SNOMED CT Content Improvement Project Combined Inception and Elaboration phases
Project ID: Topic:	JIRA: IHTSDO-810 CollabNet: artf6238 Burns
Date:	15 March 2016
Version:	0.01

https://projects.jira.snomed.org/browse/IHTSDO-810

Amendment History

Version	Date	Editor	Comments
0.01	20160315	Sarita Keni	First draft for comments
			(remove or add rows if necessary)

Matt Cordell Apr 29, 2016 Requesting review of Version 0.01 of this document. Review template: JIRA IHTSDO-810(artf6238) Burns Documentation Review

Review Timetable

Review date

Responsible owner

Comments

20160607

Matt Cordell

Accepted

This final version of the document incorporates all reviewer feedback and author responses in Appendix E. See also Confluence Document Review page

(remove or add rows if necessary)

Note: This document was reviewed by the Head of Terminology in March 2017: Provision approval with the noting that there is a need for a minor update in relation to modelling of 3rd and 4th degree burns. These concepts need to be modelled with FINDING SITE = Skin and subcutaneous tissue of <body structure>. Please see the document review page when constructing the tracker. See Cathy Richardson for access.

SNOMED CT® was originally created by the College of American Pathologists.

The International Release of SNOMED CT® is distributed by the International Health Terminology Standards Development Organisation (IHTSDO), and is subject to the IHTSDO’s SNOMED CT® Affiliate Licence. Details of the SNOMED CT® Affiliate Licence may be found at http://www.ihtsdo.org/our-standards/licensing/.

No part of this document may be reproduced or transmitted in any form or by any means, or stored in any kind of retrieval system, except by an Affiliate of the IHTSDO in accordance with the SNOMED CT® Affiliate Licence. Any modification of this document (including without limitation the removal or modification of this notice) is prohibited without the express written permission of the IHTSDO.

Any copy of this document that is not obtained directly from the IHTSDO [or a Member of the IHTSDO] is not controlled by the IHTSDO, and may have been modified and may be out of date. Any recipient of this document who has received it by other means is encouraged to obtain a copy directly from the IHTSDO [or a Member of the IHTSDO. Details of the Members of the IHTSDO may be found at http://www.ihtsdo.org/members/].

1 Table of Contents
2 1 Glossary
- 2.1 1.1 Domain Terms
3 2 Introduction
- 3.1 2.1 Purpose
- 3.2 2.2 Audience and stakeholder domain
  - 3.2.1 2.2.1 Input from stakeholders
  - 3.2.2 2.2.2 Degree of consensus on the statement of problem
4 3 Statement of the problem or need
5 4 Risks / Benefits
6 5 Requirements: criteria for success and completion
- 6.1 5.1 Criteria for success/completion
- 6.2 5.2 Strategic and/or specific operational use cases
  - 6.2.1 5.2.1 Use case 1
    - 6.2.1.1 5.2.1.1 Fit with IHTSDO strategy
7 6 Solution Development
- 7.1 6.1 Initial Design
  - 7.1.1 6.1.1 Outline of initial design
  - 7.1.2 6.1.2 Significant design or implementation decisions / compromises
  - 7.1.3 6.1.3 Evaluation of Design
    - 7.1.3.1 6.1.3.1 Exceptions and Problems
    - 7.1.3.2 6.1.3.2 Design Strengths
    - 7.1.3.3 6.1.3.3 Design Weakness
    - 7.1.3.4 6.1.3.4 Design Risks
8 7 Recommendation
- 8.1 7.1.1 Detailed design final specification
9 8 Quality program criteria
- 9.1 8.1 Quality metrics
  - 9.1.1 8.1.1 Quality metric 1
  - 9.1.2 8.1.2 Quality metric 2
  - 9.1.3 8.1.3 Quality metric 3
10 9 Project Resource Estimates
- 10.1 9.1 Scope of construction phase
- 10.2 9.2 Projection of remaining overall project resource requirements
11 10 References
12 11 Appendix A – <Type of> burn content
13 12 Appendix B – <Depth of> burn content: existing concepts with skin burn terminology applied to non-skin body structures
- 13.1 12.1 Existing concepts
  - 13.1.1 12.1.1 First degree burn content
  - 13.1.2 12.1.2 Second degree burn content
  - 13.1.3 12.1.3 Third degree burn content
  - 13.1.4 12.1.4 Fourth degree burn content
- 13.2 12.2 Classification systems for burns of some non-skin body structures
  - 13.2.1 12.2.1 Burn injuries of the eye
  - 13.2.2 12.2.2 Burn injuries of the gastrointestinal tract
  - 13.2.3 12.3.1 Burn injuries of the respiratory tract
14 13 Appendix C – <Depth of> burn content recommendations: existing concepts requiring changes
- 14.1 13.1 First degree burn content
- 14.2 13.2 Second degree burn content
- 14.3 13.3 Third and fourth degree burn content
  - 14.3.1 13.3.1 Recommended description changes
  - 14.3.2 13.3.2 Recommended modeling changes
15 14 Appendix D – IHTSDO SIRS requests for burn <disorder> content
16 15 Appendix E – Post-review addendum: Reviewer comments and author responses

