The group that is attempting to build a FHIR IG for Anesthesia records has begun working on the Epidural use case.
Several SNOMED codes have been included but there doesn't seem to be a code for "identification of the epidural space". There are codes for levels, structures and insertion of a catheter. There are also codes for the loss of resistance techniques (air, saline and hanging drop).
Is there an appetite for a concept of "identification of a target structure" that could then be speci
Thoughts from our discussion today
Could use "Method of identification (attribute)" on "identification of a target structure". Then one of the body structure concepts for intervertebral space could be another attribute. Would still need a new concept for "identification of a target structure". We looked for other "identification of X" procedures but did not find any looking through the browser.
There are terms for the intervertebral foramina, however, the intervertebral foramen is the opening between every two vertebrae where the nerve roots exit the spine, so that is not correct for epidurals. It is good for foraminal blocks
Currently there is
Structure of intervertebral space (body structure) SCTID: 47886009 and
image-2024-3-11_11-45-9.png
Not really sure what these refer to? Is this referring to the space between the vertebral bodies where the disc lies? It doesn't say betwe
Caudal doesn't have an insertion/approach "level" as such, so the record would likely be "Sacral Epidural Block", Caudal is a synonym:
https://browser.ihtsdotools.org/?perspective=full&conceptId1=110533007&edition=MAIN&release=&languages=en https://browser.ihtsdotools.org/?perspective=full&conceptId1=110533007&edition=MAIN&release=&languages=en
I agree with Steven's comments. The grouping of Anesthesia AND/OR Sedation only makes sense if there is a use case for a procedure where we don't know in advance what the requirements are or what plan has been made with the patient. So it could (in theory) be used as part of a pre-assessment plan, with the expectation that agreement will be reached with the patient on whether the procedure can be done under an anesthetic (of any type) and if regional/topical/local, is sedation given.
In the case where a procedure begins under local or regional and subsequently requires conversion to GA, this would be recorded in a sequential manner.
Patrick also mentioned that there is a use case in the US where the conflation of Anesthesia and Sedation has implications for billing but I can't remember the details.
Also, see:
Anesthesia, sedation and analgesia procedures classification
We have received a CRS request to inactivate one or other of the above referenced concepts. Suggest a review of the hierarchy under 274497003 |Nerve injection (procedure)| is required.
There is a tracker on this topic as well. It is here:
https://confluence.ihtsdotools.org/display/IHTSDO1/Content+Project+Tracker+Documents?preview=%2F18777631%2F18777817%2FProject+1_Artf221500-RestructuringofLocalanesthesia_Inception_20141202.docx https://confluence.ihtsdotools.org/display/IHTSDO1/Content+Project+Tracker+Documents?preview=%2F18777631%2F18777817%2FProject+1_Artf221500-RestructuringofLocalanesthesia_Inception_20141202.docx
This area of the hierarchy is under review in an effort to distinguish between procedures i.e. one time occurrence vs multiple occurrences over time whether continuous or intermittent. Please review the xls here: https://docs.google.com/spreadsheets/d/1u9WAEIoqvzn0_dmrSTvgW8QI6W0D_O9cp452TkMwayI/edit?usp=sharing https://docs.google.com/spreadsheets/d/1u9WAEIoqvzn0_dmrSTvgW8QI6W0D_O9cp452TkMwayI/edit?usp=sharing and add your comments to the appropriate column or add a column. We hope to discuss
Hi Monica, just to reiterate my comments from Monday - the patient-ventilator interaction can be thought of as a feedback loop. Settings/actions/prescriptions are made and adjusted in real time and the outcome of those settings and adjustments are measured and monitored as observations, both clinical (e.g. effort, skin changes) and from the ventilator itself and associated sensors. From a record-keeping perspective, the data is usually presented as a time-axis chart. Adjustments to therapy in the form of changes to settings, position (e.g. prone) and other airway interventions are accompanied by some form of assessment - did the change in settings/therapy achieve the desired effect, was there no change, or did the condition worsen.
I hope that helps.
A couple of other scores in common use that do not have clinical findings in SNOMED. The score itself exists 445520006 | Visual infusion phlebitis score (observable entity) | and the assessment exists 445577007 | Assessment using visual infusion phlebitis scale (procedure) |
image2020-11-10_14-39-20.png
Regarding the Glasgow Coma scale, I would propose using the concepts that are used in the Netherlands copied below. The concept names, in my opinion are very well done as they can easily be used in postcoordinated terms for reasons other than the GCS. I propose that SNOMED include all the Conceptnames in the tables below as clinical findings.
One then for the motor functions postcoordinate with bodysite and laterality
from: GlasgowComaScale-v3.2(2020EN) - Zorginformatiebouwstenen (zibs.nl) https://zibs.nl/wiki/GlasgowComaScale-v3.2(2020EN)
Valuesets
1 ConditionsDuringMeasurementCodelist
Valueset
Binding: Extensible
Conceptname
Codesystem name
Description
Sedated
SNOMED CT
sedated
Paralysis caused by skeletal muscle relaxant
SNOMED CT
muscle relaxants
Aphasia
SNOMED CT
Aphasia
Endotracheal tube present
SNOMED CT
tube present
Tracheostomy present
SNOMED CT
tracheostoma present
other
NullFlavor
Else
2 GCS_EyesCodelist
Valueset OID:
Binding: Required
Conceptname
Concept value
Codesystem name
Description
Spontaneous
4
GCS_Eyes
Spontaneous [Eyes are opened without exhortation
To sound
3
GCS_Eyes
When addressing or calling [The eyes are only opened at the patient's address]
To stimuli
2
GCS_Eyes
In case of an incentive [The eyes are only opened after giving a physical stimulus]
No response
1
GCS_Eyes
No response [Eyes remain closed under any circumstance]
Not applicable
0
NullFlavor
Not testable by a local limiting factor
GCS_MotorCodelist
Valueset OID:
Binding: Required
Conceptname
Concept value
Codesystem name
Description
Obeys
6
GCS_Motor
Executes Command [A Simple Command Is Executed]
Localises pain
5
GCS_Motor
Locating [Being able to clearly locate the pain]
Withdrawal response
4
GCS_Motor
Retreat [Able to make a repellent or retreating motion on a pain stimulus]
Flexor response
3
GCS_Motor
Bending reaction [Arms and hands folded in spasmodic way. Usually legs stretched.]
