It was confirmed last week by DX Revision Watch, that the recording of M.E. and CFS as previous examples of a ‘multisystem disorder' will now be replaced in SNOMED CT by the more appropriate, ‘disorder of the nervous system'.
This follows the welcome efforts of advocate Suzy Chapman, who writes the authoritative blog, DX Revision Watch, and Sonya Chowdhury, on behalf of Forward ME and Action for M.E.
- Chronic fatigue syndrome classified under Neurological disorder in SNOMED CT International Edition
- GP system updated to reflect M.E. as neurological
SNOMED CT is a comprehensive electronic clinical classification system used by the NHS, that records known diagnoses and symptoms with the aim of making clinical information consistent across healthcare settings.
In some respects it would seem to be more relevant to UK residents than the World Health Organisation international classification system, as electronic NHS patient records should be updated to reflect the change.
While chronic fatigue syndrome unfortunately remains the parent term in this clinical vocabulary, M.E. is recognised as a synonym along with other recognised terms.
The change will take place in the UK in October, and, as SNOMED CT is also used internationally, it will also be reflected in the United States, Canada, New Zealand, Australia and other European countries.
It is too soon to say what practical effect, if any, this might have on patient relations and treatment within the NHS, but it at least means that ME/CFS will now be listed under a more appropriate heading.
Dr Charles Shepherd, Hon. Medical Adviser, ME Association:
“This is a subject that the Countess of Mar and the Forward ME group of charities have been closely following for some time. So, it is good news to see that M.E. will now be classified as a neurological disorder in the SNOMED CT system – a position that appears consistent with WHO classification of M.E.”
“As our summary states, it is difficult to know what practical effect this will have in the consulting room – because doctors are not normally following, or reading about, changes to the SNOMED classification system.”
“But it will be helpful when we still have to challenge a media or medical profession statement that ME/CFS is a mental health condition. It may also be helpful for people with ME/CFS when they are having to challenge a faulty benefit, insurance or legal decision which is again being based on an inaccurate mental health classification of M.E.”
Let’s be prepared for the followinf
“yes, ME is indeed a neurological disorder, a functional neurological disorder, that’s what some good and much misunderstood/abused colleagues have been saying for years and it’s real, of course, oh and btw functional = real = psychological”.
I hope neurologists who concern themselves with ME in the future will be open minded, immune literate, that they will recognise subtle thyroid disorder, as reported e.g. on this site, that they will recognise masked food allergy, be Lyme literate, be seeking ways to diagnose DRG and its causes etc. etc.
This could still amount to Gabapentin and therapy for everyone, so let’s keep pressing. Anyone treating ME/CFS must be immune, infection, micronutrient and endocrine informed or in a team with this profile.
Postviral fatigue syndrome and Benign myalgic encephalomyelitis have been classified in the Tabular List of the World Health Organization’s ICD-10 under Chapter VI: Diseases of the nervous system (the neurological chapter), under G93 Other disorders of brain, at G93.3, since ICD-10 was published in 1992.
Chronic fatigue syndrome is included in the ICD-10 Alphabetical Index and is indexed to the G93.3 code.
This post is to confirm that the October 01, 2018 release of the SNOMED CT UK Edition is now available.
The UK release incorporates the addition of the parent “Disorder of nervous system” for CFS and the terms listed under Synonyms that was approved and implemented for the July 2018 release of the SNOMED CT International Edition.
The UK Edition entry can be viewed here:
https://termbrowser.nhs.uk/?perspective=full&conceptId1=52702003&edition=uk-edition&release=v20181001&server=https://termbrowser.dataproducts.nhs.uk/sct-browser-api/snomed&langRefset=999001261000000100,999000691000001104
SNOMED CT Concept: SCTID: 52702003 Chronic fatigue syndrome (disorder) is now classified under SCTID: 118940003 Disorder of nervous system (disorder) in both the International Edition and the UK Edition.
Note that the term and its Synonyms terms were already cross mapped to ICD-10 G93.3 Postviral fatigue syndrome in the SNOMED CT to ICD-10 cross map. This change of parent Concept/supertype consolidates this existing cross map relationship.
This change of parent Concept/supertype has now been incorporated into the following SNOMED CT Editions and national editions:
International Edition
U.S. Edition
Belgium Edition
Netherlands Edition
Danish Edition
UK Edition.
The next release of the SNOMED CT Canadian Edition is due to be published on October 30.
Next Swedish Edition – November 31;
Next Uruguay Edition due – December 15;
Next Australian Edition due – December 30.
I have been advised that for the March 2019 release of the SNOMED CT Netherlands Edition, the term “neurasthenie” will be removed from the Synonyms list under Concept 52702003 Chronic fatigue syndrome (disorder) for consistency with the SNOMED CT International Edition, UK Edition and Danish Edition, and for consistency with the WHO’s ICD-10, which has an exclusion for G93.3 under F48.0 Neurasthenia.
To the best of my knowledge, no other national editions of SNOMED CT had retained Neurasthenia, either as a SCTID Concept term or as a term under Synonyms, following the retirement of the Neurasthenia term from the International Edition a number of years ago.
The removal of “neurasthenie” from the next release of the Netherlands Edition is welcomed and with thanks to the Netherlands advocate who has engaged with Mr Volkert for a successful and prompt resolution.