Update for Concepts Using 'Caused by'

Clinical finding concepts containing "Caused by" in their FSN will be reviewed and will be updated (if applicable) according to the editorial guidelines related to causation here. 

There is one area where work is still in progress:  

• Clinical finding caused by radiation.

Ongoing in phases across 2024 International Releases

Updates to the Inactivation Reason and Historical Association for 'On Examination' and 'Complaining of' Inactive Content

Many of the 'on examination' and 'complaining of' concepts were previously inactivated with the inactivation reason of |Moved elsewhere| with a historical association value |Extension Namespace 1000000|.

This content will be updated with an inactivation reason of |Non-conformance to editorial policy| and a historical association of |Alternative| to a suitable international concept. 

Ethnic/Racial Group Social Context Content Inactivation

The subtypes of 372148003 |Ethnic group (ethnic group)| and 415229000 |Racial group (racial group)| will be inactivated as they are out of scope for the International Edition.  A briefing note is available here.

Patient/Subject concepts in the Clinical finding and Procedure Hierarchies

Concepts in the Clinical finding and Procedure hierarchies that contain the explicit context of patient or subject will be inactivated and replaced with concepts without this explicit context. For further information please see briefing note.

Inactivation of 277132007|Therapeutic procedure (procedure)

The concept 277132007 |Therapeutic procedure (procedure) will be inactivated with the inactivation reason of Outdated and a replacement association target of 71388002 |Procedure (procedure)|. The nearly 2000 descendants will be reviewed as to the appropriateness of either the Has intent (attribute) of Therapeutic intent, or a Method (attribute) of Therapy - action.

For further information please see briefing note.

OWL Axiom Expressions for Annotation Properties

The new annotation properties are represented in the OWL expression axiom refset as follows:

• The 1295447006 |Annotation attribute (attribute)| is correctly represented as subClassOf

  • 01300ccd-d1d7-417d-a70a-f688e72c4d8c 20231201 1 900000000000012004 733073007 1295447006 SubClassOf(:1295447006 :246061005)

• All subconcepts of 1295447006 |Annotation attribute (attribute)| are represented as "SubAnnotationPropertyOf", instead of "subClassOf" as they previously were

  • e6cd65fe-cb81-4db4-9ac4-040dc74fce28 20231201 1 900000000000012004 733073007 1295448001 SubClassOf(:1295448001 :1295447006)

  • 3729ce47-a96e-4dc7-9eff-83c34740c414 20231201 1 900000000000012004 733073007 1295449009 SubClassOf(:1295449009 :1295447006)

These axiom updates are published in the March 2024 International Edition release. The authoring tool has been updated to ensure all new subconcepts of 1295447006 |Annotation attribute (attribute)| are represented as SubAnnotationPropertyOf(). Other tools will be updated to correctly consume the updated syntax. This will be carefully tested and rolled out over the next few months.

Inactivation of Mechanical Complication of <x> Device

In October 2023 the Editorial Advisory Group made a decision that the concepts that represent a mechanical complication of <x> device are ambiguous. Following this a briefing note was shared with the community of practice to both inform and collect feedback. This feedback has been reviewed and the work will be proceeding. The concepts will be inactivated as ambiguous with a historical association to 473023007 |Complication associated with device (disorder)| or a suitable subtype.

Inactivation of 410770002 |Administration of anesthesia for procedure (procedure)| and Subtypes

A Briefing note was presented to Anesthesia CRG with a proposal for review and remodeling of 1263452006 |Anesthesia and/or sedation procedure (procedure)| hierarchy.

As part of that proposal, inactivation of 410770002 |Administration of anesthesia for procedure (procedure)| hierarchy was agreed.

This inactivation will affect 410770002 |Administration of anesthesia for procedure (procedure)|and subtypes, and 10745231000119102 |Cardiac arrest due to administration of anesthesia for obstetric procedure in pregnancy (disorder)|.

Concepts in 410770002 |Administration of anesthesia for procedure (procedure)|hierarchy will be inactivated with Inactivation reason = Outdated component and Replaced by 399097000 |Administration of anesthesia (procedure)|.

