SNOMED CT Editorial Advisory Group

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Narrative description


A concept that has been inactivated because the FSN contains an error which impact the meaning. For example, while in ordinary usage the words sprain and strain are often used interchangeably, in fact they are not synonyms. A sprain refers specifically to an injury of a ligament, which connects bone to bone. A strain is an injury of a tendon, which connects muscle to bone. Therefore a sprain of the biceps tendon would be an error, it should be a strain of the biceps tendon. The important aspect here is that by making this change to the FSN there is a clear change in meaning of the concept and hence the need to inactivate the original concept.

Historically this inactivation reason has also been used to include (usually minor) technical typographical and grammar errors. However, current guidance recommends that the FSN can be changed whilst retaining the concept ID provided such corrections do not in truth change the meaning. Therefore, in the context of inactivating concepts, this inactivation reason now explicitly excludes such minor technical corrections.

Note however that, where a typographically incorrect FSN is inactivated to make way for a corrected alternate FSN on the same concept, then the Reason for Inactivation of the inactivated FSN description component would validly be: Erroneous.

Details


What is being inactivated (concept/description/any component)?The concept which is considered to be in error
What is the reason for inactivation (description)?The meaning portrayed by the FSN is clinically incorrect and/or there are typographical errors which change the meaning beyond what was originally intended or understood
Which inactivation value should be used?Erroneous component
Which historical association reference set should be used?REPLACED_BY association reference set (foundation metadata concept)

Known issues

  1. Because the description of how this inactivation reason should be used has been unclear, it is often used incorrectly with significant overlap between this and "Non-conformance to editorial policy". In particular it should not be used where:
    1. There is simply a word order change but no change in meaning
    2. A change in punctuation, but no change in meaning
    3. A spelling mistake unless the mistake has given rise to a word that gives rise to a change in meaning e.g. strain v sprain
  2. It may be difficult to distinguish between a concept description that has an error as opposed to one which is ambiguous - of course some errors may give rise to ambiguity

Examples

Simple Example

58484007 Infection caused by Madurella mycetomii (disorder)
REPLACED BY
715061003 Infection caused by Madurella mycetomatis (disorder)
385448005 Mycoplasma weynonii (organism)
REPLACED BY
422516008 Mycoplasma wenyonii (organism)
160244002 No known allergies (situation)
REPLACED BY
716186003 No known allergy (situation)
391052007 Hip dual energy X-ray absorptiometry scan (procedure)
REPLACED BY
429529009 Dual energy X-ray photon absorptiometry scan of hip (procedure)
25057004 Mercurial diuretic (product)
* no substitute *
322208004 Non-opioid analgesics (product)
* no substitute *
Complex Example
1612004 Acne rosacea (disorder)
REPLACED BY
398909004 Rosacea (disorder)
419637008 House dust allergy vaccine (substance)
REPLACED BY
346468008 House dust allergy vaccine (product)
709449000 Marine mollusk - dietary (substance)
REPLACED BY
735959004 Marine mollusk (substance)
139642006 Has nosebleeds - epistaxis (finding)
REPLACED BY
249366005 Bleeding from nose (finding)
Erroneous Example

(ie examples of prior improper use of the "erroneous" reason for a concept becoming inactive)
277751005 6 meters (finding)
inactivation reason should have been DUPLICATE
REPLACED BY 419493001 6 meters (finding)
218244000 Accidents NOS (morphologic abnormality)
inactivation reason should have been LIMITED
REPLACED BY 19130008 Traumatic abnormality (morphologic abnormality)
78461004 Memory impairment (finding)
inactivation reason should have been DUPLICATE
REPLACED BY 386807006 Memory impairment (finding)

Impact

(Describe how specific stakeholders are affected by the inactivation)

  • Authors
  1. Authors must be careful to avoid using this inactivation reason where it would be more appropriate to use either an allowed change to the FSN without inactivation of the concept or non-conformance to editorial policy.
  • Release Management Team

Local Release Management Team:

  • Notification to end users of the changes and replacement concept
  • Developers
  • Update of Refsets and where necessary ECL queries
  • End Users

Where an end user disagrees with the judgement and that is agreed with the local NRC a replacement concept may need to be created and an adjustment to the historical relationships file

Potential improvement:

  1. Exclude typographical and grammar errors which can be addressed through the use of allowable changes to the FSN
  2. Consider restricting this inactivation reason to include only errors which indicate an error of meaning e.g. a radiological procedure which states contrast is used when this is not the case
  3. Add a text field to allow the author to state what the error type is

Supporting resources

(Provide links to any resources relevant for this scenario)

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3 Comments

  1. Cathy Richardson

    This inactivation reason is also used for descriptions and when the analysis for use with descriptions (and concepts) was done back in 2016 the decision was that this inactivation value was used for technical errors: IHTSDO-980 Review of description inactivation values#Descriptioninactivationvalueissuesandproposedactions and Description Inactivation. Changes to its use for concepts also needs to take into account its use for descriptions. In addition, the proposed changes may also impact the guidance on the order of selection of inactivation values for descriptions. 

    1. Jeremy Rogers

      Thanks Cathy. Looks like a good argument for widening the scope of this endeavour. At the moment, its supposed to be a discussion about inactivation of concepts only - modulo having already stepped somewhat outside that remit with a detour into the REFERS_TO association type. But for clarity it could usefully be extended to bring in the parallels or differences in relation to the use of the various "reasons for inactivation" in the context of inactivating other flavours of component, such as descriptions.

      Also, there is clearly some overlap whenever the inactivation of a concept necessarily entails the inactivation of some of its descriptions, and so the reasons for inactivating those descriptions may be linked to the reason the concept as a whole was inactivated.

  2. Matt Cordell

    With the Strain/Sprain example - I'd have been more than half tempted to correct the FSN. As said, they're typically used interchangeably.
    If somebody said "sprain of the biceps tendon" they've technically used the wrong word, but I don't think there's any confusion if the finding site is correct.
    Unless of course, we're not sure if either "sprain of the biceps ligament" OR "strain of the biceps tendon" was what was intended...

    Most of the examples of erroneous concepts above, seem like either typo, outdated (editorial or practice) terms used in FSN. Though admittedly, as a downstream user dealing with inactivations, I have a bias against (what at least I view as) unnecessary concept inactivation - and accept this might not be a common position.

    I can't think of more clear cut clinical examples though, maybe if the wrong causative organism or finding site was mentioned?

    It's a common problem in medicines though, where the wrong salt/base ingredient and strength might be used
    e.g. "Amoxicillin sodium 250 mg powder for solution" vs "Amoxicillin 250 mg powder for solution"