IHTSDO Nursing SIG Report
Review of skin and wound observation terms
SUBJECT
Skin and wound observation terms provided by the LOINC Nursing Workgroup dated 12/06/2012 were
reviewed from two perspectives:
1. international professional content coverage and acceptability
2. quality of proposed SNOMED CT term binding (‘concept matching’)
METHOD
1. Professional content
IHTSDO Nursing SIG members were invited to review the material provided against international and
national evidence based guidelines for skin and wound care. Three responses were received: 2 from
Australia and on from UK.
This initial review was used as a pilot to test the potential for wider international review by professional
organisations. Resource constraints meant that this second phase was not carried out.
2. Concept matching
IHTSDO Nursing SIG members were invited to review the tables provided. Two responses were received
from the UK.
FEEDBACK & RECOMMENDATIONS
1. Professional content
Overall the content was assessed as comprehensive and professionally acceptable. There were some
gaps identified - see appendix A for suggested additions. For example: The ulceration categories should
include venous, arterial, mixed, and neuropathic. There should also be options for skin cancers such as
BCC, SCC or melanoma.
One response questioned whether such detail would ever be used in practice. For example, 15 exudate
colours. It was noted that ‘Wound exudate appearance’ seems to overlap with ‘exudate colour’ - we use
‘exudate level’ and ‘exudate type’ (serous (straw), purulent (green, brown, yellow) etc . There was a
suggestion that common finding terms used in wound assessment should be pre-coordinated (if they are
not already) e.g. wound exudate amount none, scant, moderate, heavy. Are these pre-coordinated
concepts available already?
Recommended changes to SNOMED CT
 Change the SNOMED CT FSN of pressure sore to pressure ulcer
 Add pressure injury as synonym for pressure ulcer
2. Concept matching
A general comment was that only matches to FSNs were listed - it would have been useful to know
whether an exact match synonym existed in SCT or needed to be added. There was a comment
questioning whether pressure ulcer stages required the staging name to be specified.
One cause of systematic errors in concept matching was the failure to fully specify the source concept so
that its meaning was clear - term matching rather than concept matching was evident in a number of
instances. Other possible errors are summarised below according to the type of error with examples.
Type of error
Example
a) use of organising concepts as
clinical concepts
Abrasion matched with abrasion AND/OR friction burn of skin
(disorder)
surgical incision matched with surgical incision finding (finding)
b) use of qualifiers for clinical
findings (& term matching)
Absent (presence of skin alteration) matched with absent. The
concept match could have been healthy skin or intact skin
c) more specific SCT concept
required
Skin graft recipient site is more specific than recipient site (body
structure)
Pain increase is more specific than finding of pain sense (finding)
d) disorder concepts used for
finding concepts (& term
matching)
(wound bed appearance) necrotic is not the same as skin necrosis
(disorder) or necrosis of subcutaneous tissue (disorder)
e) other examples of term
matching instead of concept
matching
(periwound condition) dry is not the same as dry skin (finding)
(wound closure type) open is not the same as open wound (disorder)
And other periwound condition findings
Conclusions:
This was a very useful exercise for identifying possible gaps in SNOMEDCT content related to skin and
wound assessment. However, it does highlight the need for more detailed expert review of proposed
term bindings. It is assumed that the IHSTDO content change process would manage errors in any
proposed content changes / additions.
Report compiled by Anne Casey, chair of the IHTSDO Nursing Special Interest Group
12 December 2012
Appendix A
Other wound types: scald, sunburn