For 10745231000119102 |Cardiac arrest due to administration of anesthesia for obstetric procedure in pregnancy (disorder)|FSN will be changed to 10745231000119102 |Cardiac arrest due to administration of anesthesia in pregnancy (disorder)| and value for 42752001 |Due to (attribute)| will be changed to 399097000 |Administration of anesthesia (procedure)|.

Pharmaceutical Dose Forms with Two or More Intended Sites

Pharmaceutical Dose Forms with more than one intended site will use “and” in their descriptions and include all intended sites in the model. By representing combinations of intended sites as a conjunction ('and' in the description) this will facilitate searching by end users. The concepts are logically modeled as conjunction.

Existing dose forms with "or" will be updated to "and" in their descriptions, this will be included in the Editorial Guide.

9 clinical drugs using these dose forms will correspondingly have their descriptions updated to 'and'.

Note - pharmaceutical dose forms with two or more administration methods:
As this is a less common requirement any requests for this type of dose form will be reviewed on a case by case basis.

Urinary Bladder

Following feedback from translation, descriptions for concepts that contain the word 'bladder' and the site of 89837001|Urinary bladder structure (body structure)| will be updated to include 'urinary' in the FSN and PT, for example:

126885006|Neoplasm of bladder (disorder)

will be updated to

126885006|Neoplasm of urinary bladder (disorder).

International Unit in Descriptions for Clinical Drugs

'International Unit' as a description is arbitrary and to be understood each product requires reference to a particular bioefficacy specification for that entity. Therefore, 'international' is not meaningful or comparable as a description at Clinical Drug level. International unit will be represented as 'unit' in Clinical Drug descriptions and 20 concepts will have their descriptions changed to 'unit'  Note: abbreviations will not be used. Editorial Guidance has been drafted.

Inactivation of  “RAST” and “RAST test” from subtypes of 104380004 |Allergen specific antibody measurement (procedure)|

Based on a proposal by the Allergies and Hypersensitivities CRG, descriptions containing “RAST” and “RAST test” will be inactivated from the concepts in this sub-hierarchy as they are not considered real synonyms.

Immunoassays for immunoglobulin specific to an allergen of interest are widely used in the diagnosis of allergic disease. These tests are often incorrectly referred to collectively as "radioallergosorbent tests" ("RAST") because they were the earliest immunoassays to be used extensively.

There are a few concepts of type "X mix radioallergosorbent test (procedure)", where RAST is in fact part of FSN. These concepts will be inactivated as they are ambiguous because they do not mention what allergens are being tested for. Replacement concepts, where individual allergens are spelled out, will be created where the information is available.

Inactivation of Congenital Morphologic Abnormality Concepts

37764001 |Congenital abnormal fusion (morphologic abnormality)| and 67798003 |Congenital premature fusion (morphologic abnormality) will be inactivated and replaced by:

• Abnormal fusion (morphologic abnormality)
• Premature fusion (morphologic abnormality)

These two new concepts do not specify occurrence which is to be modeled separately.  As a result of this change the two new concepts can be used to model fetal disorders.

This change aligns with the Editorial Guide.

Inactivation of 106109006|Number of previous induced termination of pregnancy (finding)| and Subtypes

106109006|Number of previous induced termination of pregnancy (finding)| and subtypes will be inactivated and replaced by a new concept in the situation with explicit context hierarchy:

1300163008 |Past pregnancy history of multiple induced termination of pregnancy (situation)|

This concept is already published.

713649008 |Past pregnancy history of induced termination of pregnancy (situation)|

Update 77465005 |Transplantation (procedure) and Descendants

Note this project is ongoing. Proposals for the new model will be considered by the Editorial Advisory Group (EAG).

410820007 |Surgical transplantation - action (qualifier value)| and 129407005 |Grafting - action (qualifier value)| will be siblings (not child-parent relationship)  and will be subtypes of 129338005 |Surgical implantation - action (qualifier value)|. 

129347002 |Surgical transfer - action (qualifier value)| will no longer be a subtype of 410820007 |Surgical transplantation - action (qualifier value)|.

115956009 |Release (procedure)| will be inactivated and its subtypes remodeled to proximal primitive parent modeling and attributes added where necessary.

