ALTERNATIVE - Discussion
Where a concept within a particular SNOMED product is MOVED_TO some other product, an ALTERNATIVE association can be asserted within the donor product in order to identify one or more possible active concept(s) also still active and within the same donor product that may stand in for the moved/inactivated concept.
The identified ALTERNATIVE substitute(s) are offered as semantically "sufficiently similar" to the original inactive concept, for certain unspecified use cases.
They may or may not be semantically identical to that moved, inactivated concept.
Semantically, therefore, ALTERNATIVE combines some mixture of REPLACED_BY and POSSIBLY_EQUIVALENT_TO.
For example, in the case of:
271328003 [D]Coma and stupor (situation) ALTERNATIVE 371632003 Coma (disorder)
271328003 [D]Coma and stupor (situation) ALTERNATIVE 89458003 Stupor (finding)
..the same semantics could reasonably be also expressed as two POSSIBLY_EQUIVALENT_TO associations, whereas in
206959002 [D]Lump on head (situation) ALTERNATIVE 432525007 Mass of head (finding)
207169001 [D]Retention of urine unspecified (situation) ALTERNATIVE 267064002 Retention of urine (disorder)
..usage appears much closer to either REPLACED_BY or even SAME_AS.
Historical Use
Historically, to July 2019, there had only ever been 181 uses of the ALTERNATIVE association in the International Edition, and all were in fact declared within a single release: the July 2009 International Edition.
In all 181 cases the inactive concept was also assigned a MOVED_TO association pointing at 370137002 Extension Namespace {1000000} (namespace concept), which is the namespace used by the UK NRC Clinical Extension.
By 2019, 5 of these 181 ALTERNATIVE associations had in fact themselves been withdrawn/declared inactive - usually when the association target was itself inactivated.
Combinatorial Logic
Whenever an already stated ALTERNATIVE target itself also becomes inactive - whether at the same release or later - the combinatorial logic of associations should be:
(A) ALTERNATIVE (B) and (B) SAME_AS (C) implies (A) ALTERNATIVE (C)
(A) ALTERNATIVE (B) and (B) REPLACED_BY (C) implies (A) REPLACED_BY (C)
(AIntEd) ALTERNATIVE (BIntEd) and (BIntEd) MOVED_TO (CNRC) implies (AIntEd) MOVED_TO (CNRC)
(AIntEd) ALTERNATIVE (BIntEd) and (CNRC) MOVED_FROM (BIntEd) implies (AIntEd) ALTERNATIVE (CNRC)
(A) ALTERNATIVE (B) and (B) POSSIBLY_EQUIVALENT_TO (C, D) implies (A) ALTERNATIVE (C, D)
(A) ALTERNATIVE (B) and (B) WAS_A (C AND D) implies (A) WAS_A (C AND D)
Sample Data
All 176 ALTERNATIVE associations that were still current by the July 2019 release of the International Edition are shown below.
Where a single inactive concept has more than one ALTERNATIVE association, they are listed together and appear in bold text:
INACTIVE CONCEPT (MOVED TO UK) | ALTERNATIVE CONCEPT BUT IN INTERNATIONAL EDITION | |
206734000 [D]Convulsions, infantile (situation) | ALTERNATIVE | 87476004 Convulsions in the newborn (disorder) |
206737007 [D]Other specified convulsion (situation) | ALTERNATIVE | 91175000 Seizure (finding) |
206744003 [D]Acute vertigo (situation) | ALTERNATIVE | 399153001 Vertigo (finding) |
206747005 [D]Sleep disturbance, unspecified (situation) | ALTERNATIVE | 44186003 Dyssomnia (disorder) |
206753005 [D]Sleep rhythm irregular (situation) | ALTERNATIVE | 271793004 Irregular sleep-wake pattern (disorder) |
206770002 [D]Postviral (asthenic) syndrome (situation) | ALTERNATIVE | 266226000 Postviral infection debility (disorder) |
206770002 [D]Postviral (asthenic) syndrome (situation) | ALTERNATIVE | 51771007 Postviral fatigue syndrome (disorder) |
206783001 [D]Other general symptoms (situation) | ALTERNATIVE | 267022002 General symptom (finding) |
206787000 [D]Hypothermia, of non-environmental cause (situation) | ALTERNATIVE | 386689009 Hypothermia (finding) |
206794002 [D]Physical violence (situation) | ALTERNATIVE | 442084003 Victim of physical violence (finding) |
