New Route of Administration

Hi Tom,

Thank you for your message.

Regarding #1, there is a different SNOMED CT concept 103388001|Percutaneous approach - access (qualifier value)| (which is a subtype of 309795001|Surgical access values (qualifier value)|) that is specific for surgical procedures. It is used in over 1,000 concept definitions.

Regarding #2, as you correctly pointed out, 428191002|Percutaneous route (qualifier value)| does have a definition of a topical route that begins on the skin and that has the propensity to be absorbed through the skin in SNOMED CT, so that is the appropriate concept for our use cases.

Therefore I do not think there will be confusion between the two concepts of 103388001|Percutaneous approach - access (qualifier value)| and 428191002|Percutaneous route (qualifier value)|.

We need an abbreviation for percutaneous to match the other concepts in the ImmunizationRouteOfAdministrationCode subsets, which are all subtypes of 284009009|Route of administration value (qualifier value)|:

Infiltrate: INFL
Intradermal: ID
Intramuscular: IM
Intravenous: IV
Intranasal: IN
Oral: PO
Subcutaneous: SC

In our current use case, ACAM2000 is administered via percutaneous scarification, but PHAC has not requested that we need that level of detail, and that percutaneous is sufficient for the ImmunizationRouteOfAdministrationCode subset. To date, we have not found any authoritative sources on an abbreviation for percutaneous.

On a side note, within SNOMED CT, there is the concept 129301005|Scarification - action (qualifier value)|, but it is subtype of 129284003|Surgical action (qualifier value)|. Sweden has also created an extension concept 59681000052101|Skin scarification (administration method)|, but that is also in a different part of the hierarchy as a subtype of 736665006|Dose form administration method (administration method)|. Both concepts are not applicable as they are not subtypes of 284009009|Route of administration value (qualifier value)|.

Hi Naureen,

Thank you for your reply. We have not received any suggestions on the abbreviation but will put it on the agenda for the PHSC call for this coming Thursday, April 4.

Dennis, I was wondering whether there is a possibility for confusion with other terms used:

1) Surgical procedure: percutaneous approach is used to describe a small incision, just enough for an endoscope, surgical instruments, or drainage to avoid opening up the entire area (e.g., ICHI icd.who.int/dev11/l-ichi/en#/http://id.who.int/icd/entity/551666666 )

2) existing SNOMED-CT CA definition : browser.ihtsdotools.org/?perspective=full&conceptId1=428191002&edition=MAIN/SNOMEDCT-CA/2024-02-29&release=&languages=en,fr

Percutaneous route (qualifier value)
SCTID: 428191002

428191002 | Percutaneous route (qualifier value) |
en Percutaneous route (qualifier value)
en Percutaneous route
en A topical route that begins on the skin and that has the propensity to be absorbed through the skin.
fr voie percutanée
fr voie percutanée (valeur de l'attribut)

Could you clarify the description of the new route PHAC proposed? Is it akin to transdermal for a patch, a different word for intradermal, or an actual opening of the skin for injection into a deeper organ?

Thank you Dennis. BCY is in support of this new route. In Panorama we do not use abbreviations under the route field. Open to suggestions from other jurisdictions.
Update 26 March 2024
In discussion with our team we would be more supportive of a shorter abbreviation. Thanks!

Hello folks,

PHAC has requested a new route of administration, Percutaneous, to be added to the ImmunizationRouteOfAdministrationCode subset in anticipation of the new vaccine concept for ACAM2000 that is currently being authored.

If you recall, the preferred term for each route of administration in our subset includes an abbreviation:

Infiltrate: INFL
Intradermal: ID
Intramuscular: IM
Intravenous: IV
Intranasal: IN
Oral: PO
Subcutaneous: SC

Does your jurisdiction use an abbreviation for percutaneous? If so, please reply to this topic and indicate what that abbreviation is, and where possible, please include references. Thank you.