<< 422285003 |Solid organ graft - material (substance)|  and its subtypes will be updated from 'graft' to 'transplant'.  For example, 420291005 |Transplant heart (substance)|

The 77465005 |Transplantation (procedure)subtypes will be remodeled with 410820007 |Surgical transplantation - action (qualifier value) where necessary. Also, certain grafting procedures that were subtypes of transplantation procedure will be remodeled with 129407005 |Grafting - action (qualifier value)|.

Clinical Finding

Morphologic Abnormality

Situation with Explicit Context

Remodel 127575007 |Malignant neuroendocrine neoplasm, epithelial (morphologic abnormality)| and Subtypes

127575007 |Malignant neuroendocrine neoplasm, epithelial (morphologic abnormality)|, its subtypes and related disorder concepts will be revised to align with the 5th edition of the WHO Blue Book chapter on Endocrine and Neuroendocrine Tumours as part of the Histology Quality Improvement Project.

Please see the briefing note for more information about these changes.

Update for 73632009 |Laparoscopy (procedure)| and Subtypes 

There will be a bulk update to align 73632009 |Laparoscopy (procedure)| and subtypes with the template here: https://confluence.ihtsdotools.org/display/SCTEMPLATES/Laparoscopy+%28procedure%29+-+Draft

These changes include the addition of INCISION ROLE GROUP and INSPECTION ROLE GROUP for all Laparoscopic procedures. 

Update for Diabetes Insipidus

Based on a report from October 2022 from the Working Group for Renaming Diabetes Insipidus, concepts using the term “Diabetes insipidus” will be renamed and/or replaced with terms that more appropriately represent the pathophysiology of this condition.  The top-level concept replacing "Diabetes insipidus" will be "Arginine vasopressin-related polyuria" and the specific subtypes will be represented by two renamed conditions: 

• Arginine Vasopressin Deficiency (AVP-D)” for central etiologies

• Arginine Vasopressin Resistance (AVP-R)” for nephrogenic etiologies

The legacy descriptions of "Diabetes insipidus", "Central diabetes insipidus" and "Nephrogenic diabetes insipidus" will be retained where appropriate to facilitate retrieval of concepts by their newer names. This affects approximately 18 existing concepts in SNOMED CT.

17423001 |Epiphysiodesis (procedure) - Remodel Subtypes Epiphyseal Stapling

Epiphyseal stapling concepts will be moved from being a subtype of 17423001 |Epiphysiodesis (procedure)|. 

Epiphysiodesis is a fusion of the epiphyseal plate resulting in a permanent arrest of growth, whereas Epiphyseal stapling is a fixation of the epiphyseal plate in order to arrest growth and is often reversible once the staples are removed.  

NOTICE PROPOSED CHANGE(s) TO THE COVERAGE OF LANGUAGE IN ANNOTATIONS REFSET

After discussions with the community, SNOMED International is proposing to change the coverage of language in the Annotations refsets in the following way:

The langueCode field was specified as the two characters of ISO-639-1 code for the language of the annotation text. The change is to include support for specifying dialect when it is applicable by adhering to RFC 5646, which allows the combination of two characters of ISO 639-1 code and two uppercase letters of country code (ISO 3166) separated by a hyphen. The "languageCode" will be changed to "languageDialectCode" in the field column. A new metadata c "Language dialect", a subconcept of "Language Code", will be used for the metadata of this column in the descriptor refset.

Please provide any feedback to info@snomed.org by Friday 26th January 2024 at the absolute latest, as lack of response will be taken as acceptance, and the changes will proceed as planned. 

Inactivation of Congenital Morphologic Abnormality Concepts

61295008 |Congenital abnormal number (morphologic abnormality)|

125226006|Congenital malposition, left (morphologic abnormality)|

125225005|Congenital malposition, right (morphologic abnormality)|

56457002|Congenital atresia (morphologic abnormality)| 

41086002 |Congenital smallness (morphologic abnormality)|

81850003 |Congenital sequestration (morphologic abnormality)|

These concepts will be inactivated and replaced by a concept that does not specify congenital. Concepts that are modeled with these morphologic abnormality concepts will be remodeled using the replacement concept. This change aligns with the Editorial Guide.