206801005 [D]Nervous and musculoskeletal symptoms (situation) | ALTERNATIVE | 267070008 Nervous system symptoms (finding) |
206801005 [D]Nervous and musculoskeletal symptoms (situation) | ALTERNATIVE | 440574002 Abnormal response to nerve stimulation (finding) |
206734000 [D]Convulsions, infantile (situation) | ALTERNATIVE | 87476004 Convulsions in the newborn (disorder) |
206737007 [D]Other specified convulsion (situation) | ALTERNATIVE | 91175000 Seizure (finding) |
206814006 [D]Parosmia (situation) | ALTERNATIVE | 112105008 Sense of smell altered (finding) |
206840000 [D]Other nervous and musculoskeletal symptoms (situation) | ALTERNATIVE | 267070008 Nervous system symptoms (finding) |
206847002 [D]Symptoms affecting skin and other integumentary tissue (situation) | ALTERNATIVE | 271804005 Symptom of skin and integumentary tissue (finding) |
206852007 [D]Pricking of skin (situation) | ALTERNATIVE | 162248005 Prickling sensation of skin (finding) |
206860008 [D]Rash and other nonspecific skin eruption (situation) | ALTERNATIVE | 271807003 Eruption of skin (disorder) |
206865003 [D]Local superficial swelling, mass or lump (situation) | ALTERNATIVE | 276438008 Swelling / lump finding (finding) |
206866002 [D]Swelling, local and superficial (situation) | ALTERNATIVE | 441804001 Superficial swelling (finding) |
206867006 [D]Mass, localized and superficial (situation) | ALTERNATIVE | 441845009 Superficial mass (finding) |
206868001 [D]Lump, localized and superficial (situation) | ALTERNATIVE | 441845009 Superficial mass (finding) |
206895006 [D]Jaundice (not of newborn) (situation) | ALTERNATIVE | 18165001 Jaundice (finding) |
206734000 [D]Convulsions, infantile (situation) | ALTERNATIVE | 87476004 Convulsions in the newborn (disorder) |
206737007 [D]Other specified convulsion (situation) | ALTERNATIVE | 91175000 Seizure (finding) |
206914005 [D]Nutrition, metabolic and developmental symptoms (situation) | ALTERNATIVE | 297269007 Endocrine, nutritional and metabolic finding (finding) |
206932005 [D]Other specified failure of physiological development (situation) | ALTERNATIVE | 274626005 Physiological development failure (finding) |
206955008 [D]Localized swelling, mass and lump, head (situation) | ALTERNATIVE | 432525007 Mass of head (finding) |
206957000 [D]Intracranial lesion (situation) | ALTERNATIVE | 85974009 Mass of intracranial structure (finding) |
206959002 [D]Lump on head (situation) | ALTERNATIVE | 432525007 Mass of head (finding) |
206960007 [D]Lump on nose (situation) | ALTERNATIVE | 441766009 Mass of nose (finding) |
206978002 [D]Other speech disturbance (situation) | ALTERNATIVE | 29164008 Disturbance in speech (finding) |
206983005 [D]Other symbolic dysfunction (situation) | ALTERNATIVE | 271721006 Symbolic dysfunction (finding) |
206984004 [D]Symbolic dysfunction, unspecified (situation) | ALTERNATIVE | 271721006 Symbolic dysfunction (finding) |
206995005 [D]Other symptoms affecting head and neck (situation) | ALTERNATIVE | 267106000 Symptom of head and neck region (finding) |
207003004 [D]Tachycardia, unspecified (situation) | ALTERNATIVE | 3424008 Tachycardia (finding) |
207009000 [D]Heart murmur, undiagnosed (situation) | ALTERNATIVE | 441790005 Heart murmur, undetermined whether functional or organic (situation) |
207010005 [D]Heart murmur, benign (situation) | ALTERNATIVE | 59935001 Functional heart murmur (finding) |
207011009 [D]Heart murmur, innocent (situation) | ALTERNATIVE | 59935001 Functional heart murmur (finding) |
207015000 [D]Cardiac dullness decreased (situation) | ALTERNATIVE | 55659000 Cardiac dullness to percussion diminished (finding) |
207020000 [D]Gangrene, spreading cutaneous (situation) | ALTERNATIVE | 441784006 Progressive cutaneous gangrene (disorder) |
207021001 [D]Phagedena (situation) | ALTERNATIVE | 32940002 Tropical phagedenic ulcer (disorder) |
207022008 [D]Gangrene of toe in diabetic (situation) | ALTERNATIVE | 195302000 Gangrene of toe (disorder) |
