An adverse clinical response that is possible, probable or proven to result from exposure to a substance, group of substances or radiation.
Purpose
Information about an adverse reaction in a patient to exposure to a substance or radiation is important for the healthcare provider to determine whether or not re-exposure to that substance or radiation is desirable. An undesirable reaction may lead to a decision to start monitoring.
Evidence Base
Note on zib Reaction
The zib Reaction broadly covers all diagnoses that amount to an adverse response by the patient that is possibly, probably or confirmed to be the result of exposure to a specific substance, group of substances or type of radiation. In terms of substances, the causative agent covers, among other things, medicines, food ingredients, inhalation allergens (e.g. pollen), insect poison and contact allergens (e.g. nickel and latex).
The zib Reaction is based on the zib DiagnosticInsight, because it concerns a diagnosis. Only 1 diagnosis can be recorded as a reaction and no differential diagnosis, because the reaction is linked to the cause. For this reason, CausativeAgent also has cardinality 1.
The zib Reaction has a number of elements that are specific to a reaction, such as CausativeAgent, LatencyTime and RouteOfExposure. The latter only applies to a reaction to medicines. For example, with pollen, insect poison and contact allergens, the route of exposure speaks for itself.
Just like DiagnosticInsight, if a reaction is (possibly) present, there is a reference from reaction to Condition, because it concerns the diagnostic interpretation of the condition.
In addition, there is also the possibility of a reference from Reaction to HypersensitivityIntolerance to establish the relationship between an actual reaction and the tendency to develop a reaction. Sometimes the patient is known to have a hypersensitivity or intolerance with a relatively mild risk of exposure. In that case, one can decide to administer the substance(s) in question and record the actual reactions to monitor whether the risk increases.
Functionality (informative)
EHRs already offer the option to distinguish between recording a new diagnosis or changing a diagnosis. Similar functionality is also needed when it concerns a reaction. When recording a new reaction, the EHR must create a new Condition and have the new instance of Reaction refer to it.
Because a reaction is also a diagnosis, the EHR must also make it possible to change a 'normal' diagnosis to a reaction and vice versa. In the event of such a change, the EHR must have the new instance of Reaction or DiagnosticInsight refer to the same Condition as the previous instance of Reaction or DiagnosticInsight.
In order to be able to distinguish between a 'normal' diagnosis and a reaction, the EHR should preferably have meta-knowledge of whether a diagnosis concerns a reaction or not and, on that basis, offer the correct subset of the diagnosis list. If not, there is no validation as to whether the diagnosis chosen by the user is a 'normal' diagnosis or a reaction.
Information Model
Type
Id
Concept
Card.
Definition
DefinitionCode
Reference
NL-CM:5.3.1
Reaction
This is a reference to the rootconcept of information model Reaction.
The health professional that acquired the diagnostic insight of the reaction. This can be a different individual than the person who recorded the diagnostic insight.
Columns Concept and DefinitionCode: hover over the values for more information
For explanation of the symbols, please see the legend page
Example Instances
Only available in Dutch
Reactie
DiagnostischInzichtDatum
07-10-2023
ZekerheidsStatus
Waarschijnlijk
WijzeVanVaststellen
Vastgesteld op basis van het klinisch beeld en aanvullend onderzoek.
WijzeVanBlootstelling
Oraal
Diagnose
DiagnoseNaam
Pneumonitis
NadereSpecificatieDiagnoseNaam
Amiodaron geïnduceerde pneumonitis
Veroorzaker
VeroorzakendeStof
Amiodaron
Toelichting
Radioloog beschrijft in het CT-verslag het volgende: gemalen glas en reticulaire opaciteit of CT-scan passend bij COP. Klinisch beeld past hier ook bij.
Latentietijd::Bereik
nominaleWaarde
30 dg
Diagnosesteller::Zorgverlener
Naam
H. Kuch
Specialisme
Longgeneeskunde
OvergvoeligheidIntolerantie
DiagnoseNaam
Neiging tot ongewenste reactie op medicatie en/of drug
Categorie
Geneesmiddelen
Stof
Amiodaron
AandoeningOfGesteldheid
PeriodeAanwezig
StartDatumTijd
03-10-2023
StatusDatum
07-10-2023
Ernst
Ernstig
Reactie
DiagnostischInzichtDatum
12-04-2023
ZekerheidsStatus
Waarschijnlijk
WijzeVanVaststellen
Vastgesteld op basis van het klinisch beeld
WijzeVanBlootstelling
Intraveneus
Diagnose
DiagnoseNaam
Geneesmiddelbijwerking
NadereSpecificatieDiagnoseNaam
Veroorzaker
VeroorzakendeStof
Rixathon
Toelichting
15 min na verhoging van de pompstand naar 5
Latentietijd::Bereik
nominaleWaarde
15 min
Diagnosesteller::Zorgverlener
Naam
L. van der Hoeven
Specialisme
Neurologie
AandoeningOfGesteldheid
PeriodeAanwezig
StartDatumTijd
12-04-2023 11:15
EindDatumTijd
12-04-2023 12:15
StatusDatum
12-04-2023
Ernst
Matig
Reactie
DiagnostischInzichtDatum
13-08-2023
ZekerheidsStatus
Bevestigd
WijzeVanVaststellen
Vastgesteld op basis van het klinisch beeld
WijzeVanBlootstelling
Diagnose
DiagnoseNaam
Anafylactische shock
NadereSpecificatieDiagnoseNaam
Veroorzaker
VeroorzakendeStof
Bijengif
Toelichting
Latentietijd::Bereik
nominaleWaarde
5 min
Diagnosesteller::Zorgverlener
Naam
G.H. Schweers
Specialisme
SEH-geneeskunde
AandoeningOfGesteldheid
PeriodeAanwezig
StartDatumTijd
13-08-2023 15:20
EindDatumTijd
StatusDatum
13-08-2023 15:20
Ernst
Ernstig
Instructions
A reaction always refers to the condition of which it is the interpretation. If > 1 instance of hypersensitivity or intolerance or reaction or diagnostic insight refers to the same condition, then the instantiation with the most recent diagnosis date represents the current diagnostic insight.
Technical specifications in HL7v3 CDA and HL7 FHIR
To exchange information based on health and care information models, additional, more technical specifications are required.<BR>
Not every environment can handle the same technical specifications. For this reason, there are several types of technical specifications:
HL7® version 3 CDA compatible specifications, available through the Nictiz ART-DECOR® environment
HL7® FHIR® compatible specifications, available through the Nictiz environment on the Simplifier FHIR
Reaction
Condition
or as spreadsheet 