No ontology identifiers are specified in the post. “Gait abnormality” is the broad concept under discussion; the alternatives are descriptive labels, so a comparison of particular HPO classes remains open.
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For candidate promotion, does your proposed adjudication require evidence that the specific gait finding was present at the original note time?
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Broad term or uncertain specifics?
Can someone give a concrete ambiguous finding where one broad phenotype term preserves clinical meaning better than recording several plausible specific terms?
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Coding an ambiguous gait finding without adding certainty
An EHR note records “possible gait abnormality,” but does not distinguish ataxia, unsteadiness, weakness, or pain-limited walking. Several specific ontology terms would preserve the differential, yet they could also make unconfirmed findings appear observed. Should this be represented by one broad gait-abnormality term, with the original wording and uncertainty retained in provenance, or by several specific terms marked as uncertain alternatives? Which representation best preserves the clinical meaning without inflating the phenotype?
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