207023003 [D]Widespread diabetic foot gangrene (situation) | ALTERNATIVE | 402864004 Diabetic wet gangrene of the foot (disorder) |
207025005 [D]Shock without mention of trauma (situation) | ALTERNATIVE | 27942005 Shock (disorder) |
207026006 [D]Failure of peripheral circulation (situation) | ALTERNATIVE | 4249000 Poor peripheral circulation (disorder) |
207043009 [D]Other cardiovascular symptoms (situation) | ALTERNATIVE | 267037003 Cardiovascular symptoms (finding) |
207047005 [D]Respiratory system and chest symptoms (situation) | ALTERNATIVE | 161920001 Respiratory symptom (finding) |
207048000 [D]Respiratory abnormalities (situation) | ALTERNATIVE | 50043002 Disorder of respiratory system (disorder) |
207048000 [D]Respiratory abnormalities (situation) | ALTERNATIVE | 386813002 Abnormal breathing (finding) |
207049008 [D]Respiratory symptom, unspecified (situation) | ALTERNATIVE | 161920001 Respiratory symptom (finding) |
207069003 [D]Cough with hemorrhage (situation) | ALTERNATIVE | 66857006 Hemoptysis (finding) |
207076008 [D]Abnormal sputum - tenacious (situation) | ALTERNATIVE | 274708000 Abnormal sputum (finding) |
207099007 [D]Abnormal chest sounds (situation) | ALTERNATIVE | 301273002 Abnormal breath sounds (finding) |
207101000 [D]Friction sounds, chest (situation) | ALTERNATIVE | 37636003 Pleural friction rub (finding) |
207101000 [D]Friction sounds, chest (situation) | ALTERNATIVE | 7036007 Pericardial friction rub (finding) |
207106005 [D]Other respiratory system and chest symptoms (situation) | ALTERNATIVE | 267107009 Symptom: chest wall (finding) |
207107001 [D]Breath-holding spell (situation) | ALTERNATIVE | 90091006 Breath holding with temper (finding) |
207114004 [D]Drug-induced vomiting (situation) | ALTERNATIVE | 419219000 Drug-induced nausea and vomiting (disorder) |
207130007 [D]Tympanites (abdominal) (situation) | ALTERNATIVE | 271835004 Abdominal distension, gaseous (finding) |
207150006 [D]Other digestive symptoms (situation) | ALTERNATIVE | 308925008 Digestive symptom (finding) |
207154002 [D]Urinary system symptoms (situation) | ALTERNATIVE | 236714000 Symptomatic disorders of the urinary tract (disorder) |
207169001 [D]Retention of urine unspecified (situation) | ALTERNATIVE | 267064002 Retention of urine (disorder) |
207176006 [D]Frequency of micturition, unspecified (situation) | ALTERNATIVE | 162116003 Increased frequency of urination (finding) |
207186007 [D]Other urination abnormality (situation) | ALTERNATIVE | 47252008 Alteration in patterns of urinary elimination (finding) |
207198002 [D]Other urinary system symptom (situation) | ALTERNATIVE | 106098005 Urinary system finding (finding) |
207210004 [D]Abdominal cramps (situation) | ALTERNATIVE | 249531009 Bowel spasm (finding) |
207210004 [D]Abdominal cramps (situation) | ALTERNATIVE | 51197009 Stomach cramps (finding) |
207229005 [D]Other specified abdominal pain (situation) | ALTERNATIVE | 21522001 Abdominal pain (finding) |
207262002 [D]Nonspecific abnormal findings (situation) | ALTERNATIVE | 442618008 Abnormal finding on evaluation procedure (finding) |
207263007 [D]Nonspecific blood findings (situation) | ALTERNATIVE | 166318006 Blood chemistry abnormal (finding) |
207264001 [D]Red blood cell abnormality (situation) | ALTERNATIVE | 38292009 Red blood cell disorder (disorder) |
207273009 [D]Alcohol blood level excessive (situation) | ALTERNATIVE | 442669008 Ethanol in blood specimen above legal threshold for operating vehicle (finding) |
207276001 [D]Acid phosphatase raised (situation) | ALTERNATIVE | 166579007 Serum acid phosphatase raised (finding) |
207281005 [D]Other blood chemistry abnormality (situation) | ALTERNATIVE | 166318006 Blood chemistry abnormal (finding) |
207284002 [D]Iron, blood level abnormal (situation) | ALTERNATIVE | 165631003 Serum iron level abnormal (finding) |
207290003 [D]Abnormality of albumin (situation) | ALTERNATIVE | 127353009 Abnormal structure of albumin (finding) |
