This briefing note outlines the steps for revising descriptions within the Clinical Finding hierarchy. The scope includes concepts where the causative agent is 419442005 |Ethanol (substance)|.
| Date created | 15 April 2026 |
|---|---|
| Action | For Information Only |
| Status |  Closed |
Revision of clinical findings defined by ethanol.pdf (99.2 KB)
HI @crichardson
I read through the BN and agree with the proposed changes. There are a small number of concepts, about 30ish, in the US Extension that I will need to align with this work when it occurs. Seems relatively straight forward, unless I am misunderstanding something.
I also agree with the proposal in the briefing note.
Another related issue - which I’m not sure if in scope of this change or adjacent is 53041004 |Substance with alcohol structure|. As a chemist this concept (and subtypes) are technically “correct” - but I suspect it is (at best) useless clinically - at worst confusing/ambiguous.
This extends to concepts like:
That are considered subtypes of 1255413004 |Toxic effect of substance with alcohol structure|.
A whole range of these “structure” groupers were added in 2022 as part of the SHRD, most are also low value, but the “alcohol structure” concepts are probably most prone to confusion.
Hi @mcordell
Thanks for confirming the proposal can move forward as planned.
Regarding 53041004 |Substance with alcohol structure|, you raise a helpful point. The concept is technically correct, and there are a number of similar structure-based groupers created along the same pattern. Any review or revision would likely require a more systematic approach to ensure consistency and traceability across related concepts. As such, this is out of scope for the current BN.
I also agree with the proposal and with Matt’s remark concering substance with alcohol structure. The use of the term alcohol to refer to ethanol seems pretty entrenched in medical literature. The terminology would be less confusing if these groupers (e.g. 1255413004 |Toxic effect of substance with alcohol structure (disorder)|) are eliminated.
To that purpose I recommend you also retire 63267000 |Alcohol measurement (procedure)| and its child concepts blood and urine alcohol measurements. Separate concepts for ethanol measurements to serve as replacements are already in place.
However, I also see 9 concepts for injection of alcohol defined with the alcohol structure concept, e.g. 88572002 |Injection of alcohol into nerve (procedure)|. From what I can find on https://www.clinicalkey.com/#!/content/67-s2.0-MC292 , different alcohol substances can be injected, such as ethanol and glycerol. Yet this same paper refers only to ethanol as alcohol:
I’m not sure which set of concepts would be more useful clinically: a single concept for Injection of alcoholic substance into nerve or two concepts Injection of alcohol into nerve & Injection of glycerol into nerve.
Hi @fhielkema,
Glycerol and ethanol have different properties when used as neurolytic agents. As an anesthesiologist my suggestion is two concepts “Injection of alcohol into nerve” with “ethanol” in the synonym & “Injection of glycerol into nerve”.
Yes, that’s an excellent reason to separate them into two concepts - and shows that the current modelling is problematic, too.
Hi @fhielkema and @cspook
Thank you for the informative responses and for highlighting these additional considerations.
Based on the feedback provided, a broader review of concepts defined by 53041004 |Substance with alcohol structure (substance)| across multiple hierarchies appears warranted and would likely benefit from further internal review and potentially external consultation.
As noted previously, the current focus of this published BN is limited to the review and update of concepts within the finding hierarchy that are defined by Ethanol. To ensure timely progression of the agreed action items and deliverables associated with the BN, we would prefer to proceed with the scope as currently defined.
At the same time, we would certainly like to consider the additional areas that have been identified. To support appropriate tracking, assessment, and prioritization of this work, could you please submit a CRS outlining the requested broader changes? This would allow us to initiate review and planning for the additional scope in parallel with the ongoing BN activities.
Thanks and best wishes,
Farzaneh
CC: @mcordell
Hi @fashrafi I have submitted the request: https://request.ihtsdotools.org/#/requests/edit/977362?fromList=true
Many thanks @fhielkema . The request has now been assigned to me.
As the 30-day review period for the posted BN has concluded, I will proceed with closing it and implementing the applicable changes as suggested. I will also review the CRS items in parallel and will reach out if any clarification or further discussion is needed.
Thanks again,
Farzaneh
Hi Christian,
I have now completed my review of the nine injection concepts containing “alcohol.” I would greatly appreciate your insights on the proposed approaches for these concepts:
I would be grateful for any comments or recommendations you may have.
Best regards,
Farzaneh
CC: @fhielkema @cspook
@fashrafi I have read your completed review and I have the following comments and recommendations.
All of the SCTIDs listed except the first and the last one are incorrect. An extra digit is placed in front of the SCTID. Here is the correct SCTIDs for the affected concepts:
Regarding 1. Inactivation Due to Ambiguity - I support this.
Regarding 2. Substance Replacement (Ethanol-Specific) - I support the suggested changes, but I have comments about two of the concepts.
537127001 | Injection of inner ear with alcohol| - This is not used very often now and may be outdated, the preferred method for treating Intractable Meniere’s Disease is using gentamicin since it is less neurotoxic than ethanol. An even milder alternative is injecting corticosteroids.
References:
7236842007 | Subcutaneous alcohol injection of the vulva| - References here are also to old for reference use, suggesting that this concept may be outdated.
Bear in mind that my comments here are about procedures outside my field which is anesthesiology. Maybe an ENT surgeon and a gynecolgist would like to comment?
Thank you @cspook for the detailed review and thoughtful feedback. I will transfer your comments to the associated CRS and implement the suggested changes accordingly.
I would also like to apologize for the incorrect SCTIDs and any confusion or inconvenience this may have caused. This was the result of a copy-and-paste error on my part.
Thank you again for your careful review and assistance.
307189004 |Alcohol injection of liver metastases (procedure)| has been added to the list of concepts identified for replacement.
The requested changes have been implemented as described above and will be communicated through an Early Visibility Notice prior to publication in a forthcoming SNOMED CT release.