Greetings,
Working with healthcare data, I am running into the phrase “proximal lower extremity” with regard to documentation of Deep Vein Thrombosis (DVT) and location of primary or metastatic malignant neoplasms.
To the best of my understanding, SNOMED CT does not contain a grouping concept that includes the hip through the knee like it does for “lower leg” which is defined as the knee through the ankle.
Does anyone have any suggestions for how best to handle this gap?
Hi, isn’t 41240009 |Structure of above knee region (body structure)| what you are looking for? Or its higher level parent 68367000 |Thigh structure (body structure)|? I see however no text definition of upper the limits of those structures. Maybe adding that would be interesting.
Hi Marie-Alexandra,
That is an interesting possibility, but based on classification the Structure of above knee region (body structure) classifies under the thigh structure only so it wouldn’t include the hip region. The question now becomes is the concept modeled correctly or does the modeling need to be fixed. Another question would be is the concept FSN ambiguous because “above knee region” could theoretically involve any body structure that is literally above the knee (e.g. elbow) unless the user looks at the hierarchy it wouldn’t be apparent from the FSN. I think it might be better to have a concept with an FSN that defines the proximal lower extremity as the hip through the knee for proper classification in the body structure hierarchy, but I could be wrong.
I agree those grouping concepts can be a challenge, especially when start comparing them.
I recently used “lower leg” in the Orthopedics context. I glanced over the distinction of FROM knee to ankle, as opposed to BETWEEN knee and ankle.
Note the synonym “upper arm” associated with of 40983000 |Structure of upper limb between shoulder and elbow (body structure)|.
And then, as mentioned, you have “thigh” and “forearm” without the descriptions to establish boundaries.
Hi John,
‘Proximal lower extremity’ and ‘Distal lower extremity’ are not standard anatomy terms. They seem to be originated from ICD-10 for DVT (Deep Venous Thrombosis). They are not included in the ICD-11. https://icd.who.int/browse/2025-01/mms/en#615253204
The challenge is to determine the exact boundary of ‘proximal lower limb’ and ‘distal lower limb’. Is the entire knee region part of the proximal or distal lower limb? The following ECL query includes the knee region as part of the proximal lower limb to return DVTs of proximal lower limb.
<< 128053003 |Deep venous thrombosis (disorder)| : 363698007 |Finding site (attribute)| = (<< 61685007 |Lower limb structure (body structure)| MINUS (<<419605007 |Structure of ankle and/or foot (body structure)| OR << 30021000 |Structure of lower limb from knee to ankle (body structure)|))
Thanks Yong,
This is where we cross between academic and real-world practice. I am seeing “Proximal lower extremity” being documented in notes by clinician’s so ideally there needs to be a way to define it in a similar fashion as to 30021000 |Structure of lower limb from knee to ankle (body structure)| with the synonym of “lower leg”. I understand the groupings are not a part of standard anatomical terms, but having a SNOMED definition would be incredibly helpful in the application of the terminology to mapping scenarios of real world data.
Unfortunately, in the current paradigm of mapping tools, we can’t map a source string or source code to an ECL query. I have to admit, that I would likely be hesitant to do so even if we were technologically capable.