207290003 [D]Abnormality of albumin (situation) | ALTERNATIVE | 71628007 Abnormal presence of albumin (finding) |
207291004 [D]Abnormality of globulin (situation) | ALTERNATIVE | 442089008 Abnormal structure of globulin (finding) |
207291004 [D]Abnormality of globulin (situation) | ALTERNATIVE | 127396004 Abnormal globulin level (finding) |
207292006 [D]Abnormality of alpha-fetoprotein (situation) | ALTERNATIVE | 441772009 Abnormal presence of alpha-fetoprotein (finding) |
207292006 [D]Abnormality of alpha-fetoprotein (situation) | ALTERNATIVE | 441595003 Abnormal structure of alpha-fetoprotein (finding) |
207294007 [D]Unspecified bacteremia (situation) | ALTERNATIVE | 5758002 Bacteremia (finding) |
207295008 [D]Unspecified viremia (situation) | ALTERNATIVE | 2528003 Viremia (finding) |
207297000 [D]Laboratory evidence of human immunodefiency virus [HIV] (situation) | ALTERNATIVE | 165816005 Human immunodeficiency virus positive (finding) |
207299002 [D]Findings of drugs and other substances, not normally found in blood (situation) | ALTERNATIVE | 365749008 Finding of blood drug level (finding) |
207304001 [D]Finding of opiate drug in blood (situation) | ALTERNATIVE | 441970008 Opiate agonist in blood specimen positive (finding) |
207306004 [D]Other nonspecific blood finding (situation) | ALTERNATIVE | 166318006 Blood chemistry abnormal (finding) |
207309006 [D]Nonspecific urine findings (situation) | ALTERNATIVE | 102866000 Abnormal urine (finding) |
207324002 [D]Cells and casts in urine (situation) | ALTERNATIVE | 365683008 Finding of urine microscopy: presence of cells (finding) |
207324002 [D]Cells and casts in urine (situation) | ALTERNATIVE | 5277004 Urinary casts (finding) |
207327009 [D]Other nonspecific urine finding (situation) | ALTERNATIVE | 301830001 Urine finding (finding) |
207334006 [D]Nonspecific findings in other body substances (situation) | ALTERNATIVE | 365841001 Body substance analysis finding (finding) |
207380008 [D]Abnormal findings in specimens from male genital organs (situation) | ALTERNATIVE | 274685007 Abnormal cytological finding in specimen from male genital organ (finding) |
207389009 [D]Abnormal findings in specimens from female genital organs (situation) | ALTERNATIVE | 274688009 Abnormal cytological finding in specimen from female genital organ (finding) |
207399004 [D]Skull or head X-ray or scan abnormal (situation) | ALTERNATIVE | 441914009 Imaging of head abnormal (finding) |
207400006 [D]Skull or head X-ray abnormal (situation) | ALTERNATIVE | 442276009 X-ray of head abnormal (finding) |
207408004 [D]Other intrathoracic X-ray or scan abnormality (situation) | ALTERNATIVE | 442147002 Imaging of thorax abnormal (finding) |
207414006 [D]Biliary tract X-ray or scan abnormality (situation) | ALTERNATIVE | 442717005 Imaging of biliary tract abnormal (finding) |
207417004 [D]Gastrointestinal X-ray or scan abnormality (situation) | ALTERNATIVE | 442182001 Imaging of gastrointestinal tract abnormal (finding) |
207418009 [D]Genitourinary X-ray or scan abnormality (situation) | ALTERNATIVE | 441687008 Imaging of genitourinary system abnormal (finding) |
207423009 [D]Abdominal area X-ray or scan abnormality (situation) | ALTERNATIVE | 441988000 Imaging of abdomen abnormal (finding) |
207424003 [D]Musculoskeletal X-ray or scan abnormality (situation) | ALTERNATIVE | 441928003 Imaging of musculoskeletal system abnormal (finding) |
207428000 [D]Breast imaging abnormal (situation) | ALTERNATIVE | 274530001 Abnormal findings on diagnostic imaging of breast (finding) |
207431004 [D]Other imaging abnormality (situation) | ALTERNATIVE | 408574004 Imaging result abnormal (finding) |
207432006 [D]Placental imaging abnormal (situation) | ALTERNATIVE | 168880005 Placentography abnormal (finding) |
207434007 [D]Nonspecific abnormal function studies (situation) | ALTERNATIVE | 442618008 Abnormal finding on evaluation procedure (finding) |