Extensor response
2
GCS_Motor
Stretching reaction [Arms and hands folded in a convulsive way with hand turned outwards. Possibly all muscles of the body tense]
No response[DEPRECATED]
1
GCS_Motor
No response to pain stimuli [No physical reaction movement to a pain stimulus] [DEPRECATED]
No response
1
GCS_Motor
No movement on stimulus [No movement on a stimulus]
Not applicable
0
NullFlavor
Not applicable
GCS_MotorCodelistBaby
Valueset OID:
Binding: Required
Conceptname
Concept value
Codesystem name
Description
Moves spontaneously and purposefully
6
GCS_Motor
Normal [moves as expected]
Localizing
5
GCS_Motor
Retreat on touch [Pulls back on touch]
Normal flexion
4
GCS_Motor
Retreat in response to pain [Makes repellent or receding movement in case of a pain stimulus]
Abnormal flexion
3
GCS_Motor
Bending response [Slow, bending of arms and/or legs]
Abnormal extension
2
GCS_Motor
Decerebral stretching response [stretching of arms and/or legs]
No response
1
GCS_Motor
No movement on stimulus [No movement on a stimulus]
Not applicable
0
NullFlavor
Not applicable
3 GCS_MotorCodelistToddler
Valueset OID:
Binding: Required
Conceptname
Concept value
Codesystem name
Description
Obeys commands
6
GCS_Motor
Executes order to move [A simple request for movement is performed]
Localising
5
GCS_Motor
Retreat on touch [Pulls back on touch]
Normal flexion
4
GCS_Motor
Retreat in response to pain [Makes repellent or receding movement in case of a pain stimulus]
Abnormal flexion
3
GCS_Motor
Bending response [Slow, bending of arms and/or legs]
Abnormal extension
2
GCS_Motor
Decerebral stretching response [stretching of arms and/or legs]
No response
1
GCS_Motor
No movement on stimulus [No movement on a stimulus]
Not applicable
0
NullFlavor
Not applicable
4 GCS_VerbalCodelist
Valueset OID:
Binding: Required
Conceptname
Concept value
Codesystem name
Description
Oriented
5
GCS_Verbal
Oriented [Clearly and clearly aware of the situation]
Confused [DEPRECATED]
4
GCS_Verbal
Confused [Confused conversation but able to answer the questions] [DEPRECATED]
Confused
4
GCS_Verbal
Confused [confused but communicates coherently]
Inappropriate speech
3
GCS_Verbal
Inadequate [Words are understood but do not form sentences]
Incomprehensible sounds [DEPRECATED]
2
GCS_Verbal
Unintelligible [Speech is not understood] [DEPRECATED]
Moaning
2
CGS_Verbal
Moaning [no speech, just moaning]
No response
1
GCS_Verbal
No response [No verbal response]
Not applicable
0
NullFlavor
Not applicable
5 GCS_VerbalCodelistBaby
Valueset OID:
Binding: Required
Conceptname
Concept value
Codesystem name
Description
Oriented [DEPRECATED]
5
GCS_Verbal
Laughing and crying [Laughs or Cries Softly] [DEPRECATED]
Coos/babbles
5
GCS_Verbal
Kirt/babble
Confused
4
GCS_Verbal
Crying [Cries and Is Impassable] [DEPRECATED]
Irritable cries
4
GCS_Verbal
Cries irritable
Inappropriate speech [DEPRECATED]
3
GCS_Verbal
Not adequate crying [Persistent crying or screeching] [DEPRECATED]
Cries to pain
3
GCS_Verbal
Cries of pain
Incomprehensible sounds [DEPRECATED]
2
GCS_Verbal
Moaning [Moaning and Restless/Restless] [DEPRECATED]
Moans
2
GCS_Verbal
Wails/groans
No response
1
GCS_Verbal
No response [No verbal response]
Not applicable
0
NullFlavor
Not applicable
6 GCS_VerbalCodelistToddler
Valueset OID:
Binding: Required
Conceptname
Concept value
Codesystem name
Description
Orientated
5
GCS_Verbal
Oriented [Clearly and clearly aware of the situation]
Confused
4
GCS_Verbal
Confused [confused but communicates coherently]
Inappropriate speech [DEPRECATED]
3
GCS_Verbal
Crying [Persistent crying or screeching] [DEPRECATED]
Words
3
GCS_Verbal
Inadequate [Words are understood but do not form sentences]
Incomprehensible sounds [DEPRECATED]
2
GCS_Verbal
Moaning [Moaning Only] [DEPRECATED]
Sounds
2
GCS_Verbal
Incorrect words [incorrect words or sounds like moaning]
No response
1
GCS_Verbal
No response [No verbal response]
Not applicable
0
NullFlavor
Not applicable
Jeremy, Zac
I've been through this again and added more comments, also suggested a few more inclusions SNOMED codes for COVID ICU 20200406 AnesCRG comments v2.xlsx
Patrick McCormick