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There are currently approximately 774 770 (20180131 release) concepts in the Clinical findings and Disease hierarchy that contain the word "acquired" in the FSN. These are used clinically to differentiate clinical conditions that may be either congenital or acquired later in life. Of these, 449 445 are primitive and 275 are sufficiently defined. There are a number of issues related to the presence of these primitive concepts:
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Acquired conditions are those which originate and manifest after birth. Since this relates to a period of life as opposed to a specific process or structure. , all diseases that occur after birth may be considered to be acquired. According to the American medical association, the periods of life that are included under the "postnatal period" include all periods after birth including the neonatal or immediate postpartum period. Diseases that manifest during the neonatal period of life are challenging since the inciting cause may be present at birth, the clinical manifestation may take a day or two to appear (e.g. Neonatal isoimmune neutropenia).
Three alternatives have been considered:
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The general pattern for revising the affected concepts is shown in the diagram below:
5. Construction
The tabel attached file is a listing of the concepts present in the 20180131 release if SNOMED International:
https://docs.google.com/spreadsheets/d/1K1LhTklXJl8GhRGMN6G6j3xuX3HfGa7UoQS-0hiBRB8/edit?usp=sharingView file
Some identified issues;
- Most definitions include the neonatal period in definitions of "Postnatal period". What are the advantages disadvantages of including it in this remodeling.
- Some disorders that are developmental but manifest later in life are currently classified as acquired. AMA definition excludes genetic diseases even if manifesting later in life.
- Missing some “musculoskeletal structure of X” concepts for deformities
- Due to existence of primitive concepts, there is a need to inactivate:
- 367335002 - Claw hand - acquired (finding) DUPLICATE TO 367393006 - Acquired claw hand (disorder)
- Acquired forearm deformity, excluding fingers DUPLICATE to “Acquired forearm deformity as the fingers are not anatomically part of the forearm.
- Inactivate 45402003 – Juvenile disease (finding) as ambiguous.
- Add new body structure “Musculoskeletal structure of forearm (body structure)”
- Periods of life assignment where the onset is at one stage of life but persists throughout the rest of life. How to assign OCCURRENCE?
- Some concepts contain the phase "congenital OR acquired". Inactivate and replace?
- There are some duplicate concepts that need to be resolved (e.g.
6. Transition phase
| Item | Status |
|---|---|
7. Glossary of Terms
| Term | Definition |
|---|---|
| Acquired disease | Developed or originating after birth : not congenital or hereditary. Hyperoxaluria may be due to overproduction from hereditary disorders of metabolism or it may be an acquired disorder caused by intestinal disease or diet. Source JAMA 1988. Of or relating to a disease, condition, or characteristic that is not congenital but develops after birth. |
| Postnatal period | That interval of life after birth; in humans, usually divided into periods: neonatal, infancy, childhood, adolescence, and adulthood. |