SNOMED CT contains a large number of Clinical finding concepts (>1200) that were initially obtained from ICD-9 having the format "X without Y".

Examples:

• X without infection - 153 concepts
• X without complication - 121 concepts
• X without obstruction - 81 concepts

In most cases, these are paired with "X with Y" concepts. Both ICD-10 and ICD-11 have retained a small subset of this type of term, although many are index terms

Examples:

ICD -10

• B01.9 Varicella without complication

• K80.2 Calculus of gallbladder without cholecystitis

• J85.2 Abscess of lung without pneumonia

ICD-11

• 1E90.0 Varicella without complication
  
• 8A80.0 Migraine without aura
  
• 9A04.0 Trichiasis without entropion
  

Prior discussion with the EAG about a limited set of this type of term involving <<"Brain injury without open intracranial wound" found very limited use of this type of concept and a recommendation to inactivate them as AMBIGUOUS, pointing to the immediate parent.

Questions:

• Can we consider these terms functionally equivalent to their immediate parent? i.e. "X without Y" = "X"?
• Should they be inactivated as the top level concepts in a subhierarchy cannot be defined and leads to a number of intermediate primitives (e.g. 400081000 |Blister without infection (disorder)|)?
• If so, should we follow the prior pattern of inactivation reason = AMBIGUOUS or consider another inactivation reason (e.g. DUPLICATE)?

Discussion:

Background: Initial evaluation of modeling approaches for devices found that there is no single modeling pattern that universally applies to all devices. In an effort to constrain the number of defining attributes that would be required to describe all of the different characteristics that differentiate classes of devices, the Devices Project Group determined that a single general attribute, "HAS_DEVICE_CHARACTERISTIC" could be used to describe any of the various characteristics or qualities of devices, with the primary differentia being captured in the associated values of the relationship. This is contrary to the approach that was taken in the creation of the drug and vaccine models, where very specific attributes were created to support the unique characteristics.

The approach being used in the Device Project has been questioned as inconsistent with the recent approaches to modeling primitive hierarchies and has multiple potential problems in retrieval and analysis.

Question:

Should the device project reconsider its approach to model development and create multiple attributes to support specific characteristics of each class of device (placing the burden of specificity in the attrbute) or continue to pursue modeling using the general "HAS_DEVICE_CHARACTERISTIC" attribute (placing the burden of specificity on the value set).

NOTE: These two options are mutually exclusive as creating both general and specific attributes would result in a change of meaning of the general attribute (representing NEC) when a new specific attribute is created.

Discussion:

Pathologic fractures

Questions:

• Should we consider ALL fractures as traumatic (e.g. pathological fractures are minor trauma to weakened bone)? [NOTE: This has been the historical representation in SNOMED CT]
• Can we infer that all non-traumatic fractures are pathological fractures (i.e. requires some predisposing bone pathology)?
• If the distinction between traumatic and pathological fractures needs to be made, how do we interpret the meaning of “Fracture of X”? Do we need specific “Traumatic fracture of X” concepts?

Discussion: