P | ci |
Concept model:
| Attribute Cardinality | Attribute | Value | role group number | Role Group Cardinality |
|---|---|---|---|---|
| 0 | ||||
| 1 | ||||
[body structure] < 91723000 |Anatomical structure (body structure)| | ||||
[Joint structure] 371578004 |Perinatal period (qualifier value)| |
Definition status:
900000000000073002 |Defined (core metadata concept)|
Applies To:
<< 56110009 |Birth trauma of fetus (disorder)|
Rules for description generation:
- Remove semantic tag from [disorder] concept
15 Comments
Monica Harry
Peter G. Williams - I see this template now; should we use this for those 3 tickets showing as misaligned on
QI-147
.
Peter G. Williams
Well that's interesting. Yes I'll run those three concepts against this template and see how we roll. The code I'm running was designed to allow multiple templates to potentially apply within a given subhierarchy.
Cathy Richardson
Jim Case
I'm working on the bleeding hierarchy and given the hemorrhages and hematomas due to birth trauma I've been looking at the x due to birth trauma template. I suggest that the |Due to|=|Delivery procedure| is reviewed. The specific injury is due to a trauma that occurs during birth. The trauma the fetus faces may be due to the delivery procedure, something in the anatomy of the mother or baby, the presentation of the fetus etc.
https://emedicine.medscape.com/article/980112-overview#a2
https://www.uptodate.com/contents/neonatal-birth-injuries
Recommend we use |Due to|=|Birth trauma of fetus|.
This change would mean these x due to birth trauma concepts would only need one relationship group (in most cases) and the modelling would align with the modelling we use for other x due to y trauma concepts.
Cheers,
Cathy
Jim Case
Cathy,
If I read your suggestion correctly, this would make the template tautological (i.e Birth trauma due to birth trauma). The trauma occurs during the delivery procedure (procedure being a relative term, meaning the delivery process). It does not matter about the anatomy of the mother or the fetus IMHO.
What would need to be changed is the replacement of Traumatic abnormality with a more general morphology and the use of a PATHOLOGICAL PROCESS, which we do not yet support. I am curious as to your comment about a single RG as in almost all of these cases there is already only one RG.
Jim Case
Cathy Richardson has commented that the current template results in a loss of general trauma parents from birth trauma concepts
Additional comment from Cathy Richardson and discussions on the remodeling of Traumatic injury has resulted in some testing of a new template that uses DUE TO = Traumatic event and DURING = Delivery Procedure. This results in the removal of the inferred parent "Injury due to procedure". A question arises as to whether an additional DUE TO relationship is needed or a replacement of the DURING with a DUE TO?
One additional benefit from the proposed pattern is the ability to eliminate the use of <<19130008 |Traumatic abnormality (morphologic abnormality)| from the RG. (replace with 37782003 |Damage (morphologic abnormality)|
Bruce Goldberg , Maria Braithwaite , Monica Harry , would be interested in the midwife and clinician views on this.
Bruce Goldberg
I Am not certain that we want say at least for medicolegal purposes that birth trauma is necessarily due to the delivery procedure as there are several factors that may predispose to such trauma occurring during an otherwise routine delivery such as fetal size, prolonged labor, etc. (see https://www.birthinjuryguide.org/birth-injury/types/birth-trauma/). This is really a complication of trauma and not a complication of procedure. One approach is to model as isA complication due to traumatic injury during delivery procedure. Would need to remodel 116225000 |Complication of injury (disorder)| as due to traumatic injury and rename to Complication of traumatic injury (it is currently modeled as associated with traumatic injury). Traumatic injury can be remodeled as due to traumatic event and the associated morphology of traumatic abnormality removed but this won't affect the model for disorder due to birth trauma.
Bruce
Jim Case
Bruce Goldberg, I was leaning in this way, but the top level term I am trying to model is essentially the same thing (i.e. Complication due to traumatic injury during delivery procedure is semantically the same as Disorder due to birth trauma, or at least that is the way I initially modeled it); however, I would not use 417746004 |Traumatic injury (disorder)|, but would favor using DUE TO = 773760007 |Traumatic event (event)|. If you think that losing the parent of "735912006 |Injury due to procedure (disorder)|" is actually safer from a medicolegal perspective, then problem solved....
Remodeling traumatic injury would be necessary because of the need to add the DUE TO to replace the Traumatic abnormality morphology
Jim Case
Bruce Goldberg
Jim Case, your model inherits parents of complication and perinatal trauma but this does not imply that the the trauma is to the fetus/neonate rather than the mother and thus would imo not be sufficiently defined. Take a look at this alternate model and let me know what you think:
Jim Case
Bruce Goldberg , I am not sure how using fetal or neonatal period (supertype of perinatal period) helps make the definition more explicit (the default context for disorders is subject of record, so perinatal period would apply to the perinatal period of the subject, not the mother, otherwise we would need to go to a situation), but IMHO there is an issue with the FSN as well (vague as to the subject). I am not a big fan of the classification grouper 199745000 |Complication occurring during labor and delivery (disorder)|. However, as we are talking about structural issues here, we could probably leave it until we decide what to do with YAIP (yet another intermediate primitive). I will test this out and see what comes of it.
Cathy Richardson
Jim Case Did this progress any further? I have some misaligned concepts in the bleeding hierarchy 'due to birth injury/trauma' that I can either place aside for follow up or progress if there's an outcome on this. Cheers, Cathy.
Jim Case
Cathy Richardson , sorry, this seems to have fallen through the cracks...I will follow up RSN...
Bruce Goldberg
Need to investigate how the proposed model for traumatic injury will affect the modeling.
Jim Case
Bruce Goldberg , remodeling the top level concept as DURING = Delivery (procedure) and DUE TO = "Traumatic event", then changing the morphology to "Morphologically abnormal structure" does not change the current location in the taxonomy, but as you noticed, the definition does not allow for the specification of fetus vs. mother. The only reason it appears we are not getting equivalences is because all of the Complications of delivery are primitive, under 199745000 |Complication occurring during labor and delivery (disorder)|.
We had been discussing the need to move all of the fetal disorder concepts to the Situation hierarchy with a Subject relationship context of "Fetus of subject". An alternative would be to make "Birth trauma of fetus" an intermediate primitive, acknowledging our inability to specify injury to the fetus vs. the mother.
Bruce Goldberg
Jim Case If we make birth trauma of fetus a situation then we could not use that as the value of due to to define Disorder due to birth trauma. In that case, making Birth trauma an intermediate primitive would be better imo.