Exacerbated by
The periodontal community will likely be changing some of their disorder descriptions to include the phrase "exacerbated by".
Though I have no precise examples, it might be something like "severe generalized periodontitis exacerbated by uncontrolled diabetes" or even possibly a procedure such as "severe generalized periodontitis exacerbated by chemotherapy".
There are is an existing concept in SNOMED that use this phrase e.g. 707245003|Angular cheilitis due to nutritional deficiency (disorder)| with a synonym of "exacerbated by".
An unapproved qualifier exists of 410660005|Aggravated by (attribute)| that has a synonym of "Exacerbated by".
Would like your thoughts.
Comments
I've a feeling this takes discussions back to the earlier origins of the ECE group, rekindling the notion of how a disease 'progresses' (and 'pathography' - coincidentally explained in - thanks to Phil Brown from ~15 years ago).
Arguably the role played by the nutritional deficiency, the administered chemotherapy and the 'uncontrolled' diabetes (itself evolving) is still 'causal', but the thing 'caused' is a deviation in the trajectory of an existing condition rather than something emerging de novo.
Could all the "X aggravated by Y" constructs be re-framed as "Worsening X due to Y" (or, more exotically, "Worsening X due to uncontrolled Y")?. If so then there may be less need to add more 'causal' attributes' and instead value in investigating the states (e.g. 'resolved', well-controlled, poorly-controlled) and state-change vectors (worsening, improving) of a disease life-cycle.
I'm not against the phrases 'aggravated by' and 'exacerbated by', but I'm wondering whether they are better met formally in a slightly different way.
Ed
Thanks, Ed. I think another way of stating this is that certain factors can cause exacerbations or Exacerbation of X due to Y for which Y does not cause the pre-existing X but rather the phase of X that is worsening. There are 55 Exacerbation of X (disorder) concepts in SNOMED. Most are primitive except for a few that are defined with > 1 parent. Thus Exacerbation of X (disorder) could possibly be combined with a due to (or-co-occurrent and due to) relationship to another condition, material agent, event or procedure to be consistent with our present model. What may complicate this and would require further evaluation is when the underlying condition has a cause that is different than the exacerbating factor, e.g. 707245003|Angular cheilitis due to nutritional deficiency (disorder). The cheilitis is actually due to a bacterial or fungal infection but may be worsened by a vitamin deficiency.
Bruce
The editorial guide states for the definition of due to that "This attribute is used to relate a | Clinical finding | directly to its cause. If a clinical finding merely predisposes to or worsens another disorder, rather than causing it directly, then the more general attribute | ASSOCIATED WITH | is used instead.Of course, we don't want to go down this route and thus defining these disorders with a new attribute such as aggravated by is a better approach. We need to consider how such a model will fit into the current modeling of combined disorders particularly with regard to co-occurrence and temporal sequence. The example of 707245003|Angular cheilitis due to nutritional deficiency (disorder)| brings up another issue which is the potential confusion of causality with exacerbation. I would interpret this as exacerbation if the angular cheilitis was present before the nutritional deficiency.
The agenda for Monday's meeting is already full. I will add this topic the meeting after Monday's meeting. If you could provide me with some more specific examples...