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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.

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,

• • Concept
    t 4532008 |Acute inflammation (morphologic abnormality)|

    does not necessarily have a clinical course of sudden onset and/or short duration, but rather implies polymorphonuclear infiltration (

    Concept
    t 84499006 |Chronic inflammation (morphologic abnormality)|

     implies mononuclear cell infiltration, not necessarily a chronic course, although inflammation with a chronic course is highly correlated with a lymphocytic infiltration)

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).

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.