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HdBe-Burnwound

WARNING This page contains a draft CBB, as raw output from the zib export and automatic conversion to CBB. It requires thorough review and adaption to the Belgian realm. This CBB is merely added for informative use.

CBB	Description	Status
HdBe-Burnwound	A burn wound is a wound caused by skin being exposed to heat for a certain time above a certain critical temperature. Heat above this critical temperature (+/- 40°C) will cause damage to the skin. There are different types of burn wounds, which are categorized according to the depth of the burn wound. The depth of the burn wound depends on: the temperature of the impacting heat; the duration of the impact of heat on the skin; the source of the burn (e.g. fire, fluid). Purpose The description of the burn wound is of importance for starting or continuing the best possible wound treatment and to be able to properly monitor the wound healing process. Evidence Base Different degrees are used to evaluate the depth of the burn wound: First-degree burn (no wound): redness good capillary refill supple painful Superficial second-degree burn wound (partial thickness of the skin): intact / broken blisters pink, shiny, uniform good capillary refill supple painful Deep second-degree burn wound: intact / broken blisters pink, matte, not homogenous, damp slow capillary refill slightly more firm painful Third-degree burn wound intact / broken blisters, epidermis stuck to burned dermis white, brown, yellow, red (when kept in hot water for a prolonged period of time) no capillary refill, non-removable redness firm less painful than the size of the wound makes it appear (Source: Brandwondenprotocol 2010, Rode Kruis Brandwondencentrum Beverwijk [2010 Burn wound protocol, Beverwijk Red Cross Burn Wound Center]) Instructions Issues Damages to the skin as a result of exposure to intense heat and cold can lead to similar wounds. Nevertheless, we have decided not to expand the information model to become a generic thermal wound information model. The reason for this was the lack of a guideline for treating freeze wounds and insufficient agreement in the field on the applicability of the burn wound classification for freeze wounds. Freeze wounds also rarely occur in the Netherlands, due to the climate.	draft

CBB

Description

Status

HdBe-Burnwound

A burn wound is a wound caused by skin being exposed to heat for a certain time above a certain critical temperature. Heat above this critical temperature (+/- 40°C) will cause damage to the skin. There are different types of burn wounds, which are categorized according to the depth of the burn wound. The depth of the burn wound depends on:

the temperature of the impacting heat;
the duration of the impact of heat on the skin;
the source of the burn (e.g. fire, fluid).

Purpose

The description of the burn wound is of importance for starting or continuing the best possible wound treatment and to be able to properly monitor the wound healing process.

Evidence Base

Different degrees are used to evaluate the depth of the burn wound:

First-degree burn (no wound):

redness
good capillary refill
supple
painful Superficial second-degree burn wound (partial thickness of the skin):
intact / broken blisters
pink, shiny, uniform
good capillary refill
supple
painful Deep second-degree burn wound:
intact / broken blisters
pink, matte, not homogenous, damp
slow capillary refill
slightly more firm
painful Third-degree burn wound
intact / broken blisters, epidermis stuck to burned dermis
white, brown, yellow, red (when kept in hot water for a prolonged period of time)
no capillary refill, non-removable redness
firm
less painful than the size of the wound makes it appear (Source: Brandwondenprotocol 2010, Rode Kruis Brandwondencentrum Beverwijk [2010 Burn wound protocol, Beverwijk Red Cross Burn Wound Center])

Instructions

Issues Damages to the skin as a result of exposure to intense heat and cold can lead to similar wounds. Nevertheless, we have decided not to expand the information model to become a generic thermal wound information model. The reason for this was the lack of a guideline for treating freeze wounds and insufficient agreement in the field on the applicability of the burn wound classification for freeze wounds. Freeze wounds also rarely occur in the Netherlands, due to the climate.

draft

Burnwound			Burnwound	Element id Burnwound Short description Burnwound Definition Root concept of the Burnwound information model. This concept contains all data elements of the Burnwound information model. Data type Burnwound Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a
id		0..1	string	There are no (further) constraints on this element Element id Burnwound.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id Burnwound.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
DateOfOnset		0..1	dateTime	Element id Burnwound.DateOfOnset Short description DateOfOnset Definition Date on which the burn wound appeared. Data type dateTime Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a
Extent	I	0..1	Quantity	Element id Burnwound.Extent Short description Extent Definition The extent of a burn wound is indicated in a percentage of the ‘Total Body Surface Area’ (TBSA). For adults, the TBSA can be calculated on the basis of the ‘rule of nines’, in which body parts are expressed in the percentage 9 and multiples of 9. This ‘rule of nines’ cannot be used for children because a child’s body proportions are different from those of an adult. For children, separate tables were developed per age group to determine the extent of burn wounds. Another option is measuring the extent using the patient’s hand surface area. The surface area of a patient’s hand (including the fingers) equals approximately 1% of their total body surface area. (Source: Brandwonden genezen. Hoe verder? [Healing Burn Wounds. What now?) Comments The context of use may frequently define what kind of quantity this is and therefore what kind of units can be used. The context of use may also restrict the values for the comparator. Data type Quantity Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` qty-3: If a code for the unit is present, the system SHALL also be present `code.empty() or system.exists()` Mappings rim: n/a v2: SN (see also Range) or CQ rim: PQ, IVL<PQ>, MO, CO, depending on the values
AnatomicalLocation	I	0..1	Reference(HdBe-AnatomicalLocation)	Element id Burnwound.AnatomicalLocation Short description AnatomicalLocation Definition The location of the burn wound on the body. Comments References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Data type Reference(HdBe-AnatomicalLocation) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
Laterality		0..1	CodeableConceptBinding	Element id Burnwound.Laterality Short description Laterality Definition Laterality adds information about body side to the anatomic location, e.g. left Comments Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. Data type CodeableConcept Binding Laterality codes BurnwoundLaterality (required) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
Depth		1..1	CodeableConceptBinding	Element id Burnwound.Depth Short description Depth Definition Description of the severity of the burn wound, ranging from degree 1 - 3. Comments Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. Data type CodeableConcept Binding BurnwoundDepth codes BurnwoundDepth (required) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
Comment		0..1	string	Element id Burnwound.Comment Short description Comment Definition Comment on the burn wound. Comments Note that FHIR strings SHALL NOT exceed 1MB in size Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a
DateOfLastDressingChange		0..1	dateTime	Element id Burnwound.DateOfLastDressingChange Short description DateOfLastDressingChange Definition Date on which the dressing was last changed. Data type dateTime Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a
WoundImage		0..*	base64Binary	Element id Burnwound.WoundImage Short description WoundImage Definition A photo of the wound as visual information. Comments A stream of bytes, base64 encoded Data type base64Binary Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a