OWL Axiom Expressions for Annotation Properties

The new annotation properties should be represented in the OWL expression axiom refset as follows:

• The 1295447006 |Annotation attribute (attribute)| is correctly represented as subClassOf
  • 01300ccd-d1d7-417d-a70a-f688e72c4d8c 20231201 1 900000000000012004 733073007 1295447006 SubClassOf(:1295447006 :246061005)

• However, all subconcepts of 1295447006 |Annotation attribute (attribute)| should be represented as "SubAnnotationPropertyOf", instead of "subClassOf" as they currently are.
  • e6cd65fe-cb81-4db4-9ac4-040dc74fce28 20231201 1 900000000000012004 733073007 1295448001 SubClassOf(:1295448001 :1295447006)
  • 3729ce47-a96e-4dc7-9eff-83c34740c414 20231201 1 900000000000012004 733073007 1295449009 SubClassOf(:1295449009 :1295447006)

They should therefore be changed to:

• SubAnnotationPropertyOf(:1295448001 :1295447006)
• SubAnnotationPropertyOf(:1295449009 :1295447006)

However, the authoring tool will then need to be updated to ensure all new subconcepts of 1295447006 |Annotation attribute (attribute)| will be represented as SubAnnotationPropertyOf() in the future.  Numerous other tools will also need to be updated first in order to correctly consume the new format.

There are numerous systems that require updating, and that this will therefore need to be carefully tested and rolled out over the next few months.  As the potential impact was analysed and deemed to be low, the Annotations deployment will still go ahead as planned in the January 2024 International Edition release, whereas these axiom updates will be published in subsequent releases.  Please, therefore, be aware that this issue will persist for the first few International Edition releases of 2024.

Inactivation of 9258009|Gravid uterus structure (body structure)|

This concept will be inactivated, content that is modeled with this concept will be remodeled with a site of 35039007|Uterine structure (body structure)| along with occurrence <<307159006|Pregnancy time period (qualifier value)|.  

The domain of 246454002 |Occurrence (attribute)| has been extended in the October 2023 release to include << 71388002 |Procedure (procedure)| to support these content changes. Content areas that will be updated include 386811000|Fetal procedure (procedure)| and 386637004|Obstetric procedure (procedure)|.

Inactivation of Concepts Specified Male/Female in Descriptions

67770001 |Male mammary gland structure (body structure)| and 91532001 |Female mammary gland structure (body structure)| and subtypes plus associated disorder and specimen concepts will be inactivated.  Further information is available here (Confluence log in required).

NOTE: this update will include the inactivation of neoplasm concepts that specify male/female, this includes

<<126927001|Neoplasm of female breast (disorder)|

<<126937006|Neoplasm of male breast (disorder)|

These concepts will be replaced with a concept that does not specify male/female, a new concept will be added where one does not already exist.

April 2024 release:

• 168537006|Plain radiography (procedure)| and subtypes
• 168500000|Radiology result normal (finding)| and subtypes
• 168501001|Radiology result abnormal (finding)| and subtypes

Remaining changes across 2024 International Releases

Change Parent for 410460000|Illumination - action (qualifier value)| and Subtypes

410460000|Illumination - action (qualifier value)| and descendants will be updated to be a subtype of 272394005|Technique (qualifier value)|.  The concepts will not be inactivated.  Descriptions that currently include '- action’ will be inactivated and replaced. 

Concepts that are currently modeled with method 410460000|Illumination - action (qualifier value)| will be remodeled with a method of 360037004|Imaging - action (qualifier value)|.  These changes will complete this Content Tracker.

Inactivation of 118661008|Physician service (procedure)| and Descendants

118661008|Physician service (procedure)| and subtypes will be inactivated and replaced with concepts that are a subtype of 224891009|Healthcare services (qualifier value)| where appropriate.

These changes will complete this Content Tracker.

Addition of New Technique Qualifier Value Concepts

Around 80 new laboratory technique concepts will be added in the 272394005 |Technique (qualifier value)| subhierarchy.