SNOMED International is seeking input on the foreign body disorder concepts. See: https://dailybuild.ihtsdotools.org/?perspective=full&conceptId1=125670008&edition=MAIN&release=&languages=en and subtypes. The questions are:
- Within this hierarchy there are 95 superficial foreign body disorder concepts e.g., 874928002 |Superficial foreign body in axilla (disorder)|. Are these concepts seen as having the same meaning as the concepts that represent a foreign body in the skin e.g., 298075005 |Foreign body of skin of axilla (disorder)|?
- If these concepts are deemed to be equivalent in meaning, then the duplicates would require inactivation.
- Note, where the structure does not have skin then the relevant superficial structure e.g. mucosa, would apply.
- In doing this the proposed concepts to be kept would be |Foreign body of skin of <x> (disorder)|. Would this be acceptable?
- At present there are more |Superficial foreign body in <x> (disorder)| concepts than |Foreign body of skin of <x> (disorder) concepts|. In addition to the inactivation, we propose |Superficial foreign body in <x> (disorder)| concepts without a duplicate have the FSN updated to Foreign body of skin of <x> (disorder) or as relevant for structures without skin e.g. mucosa, to support consistency. Would this be acceptable?
- There are 65 |Splinter of <x>, without major open wound (disorder)|concepts. These are concepts are classification constructs. Has this content been used and is it currently being used by members? If not, this content will be considered for inactivation.
Responses are due by 23 July 2021. Please advise if you will require additional time.
Relevant documents
Actions
| Date | Requested action | Requester(s) | Response required by: | Comments |
|---|---|---|---|---|
| 17 June 2021 | Please see the questions above. | Please post your comments below. Discussion comments can be made as comments. |
Links
Country response
| Country | Date | Response |
|---|---|---|
| Denmark | 20210721 | The DK NRC does not have any input concerning these concepts. |
| US | 20210706 | No evidence of use for any of these concepts (superficial foreign body in, foreign body of skin of, splinter of) in value sets from VSAC. No specific concerns about the proposed consolidation. |
| Sweden | 20210709 | No specific concerns about the proposed changes. |
| UK | 2021/07/09 | Hi we have discussed this in UK, and we have following comments: - we are not 100% convinced that Superficial foreign body has the same meaning as Foreign body of skin. It appears to us that superficial foreign body is a foreign body that is palpable - therefore hypothetically, it is possible for a foreign body to be palpable but not located in skin (for example in an eye). We are not saying that concepts for Superficial foreign body should remain active though - our existing data for usage of "splinter" concepts shows almost non existing usage, however our data is for primary care, as this is where SNOMED is mainly used in UK. We are not sure about value of these concepts and it is not clear to us when would clinician want to use a code for "splinter" as opposed to code for a "foreign body" (what is splinter, how can they tell it is a splinter and so on). Splinter of X makes is seem it is a splinter that originates from X rather than splinter that went into X - Regarding proposed format : Foreign body of skin of X, it appears that this is more often referred to as Foreign body in skin of X Thank you. |
| Canada | 20210720 | We think, the "superficial" modifier is legacy of ICD9/10 and the heavy use of superficial wound in a classification. Makes more sense to be specific to skin when it comes to high level generic items. We agree with the proposed actions in bullet 2 and 3. Agree with removing “Splinter of X”., although there is perceived benefit from coding the nature of the foreign body, but there is not practical benefit from coding it. We think this can be kept generic and more granular concepts be added as postcoordinated or by the national release center for a country. |
| Member countries without a CMAG rep |
CMAG response
| Date | CMAG Response | Next steps |
|---|---|---|
2 Comments
Cathy Richardson
I have received a request to push the due date on this work item back until 23 July. This will be updated in the action item above for the group members. Thank you, Cathy.
Matt Cordell
I can confirm that the |Splinter of <x>, without major open wound (disorder)| concepts are used in Australia, and would affect 140 maps within our ED Master map (SNOmap). I can chase some specific usage metrics if required.
As for "Superficial foreign body" I agree, it means the skin (or similar). But this also highlights an issue with the overloading of morphologies (not just for foreign bodies). (See further below).
Also, it's unclear what exactly "Foreign body (disorder)" means...
Consider these three subtypes of |Foreign body - finger (disorder)|
Should the concepts |Injury due to arrow (disorder)| and |Injury due to bullet (disorder)| be foreign body injuries?
I had thought that "splinter" implicitly means "wood splinter" (or maybe plant splinter?). If it was glass/metal/other it would say so. But I couldn't find a single instance specify these other types.
Looking at the content I think this whole content area needs an overhaul. And that, unfortunately, means that a bunch of concepts probably need to be retired (or we assume a meaning... )
Most of the subtypes of |Superficial injury (disorder)| are bites, scratches and abrasions.
Most superficial injuries should only affect <<|Structure of skin and/or mucous membrane|. (The main exception I noticed were teeth). However, half the body sites, aren't that specific.
Another problem is that Superficial injury (disorder) has an attribute - "Due to=Traumatic event" (added January 21). As a result, there are about 80 "superficial injuries" that aren't subtypes of "Superficial injury". E.g. 283067003|Scratch of face| and 874842006|Superficial foreign body in face|. Even before this attribute was added in January 21, there still nearly 60 subtypes missing.
There's a lot of improvements that can be made to the morphology concepts that would benefit the whole terminology..