Clinical findings with explicit context refer to situations where the presence, absence, or uncertainty of a clinical finding is documented with additional contextual details. These concepts provide a clear understanding of the specific circumstances under which a clinical finding is relevant.
The SNOMED CT concept
1290891000000109 |History of monkeypox (situation)| |
describes a past instance of monkeypox in a patient’s medical history. It is characterized by the Associated finding attribute, which specifies that the condition is
359814004 |Monkeypox (disorder)| |
. This indicates that monkeypox was the specific viral illness recorded in the patient’s history. The concept also includes information that the condition was confirmed as present, pertains to the patient, and occurred in the past.
The SNOMED CT concept
429625007 |No known food allergy (situation)| |
indicates that the patient does not have known food allergies. A key attribute here is
408729009 |Finding context (attribute)| |
, which is
410516002 |Known absent (qualifier value)| |
. This attribute specifies that the absence of a food allergy is confirmed. Additionally, the concept includes
246090004 |Associated finding (attribute)| |
as
414285001 |Allergy to food (finding)| |
, showing the specific type of allergy being assessed. The
408732007 |Subject relationship context (attribute)| |
is
410604004 |Subject of record (person)| |
, meaning the information pertains to the patient. The
408731000 |Temporal context (attribute)| |
is
410589000 |All times past (qualifier value)| |
, indicating that this absence of allergy has been consistent over time.
Note: SNOMED CT's current logical profile does not support negation. As a result, concepts that incorporate negation—such as the attribute value "Known absent"—require special interpretation when using the hierarchy's subsumption mechanism. For example, if a patient's record includes the concept "No known food allergy", it does not necessarily imply "No known allergy", as the patient may have other types of allergies. This holds true even though "No known food allergy" is a subtype of "No known allergy". |
The SNOMED CT concept
136611000119100 |History of sepsis (situation)| |
represents a patient’s past occurrence of sepsis. A key attribute here is
408731000 |Temporal context (attribute)| |
, which is
410513005 |In the past (qualifier value)| |
. This attribute specifies that the sepsis occurred in the past. The concept also includes
246090004 |Associated finding (attribute)| |
as
10001005 |Bacterial sepsis (disorder)| |
, indicating the specific condition recorded, and
408729009 |Finding context (attribute)| |
as
410515003 |Known present (qualifier value)| |
, confirming that the sepsis was known to be present. The
408732007 |Subject relationship context (attribute)| |
is
410604004 |Subject of record (person)| |
, indicating that the sepsis pertains to the patient themselves.
The SNOMED CT concept
161077003 |Father smokes (situation)| |
represents the smoking status of a patient’s father. Central to this concept is the Subject relationship context attribute, which is
66839005 |Father (person)| |
. This attribute indicates that the smoking status being recorded pertains specifically to the patient’s father. The concept also includes details such as the associated finding of
77176002 |Smoker (finding)| |
, the finding context as
410515003 |Known present (qualifier value)| |
, and the temporal context as
15240007 |Current (qualifier value)| |
, reflecting that the smoking status is currently known and applies to the patient’s father.