Burnwound		0..*
Burnwound.DateOfOnset	dateTime	0..1
Burnwound.Extent	Quantity	0..1
Burnwound.AnatomicalLocation	Reference(HdBe-AnatomicalLocation)	0..1
Burnwound.Laterality	CodeableConcept	0..1
Burnwound.Depth	CodeableConcept	1..1
Burnwound.Comment	string	0..1
Burnwound.DateOfLastDressingChange	dateTime	0..1
Burnwound.WoundImage	base64Binary	0..*

Burnwound
Definition	Root concept of the Burnwound information model. This concept contains all data elements of the Burnwound information model.
Cardinality	0...*
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a
Burnwound.id
Definition	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality	0...1
Type	string
Mappings	rim: n/a
Burnwound.extension
Definition	May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality	0...*
Type	Extension
Alias	extensions, user content
Comments	There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Slicing	Unordered, Open, by url(Value)
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim: n/a rim: N/A
Burnwound.DateOfOnset
Definition	Date on which the burn wound appeared.
Cardinality	0...1
Type	dateTime
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a
Burnwound.Extent
Definition	The extent of a burn wound is indicated in a percentage of the ‘Total Body Surface Area’ (TBSA). For adults, the TBSA can be calculated on the basis of the ‘rule of nines’, in which body parts are expressed in the percentage 9 and multiples of 9. This ‘rule of nines’ cannot be used for children because a child’s body proportions are different from those of an adult. For children, separate tables were developed per age group to determine the extent of burn wounds. Another option is measuring the extent using the patient’s hand surface area. The surface area of a patient’s hand (including the fingers) equals approximately 1% of their total body surface area. (Source: Brandwonden genezen. Hoe verder? [Healing Burn Wounds. What now?)
Cardinality	0...1
Type	Quantity
Comments	The context of use may frequently define what kind of quantity this is and therefore what kind of units can be used. The context of use may also restrict the values for the comparator.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` qty-3: If a code for the unit is present, the system SHALL also be present `code.empty() or system.exists()`
Mappings	rim: n/a v2: SN (see also Range) or CQ rim: PQ, IVL<PQ>, MO, CO, depending on the values
Burnwound.AnatomicalLocation
Definition	The location of the burn wound on the body.
Cardinality	0...1
Type	Reference(HdBe-AnatomicalLocation)
Comments	References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))`
Mappings	rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
Burnwound.Laterality
Definition	Laterality adds information about body side to the anatomic location, e.g. left
Cardinality	0...1
Type	CodeableConcept
Binding	Laterality codes BurnwoundLaterality (required)
Comments	Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
Burnwound.Depth
Definition	Description of the severity of the burn wound, ranging from degree 1 - 3.
Cardinality	1...1
Type	CodeableConcept
Binding	BurnwoundDepth codes BurnwoundDepth (required)
Comments	Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
Burnwound.Comment
Definition	Comment on the burn wound.
Cardinality	0...1
Type	string
Comments	Note that FHIR strings SHALL NOT exceed 1MB in size
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a
Burnwound.DateOfLastDressingChange
Definition	Date on which the dressing was last changed.
Cardinality	0...1
Type	dateTime
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a
Burnwound.WoundImage
Definition	A photo of the wound as visual information.
Cardinality	0...*
Type	base64Binary
Comments	A stream of bytes, base64 encoded
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a

Example instances

[CBB name]
[Concept name ]	[example value]

// example of NameInformation

## Example instances

| NameInformation      |                   |
|----------------------|-------------------|
| FirstNames | Johanna Petronella Maria   
| Initials | J.P.M. 
| GivenName | Jo 
| NameUsage | Geslachtsnaam partner gevolgd door eigen geslachtsnaam
| LastName.Prefix | van
| LastName.LastName | Putten
| LastNamePartner.PartnerPrefix | van der
| LastNamePartner.PartnerLastName | Giessen
| Titles |

zib [zib name + version](https://zibs.nl/wiki/[zib name + version(release)]) difference

Concept	Category	Description
`[element.path]`	[category of change]	[Description of change]([Reference to ticket/issue/zulip chat using MarkDown link])

Terminology Bindings

Path	Name	Strength	URL
Laterality	BurnwoundLaterality	required	https://fhir.healthdata.be/ValueSet/BurnwoundLaterality
Depth	BurnwoundDepth	required	https://fhir.healthdata.be/ValueSet/BurnwoundDepth