1 Glossary

1.1 Domain Terms

Skin	The thin layer of tissue forming the natural outer covering of the body of a person or animal. (Oxford University Press, 2016) Skin consists of two layers, the epidermis and dermis. The epidermis has no vasculature and depends entirely on the dermis for nutrition. The dermis consists of two layers: 1) the papillary layer consisting of capillaries, elastic fibers, and collagen; and 2) the reticular layer, consisting of thicker connective tissue, larger blood vessels, hair follicles, sebaceous glands, and sweat glands among other structures. The skin rests on a layer of subcutaneous tissue, which then covers deeper structures such as muscle, bones, and joints. (Amirlak & Shahabi, 2015)
Burn	An injury to the skin or other organic tissue primarily caused by heat or due to radiation, radioactivity, electricity, friction or contact with chemicals. Skin injuries due to ultraviolet radiation, radioactivity, electricity or chemicals, as well as respiratory damage resulting from smoke inhalation, are also considered to be burns. (World Health Organization, 2016)
First degree burn	Burn injury limited to the epidermis layer of the skin Synonyms: Epidermal burn, Superficial burn, Burn erythema
Second degree burn	Burn injury involving both the epidermis and dermis layers of the skin, subdivided into two types: - Superficial: Burn injury is limited to the papillary layer of the dermis - Deep: Burn injury extends into the reticular layer of the dermis Synonyms: Partial thickness burn, Superficial partial thickness, Deep partial thickness
Third degree burn	Burn injury involving both the epidermis and dermis layers of the skin, and extending into the subcutaneous tissue Synonym: Full thickness burn
Fourth degree burn	Burn injury involving the skin, subcutaneous tissue, and extending into underlying structures such as muscles, bones, and joints Synonym: Deep full thickness burn

2 Introduction

2.1 Purpose

The purpose of this project is to consider the representation of content within the Burn (disorder) hierarchy, specifically naming conventions and modeling guidelines.

2.2 Audience and stakeholder domain

The audience for this document includes all standards terminology leaders, implementers, and users but is especially targeted at the community of clinicians or implementers who utilize SNOMED CT to represent burn <disorder> content within clinical information systems or for research purposes as well as SNOMED CT authors who may be requested to implement the recommended specification.

2.2.1 Input from stakeholders

SIRS: As of March 2016, there are only 5 requests related to burn <disorder> content in the IHTSDO SNOMED CT International Request Submission (SIRS) system. These requests are listed in Appendix D. The low number of outstanding requests is likely because existing content in the Burn (disorder) hierarchy is already comprehensive. However, Section 3.4 will detail the primary issue related to this content: inconsistent naming conventions and modeling. One SIRS request refers to this issue:

Request ID 531381 (submitted 22 April 2015)

Request summary: Consistency required to ensure users are able to search easily and reduce ambiguousness of concept

Request description: Burn concepts are represented in SCT by several classification systems. Currently, older concepts contain references to older classification systems (e.g. first/second/third degree) as well as the newer classification system (e.g. superficial, partial thickness, full thickness). Many concepts that have been recently created only contain the newer classification term, and do not contain the older first/second/third term. We are concerned for the lack of consistency and while these older terms may not be the preferred term, they are still commonly in use and having some concepts with these synonyms and some without could confuse users into thinking there were gaps (even though the concepts exist).

IHTSDO: An IHTSDO SNOMED CT author also commented on the JIRA tracker for this project that current Burn (disorder) hierarchy content is inconsistently modeled, specifically, second and third degree burn content. These comments are provided in Section 3.1 and addressed in Section 6.1.1.5.

2.2.2 Degree of consensus on the statement of problem

Based on the artifact description as well as the stakeholder input provided above, it is clear that there is a strong consensus on the need for comprehensive and consistent representation of content in the Burn (disorder) hierarchy.

IHTSDO-810 (artf6238) Burns