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Generally, the attributes attributes associated with, before, during, after, due to, clinical course, or temporally related to are self-grouped, meaning they must not be placed in a relationship group with other attributes; each attribute must be the only attribute in a relationship group. Any rare exceptions will be documented within the individual attribute section below. The Human Readable Concept Model (HRCM) grouped column (see the Clinical Finding Attributes Summary table on the previous page) correctly indicates that these attributes are put into a relationship group during classification because they are self-grouped. |
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has theConcept t 4989003 |Electrical burn of skin (disorder)|
ofConcept t 246075003 |Causative agent (attribute)| Concept t 18213006 |Electricity (physical force)|
The following guidelines should be considered where the causative agent is a substance:
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Although Pharmaceutical / biologic product (product) and its descendants are considered valid values for Causative agent (attribute) by the MRCM, they are not currently used as values for this attribute in the International Release. The only exception is 787859002 |Vaccine product (medicinal product)| and its descendants, which can be used as valid values for this attribute. |
The following guidelines should be considered where the causative agent is a substance:
Concepts representing a clinical finding caused by a base substance (e.g., 836284001 |Pentamethonium (substance)|), a substance structure grouper (e.g. 1149501006 |Substance with ether structure (substance)|), or a substance disposition grouper (Concepts representing a clinical finding caused by a base substance (e.g., 836284001 |Pentamethonium (substance)|), a substance structure grouper (e.g. 1149501006 |Substance with ether structure (substance)|), or a substance disposition grouper (e.g. 404642006 |Substance with opioid receptor agonist mechanism of action (substance)|) should be modeled using a causative agent that is a descendant of 105590001 |Substance (substance)|. Classification results are expected to be consistent with the modeling in the Substance hierarchy:
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Concepts representing a clinical finding caused by a substance role grouper modification (e.g., 372688009 82485006 |Antineoplastic agent Pentamethonium bromide (substance)|) currently follow the same guidelines noted above. However, role groupers will be transitioned from the Substance hierarchy to the 763158003 |Medicinal product (product)| hierarchy in a future release.are generally not allowed. Exceptions may be included if the condition caused by the substance modification is significantly different from the one caused by the base substance. Exceptions may include Liposome or lipid complex substances, Pegylated substances, or salt forms:
For example,
293908005 |Allergy to chloral hydrate (finding)|
296213007 |Fluphenazine decanoate 295597003 |Antineoplastic overdose (disorder)|
Concepts representing a clinical finding caused by a substance modification (e.g., 82485006 |Pentamethonium bromide (substance)|) are generally not allowed. Exceptions may be included if the condition caused by the substance modification is significantly different from the one caused by the base substance. Exceptions may include Liposome or lipid complex substances, Pegylated substances, or salt forms:
For example,
293908005 |Allergy to chloral hydrate (finding)|
296213007 |Fluphenazine decanoate overdose (disorder)|
Clinical course
This attribute is used to represent both the course and onset of a disease or condition.
For example,
has aConcept t 74973004 |Chronic fibrosing pancreatitis (disorder)|
ofConcept t 263502005 |Clinical course (attribute)| Concept t 90734009 |Chronic (qualifier value)|
Clinical course
This attribute is used to represent both the course and onset of a disease or condition. This attribute is self-grouped.
For example,
has aConcept t 74973004 |Chronic fibrosing pancreatitis (disorder)|
ofConcept t 263502005 |Clinical course (attribute)| Concept t 90734009 |Chronic (qualifier value)|
The clinical course value is added when appropriate The clinical course value is added when appropriate to the condition and thus specified in the FSN. The distinction is often necessary in those conditions that can have either an acute or a chronic course, such as bronchitis. For those conditions that have only one clinical course, i.e. diabetes is a chronic disease, a wider discussion is necessary before a decision can be made whether to assign a clinical course. Decisions on these concepts are currently made on a case-by-case basis.
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The word acute has more than one meaning, and the meanings are often overlapping or unclear. It may imply rapid onset, short duration, or high severity; in some circumstances it might be used to mean all of these. For morphological concepts, acute may also imply the kind of morphology associated with the speed of onset. For example,
2704003 |Acute disease (disorder)| is modeled with a Clinical course (attribute) of Sudden onset AND/OR short duration (qualifier value). For clinical conditions that necessitate further specificity, the more appropriate subtypes are available. Acute onset and sudden onset are synonymous; clinical conditions specifying acute onset should be modeled with a Clinical course (attribute) of Sudden onset (qualifier value). |
Normally,
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Acute-on-chronic (qualifier value) is an acute (sudden onset) event superimposed on a pre-existing chronic condition. This be either a sudden worsening of a chronic condition itself (an exacerbation) or the development of a new, separate acute illness on top of a chronic disease. |
Due to
This attribute is used to identify a clinical finding/disorder, event, or procedure concept as the direct cause of another Clinical finding or Disorder concept. If the clinical finding merely predisposes to another disorder, rather than causing it directly, the more general
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This attribute specifies the person or other entity from which the clinical finding information was obtained. It is not about the particular individual but about the category or type of informer. It is used to differentiate patient-reported symptoms from provider-determined signs. This attribute is frequently used in conjunction with
-determined signs. Concept t 418775008 |Finding method (attribute)|
Finding method
This attribute specifies the means by which a clinical finding was determined. It includes findings that were determined by examination of the patient. Finding method is frequently used with Finding informer.
For example,
has theConcept t 713071004 |Alcohol misuser in household (finding)|
ofConcept t 418775008 |Finding method (attribute)| Concept t 84100007 |History taking (procedure)|
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This attribute is used to subclass a Clinical finding concept according to its severity. However, this use is relative, i.e. it is incorrect to assume that the disease intensity or hazard is the same for all clinical findings to which this attribute is applied.
The severity attribute 246112005 |Severity (attribute)| may be applied to subtypes of Clinical finding (excluding << Symptom severity (finding)) to represent the severity of a finding or disease.
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Generally, 246112005 |Severity (attribute)| is is not used to model concepts precoordinated in the International precoordinated in the International Release, but but there are some exceptions. A valid exception requires an internationally accepted definition that can be consistently applied and used reliably for international comparison. Even though a reference may be internationally sourced, its use may not always be uniformly applied by multiple countries. Classifications of severity that represent variation in clinical presentations and enact limitations with age ranges, sex, or pregnancy status, do not apply universally to all patients of all ages, prove problematic, and may not be generally useful. The requestor is responsible for obtaining permission for use in SNOMED CT if required by the international body. As an alternative to precoordination in the international release, this attribute can be used as a qualifier in postcoordination. However, beware that postcoordination of severity results in the same irreproducibility issues as pre-coordination. |
Temporally related to
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irreproducibility issues as pre-coordination. |
Temporally related to
726633004 |Temporally related to (attribute)| applies to perioperative complications and clinical findings where there is no causal relationship but a time-relative association exists.
This attribute's subhierarchy specifies the associated time period (i.e. before, during, after) between two clinical findings, e.g., |Pediatric inflammatory multisystem syndrome temporally associated with COVID-19|; or between a clinical finding and a procedure, e.g., perioperative
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complications temporally related to a surgical procedure (i.
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e. preoperative, intraoperative, and postoperative
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This attribute is self-grouped.
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