207436009 [D]Brain and central nervous system abnormal function study, unspecified (situation) | ALTERNATIVE | 274520005 Abnormal results function studies of central nervous system (finding) |
207439002 [D]Brain scan abnormal (situation) | ALTERNATIVE | 442731005 Imaging of brain abnormal (finding) |
207442008 [D]Nerve stimulation studies abnormal, unspecified (situation) | ALTERNATIVE | 440574002 Abnormal response to nerve stimulation (finding) |
207447002 [D]Oculomotor studies abnormal (situation) | ALTERNATIVE | 442769000 Evaluation of oculomotor system abnormal (finding) |
207448007 [D]Auditory function studies abnormal (situation) | ALTERNATIVE | 275729001 Audiogram abnormal (finding) |
207448007 [D]Auditory function studies abnormal (situation) | ALTERNATIVE | 313203003 Hearing test abnormal (finding) |
207449004 [D]Vestibular function study abnormal (situation) | ALTERNATIVE | 268363004 Auditory/vestibular test abnormal (finding) |
207453002 [D]Lung scan abnormal (situation) | ALTERNATIVE | 442646005 Imaging of lung abnormal (finding) |
207454008 [D]Ventilation capacity reduced (situation) | ALTERNATIVE | 441918007 Maximal voluntary ventilation capacity below reference range (finding) |
207457001 [D]Cardiovascular function study abnormal (situation) | ALTERNATIVE | 165076002 Cardiac function test abnormal (finding) |
207457001 [D]Cardiovascular function study abnormal (situation) | ALTERNATIVE | 111970001 Abnormal cardiovascular function (finding) |
207458006 [D]Unspecified cardiovascular function study abnormal (situation) | ALTERNATIVE | 165076002 Cardiac function test abnormal (finding) |
207466002 [D]Thyroid scan abnormal (situation) | ALTERNATIVE | 441905004 Imaging of thyroid gland abnormal (finding) |
207467006 [D]Thyroid uptake abnormal (situation) | ALTERNATIVE | 442783003 Radioactive iodine uptake above reference range (finding) |
207469009 [D]Other endocrine function study abnormal (situation) | ALTERNATIVE | 106176003 Endocrine finding (finding) |
207473007 [D]Abnormal liver scan (situation) | ALTERNATIVE | 442684004 Imaging of liver abnormal (finding) |
207475000 [D]Abnormal bladder function test (situation) | ALTERNATIVE | 275731005 Urodynamic studies abnormal (finding) |
207478003 [D]Abnormal spleen function test (situation) | ALTERNATIVE | 442650003 Imaging of spleen abnormal (finding) |
207480009 [D]Nonspecific histological and immunological findings (situation) | ALTERNATIVE | 309198006 Abnormal histology findings (finding) |
207480009 [D]Nonspecific histological and immunological findings (situation) | ALTERNATIVE | 309571001 Abnormal immunology finding (navigational concept) |
207481008 [D]Nonspecific abnormal Papanicolaou cervical smear (situation) | ALTERNATIVE | 439888000 Abnormal cervical Papanicolaou smear (finding) |
207485004 [D]Nonspecific abnormal Papanicolaou smear of other origin (situation) | ALTERNATIVE | 439888000 Abnormal cervical Papanicolaou smear (finding) |
207486003 [D]Nonspecific chromosomal abnormality found on analysis (situation) | ALTERNATIVE | 168448002 Cell chromosome examination abnormal (finding) |
207489005 [D]Nonspecific positive culture findings (situation) | ALTERNATIVE | 442635007 Microbiologic culture positive (finding) |
207490001 [D]Positive culture findings in nose (situation) | ALTERNATIVE | 168296000 Nose swab culture positive (finding) |
207492009 [D]Positive culture findings in throat (situation) | ALTERNATIVE | 168300004 Throat swab culture positive (finding) |
207493004 [D]Positive culture findings in wound (situation) | ALTERNATIVE | 168143002 Wound swab culture positive (finding) |
207495006 [D]Other nonspecific histological abnormality (situation) | ALTERNATIVE | 309198006 Abnormal histology findings (finding) |
207497003 [D]Abnormal Mantoux test result (situation) | ALTERNATIVE | 164980000 Mantoux: delayed reaction (finding) |
207497003 [D]Abnormal Mantoux test result (situation) |
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