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Blood Pressure Mapping

Hi OHDSI’ans,

Here, I am facing problem in mapping Measurement (for Vitals) Table for Blood Pressure which is Observable Entity in Measurement Domain.

So here is the problem. I have field called in my source data Blood Pressure which has values like While sitting, While Lying etc. and another field called Blood Pressure Side which has values Left and Right and the other fields are for Systolic BP and Diastolic BP which has actual values and has Unit mm Hg.

Now in our Athena we have different concepts for Blood Pressure as below:

  1. Blood Pressure - 4326744
  2. Lying blood pressure - 4060832
  3. Standing blood pressure - 4060833
  4. Sitting blood pressure - 4060834
  5. Systolic blood pressure - 4152194
  6. Standing systolic blood pressure - 4292062
  7. Sitting systolic blood pressure - 4232915
  8. Lying systolic blood pressure - 4248525
  9. Diastolic blood pressure - 4154790
  10. Standing diastolic blood pressure - 4268883
  11. Sitting diastolic blood pressure - 4248524
  12. Lying diastolic blood pressure - 4236281 etc.

Now which one i need to use when I am mapping this particular Vital in Measurement table and how ?

Thanks & Regards
Priyam Munjpara

There is no good way to store both sides and position, so you’ll have to figure out what’s more important to you: sitting or left and map to it :). The full name can still be stored in the measurement_source_value so that you can distinguish.

You can theoretically store Standing/ Sitting or Left/Right using LOINC Meas Vals in the value_as_concept_id, but it’s by far not the most elegant solution.
Just curious: what’s the % of records for which you actually have both position and side?

Sounds like an opportunity to propose a THEMIS convention, ideally on the basis of the relative clinical importance of sitting vs side.

Thank you for your reply @Anna. It helped.

Yes. But at first I have to be sure about it.

I would not recommend this: the value_as_concept is supposed to be used (as you know) to store values of the measure when they are some categorical value (ie: positive, negative, etc).

The observation table has a ‘qualifier’ value (although I can not find from the documentation which domain of concepts are used in this column; the documentation for this field is only: “A foreign key to a Standard Concept ID for a qualifier (e.g., severity of drug-drug interaction alert”). Maybe if this type of field was applied to the measurement table, it would give us that flexibility. However, storing multiple qualifiers on a single measurement would not be supported. For that, we’d need something like a measurement_qualifier_xref table that can associate 1-to-many qualifiers from a measurement record to qualifiers.

I have a question regarding blood pressure mapping.
I see that there are specific concepts that are defined for both diastolic and systolic blood pressure in Athena. See below.
|3034703|Diastolic blood pressure–sitting|
|3019962|Diastolic blood pressure–standing|
|36304130|Diastolic blood pressure-lying L-lateral position|
|3018586|Systolic blood pressure–sitting|
|3035856|Systolic blood pressure–standing|
|36303812|Systolic blood pressure-lying L-lateral position|

When the EHR system does not provide the BP position value ( sitting, standing, or lying) which concept_id would you recommend that I use for systolic blood pressure or diastolic blood pressure concept? Does it make sense to have the following concept_ids?

Diastolic blood pressure–unknown position or Systolic blood pressure-unknown position

@krfeeney said I should tag you: @Christian_Reich @alexdavv

Hello, Stephanie

I am not among persons tagged, but think that I can help you :slight_smile:

There are certain limitations from a clinical perspective when it comes to BP measurement. In ICU BP cuff is on the patient’s arm 90% of the time and is scheduled to measure blood pressure every specified period of time, no matter the position of the patient (mostly lying or sitting). In cardiac department patient can sit for measurement or may not. And all the measurements still produce clinically valuable measurements.

So from the EHR perspective, if you don’t know the position of the patient, use general concepts, such as:

Systolic blood pressure

Diastolic blood pressure

1 Like

Thank you Oleg!!
This is very helpful.