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Route 'standard' concepts not standard anymore?

Implementers
#41

It’s a different story.
You run the “boiler” only against the concepts. You’d not consider the route of administration, only the form of a drug product.

Some sources provide the ingredient only + route of administration. You’d not map them to drug forms since they are more/less specific than forms. And a substantial part won’t end up in any form. That’s why routes are being mapped separately to the route_concept_id where we need a supertype “Injectable” placed above the “Intravascular”, “Intradermal”, “Subcutaneous” and some others.

Also, I’m thinking about the “parenteral” and “systemic” administration being a part of this hierarchy.

#42

Looks like the SNOMED hierarchy of routes of administration is a little lopsided. While there is a rich hierarchy for Digestive tract route, there is nothing for systemic or parenteral routes. IV, intramuscular or subcutaneous are direct desendants of the generic Route of administration value. We may want to talk to SNOMED, and in the meantime put in a manual fix.

Thoughts?

#43

Agree.
I would introduce the following categories:
Systemic
subsumes
Systemic Parenteral , Systemic Enteral , Systemic Topical (Nicotine patches are probably the systemic topical).

Local
Subsumes
Local topical, local intra-organ

And link SNOMED concepts to them

Injection without notion of systemic or local doesn’t make sense for me as, for example, intravenous and intraarticular injections have totally different clinical meaning.

New routes (and de-standardization of old SNOMED routes)
#44

In contrast to what parenteral? Aren’t all alternatives are already in topical?

In contrast to topical enteral? Does it exist?

Sonds like Transdermal route. Want to put it on the top of the hierarchy?

In order to exclude Transdermal route? Is that the point?
How would you know the distribution of the drug? It depends on the drug rather than on the route.
There is no strict connection between the actual route and the drug’s penetration into the bloodstream.

Many sources show the predominance of the “injectable” route. We don’t want to drop it.
It seems we have one option only. Assume they’re all injections to the bloodstream (or close to it - IM, subcutaneous, etc.) since other is not specified. And map them all to the “injectable systemic” leaving the “intraarticular” (and related) outside this hierarchy.

#45

Forum is asking me if I really want to revive this topic, which has been silent for the last 2 years. I do because we didn’t come to any conclusion.

There is no such thing as a systemic or local effect when we are talking about the routes of administration, @Alexdavv mentioned it briefly. The effect is attributable to the drug. Couple of examples:

  • Local anesthetics: injection in the correct dose would not produce any noticeable systemic effect, but increasing the dose would lead to significant systemic side effects (LAST - local anesthetic systemic toxicity)

  • Osmotic diuretics: such as mannitol acts systemically for sure, but the effect is related to the physical properties of the molecule. What happens if we inject mannitol intramuscularly (don’t do that)? The IM route is considered systemic. But it would not be really systemic for the mannitol and other hyperosmolar solutions (KCL 7,5%, NACL 10%, CaCl2 10%, etc.). Therefore I don’t believe, that there are “systemic” and “local” routes of administration.

What we need to do is to support the use case when the source data states, that the drug was given by “Injection”, but not “orally” for example. And the researchers would benefit from distinguishing these routes. They would be able to compare effects in different scenarios. It would make sense to include one OMOP Extension concept to the route domain to unite common injection routes, such as IV, IM, SC, and ID. We can argue whether we need an intraarticular (and other) injection or not. I believe that when anyone in a medical setting says “Injection”, an Intraarticular injection is certainly not the first thing that pops up in the head.

The parenteral route of administration is way too heterogenous and is surprisingly defined differently. I would expect it to be ‘everything except enteral’, but there are people, who think otherwise.

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New routes (and de-standardization of old SNOMED routes)
#46

maybe the people contributing to this topic are also interested in this community contribution to the OHDSI vocabulary on a new route hierarchy which has (coarse but useful) routes based on dose forms (and the newly suggested route will be mapping to current SNOMED routes, which in turn will become non-standard). New routes (and de-standardization of old SNOMED routes) - Vocabulary Users - OHDSI Forums

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