1

Welcome and role call

BGO, all

2

 Allergy/hypersensitivity editorial guidelines

BGO

• Update on allergy/hypersensitivity model and allergy to x revision project

• Input from Allergy-hypersensitivity clinical reference group

  • The term "pseudoallergy" is obsolete as discrete pathophysiologic mechanisms have been identified. Recommendation is to replace with non-allergic hypersensitivity which will align more closely with WAO/EAAAI nomencalture

• Given rather extensive changes to the model, it was suggested that @Bruce Goldberg prepare a 1-2 page briefing document consisting of the following points:

1.  

   1. Why changes are critical

   2. What is the justification for the nature of these changes

   3. What is the impact on the terminology
      
      
      

• Given that most existing content under pseudoallergy represents unknown pathologic processes, the creation of more granular pathological processes as proposed in order to define pseudoallergy concepts based on underlying mechanism was thought not to be warranted at this time

• Recommendation was to go back to Allergy CRG in order to determine if there is any objection to considering nonallergic hypersensitivity and pseudoallergy synonymous

  1. Should pseudoallergy be retained as the FSN with nonallergic hypersensitivity added as a synonym or PT?

  2. Should the existing FSN be changed to Nonallergic hypersensitivity and pseudoallergy retained as a synonym (or PT?)

@Bruce Goldberg to report back to the group after presentation of above to Allergy/Hypersensitivity CRG on October 12.

3

Arthritis syndromes

BGO

• Certain arthritis conditions can be represented as a joint inflammation as well as a systemic/multisystem disorder.

• Model presented consisting of creating upper level group Extra-articular X (disorder) concepts under Disease (disorder)

• Additional examples - gout, cystic fibrosis, psoriasis, dermatomyositis

• Alternate model proposed which would create a multisystem disorder (how to name and model) which would subsume the specific joint inflammation

• Question arose as to whether extra-articular rheumatoid arthritis can ever be present without joint involvement

Requires more deliberation

4

Modeling fetal and maternal related concepts

PBR

• Distinguishing fetus from mother when modeling fetal-maternal disorders

• Should traumatic injuries be modeled with a new pathological process of trauma vs. continuing to use morphology=Traumatic abnormality (morphologic abnormality)?

• Proposal presented by @Phil Brown to create more specific periods of life (or pregnancy time periods with extension of occurrence to include 307159006 |Pregnancy time period (qualifier value)|?) that represent more specific time intervals as well as specific reference to the mother or fetus.

• @Ed Cheetham commented that the above approach would not satisfy the requirement to document all conditions involving the mother and fetus as the time intervals are the same (e.g. Different procedures performed on the mother and fetus at the same time.

• Another approach would be to increase the representation in SNOMED CT of fetal body structures

• Issue raised that by modeling traumatic injuries using an associated morphology of Traumatic abnormality (morphologic abnormality), Surgical wounds would be classified as traumatic injuries which may not be correct

• Proposal is to create a new pathological process of Trauma

• Above relates to broader issue of conflation of morphology hierarchy with structure and process

• Requires extensive review of implications on proposal on terminology. Decision made to put on back burner pending resources being mad available to work on this.

6

Sepsis/organ dysfunction syndrome

YGA, BGO

• There are 43 subconcepts under 238151006|Sepsis-associated organ dysfunction (disorder)|. They need to be reviewed and revised following the Editorial Guide on X with Y associations. Some specific issues need to be addressed:

1. Which pattern should this concept and its subconcepts belong to, e.g. due to vs. co-occurrent and due to?

2. Should these be implemented as description changes of FSNs or inactivation of concepts?

3. Should 238151006|Sepsis-associated organ dysfunction (disorder)| be subconcept of 91302008|Sepsis (disorder)|?

4. Should 91302008|Sepsis (disorder)| is a subconcept of 238149007|Systemic inflammatory response syndrome (disorder)|?

5. Should sepsis is a subconcept of 238147009|Organ dysfunction syndrome (disorder)|?

6. Should 76571007|Septic shock (disorder)| is a subconcept of sepsis?

• Revised model of sepsis based on Sepsis-3 recommendations approved (isA multiple organ dysfunction syndrome due to infection) was approved.

• More discussion (to take place in Bratislava) is whether adding a pathological process of dysregulated host response is needed in order to define sepsis.

• There was also some question as to the best way of defining sepsis due to infection by specific organisms and sepsis due infections of specific body structures.

7

AOB, adjourn

ALL

• A full day meeting of the ECE project group is scheduled for the October business meeting in Bratislava. An agenda is being prepared and will be posted when complete.