30161000175102: Pressure injury of left ankle stage II (disorder)

SNOMED CT Concept\Clinical finding (finding)\...

\Finding of limb structure\Disorder of limb (disorder)\Disorder of soft tissue of limb\Disorder of soft tissue of lower limb\Pressure injury of left lower limb (disorder)\Pressure injury of left ankle (disorder)\Pressure injury of left ankle stage II
\Finding of limb structure\Disorder of limb (disorder)\Disorder of soft tissue of limb\Disorder of soft tissue of lower limb\Pressure injury of ankle (disorder)\Pressure injury of ankle stage II\Pressure injury of left ankle stage II
\Finding of limb structure\Disorder of limb (disorder)\Disorder of soft tissue of limb\Disorder of soft tissue of lower limb\Pressure injury of ankle (disorder)\Pressure injury of left ankle (disorder)\Pressure injury of left ankle stage II
\Finding of limb structure\Disorder of limb (disorder)\Disorder of lower limb\Disorder of left lower extremity (disorder)\Injury of left lower limb (disorder)\Injury of left ankle (disorder)\Pressure injury of left ankle (disorder)\Pressure injury of left ankle stage II
\Finding of limb structure\Disorder of limb (disorder)\Disorder of lower limb\Disorder of left lower extremity (disorder)\Injury of left lower limb (disorder)\Pressure injury of left lower limb (disorder)\Pressure injury of left ankle (disorder)\Pressure injury of left ankle stage II
\Finding of limb structure\Disorder of limb (disorder)\Disorder of lower limb\Disorder of free lower limb (disorder)\Injury of free lower limb\Injury of ankle\Injury of left ankle (disorder)\Pressure injury of left ankle (disorder)\Pressure injury of left ankle stage II
\Finding of limb structure\Disorder of limb (disorder)\Disorder of lower limb\Disorder of free lower limb (disorder)\Injury of free lower limb\Injury of ankle\Pressure injury of ankle (disorder)\Pressure injury of ankle stage II\Pressure injury of left ankle stage II
\Finding of limb structure\Disorder of limb (disorder)\Disorder of lower limb\Disorder of free lower limb (disorder)\Injury of free lower limb\Injury of ankle\Pressure injury of ankle (disorder)\Pressure injury of left ankle (disorder)\Pressure injury of left ankle stage II
\Finding of limb structure\Disorder of limb (disorder)\Disorder of lower limb\Disorder of free lower limb (disorder)\Disorder of ankle (disorder)\Ankle ulcer (disorder)\Pressure injury of ankle stage II\Pressure injury of left ankle stage II
\Finding of limb structure\Disorder of limb (disorder)\Disorder of lower limb\Disorder of free lower limb (disorder)\Disorder of ankle (disorder)\Injury of ankle\Injury of left ankle (disorder)\Pressure injury of left ankle (disorder)\Pressure injury of left ankle stage II
\Finding of limb structure\Disorder of limb (disorder)\Disorder of lower limb\Disorder of free lower limb (disorder)\Disorder of ankle (disorder)\Injury of ankle\Pressure injury of ankle (disorder)\Pressure injury of ankle stage II\Pressure injury of left ankle stage II
\Finding of limb structure\Disorder of limb (disorder)\Disorder of lower limb\Disorder of free lower limb (disorder)\Disorder of ankle (disorder)\Injury of ankle\Pressure injury of ankle (disorder)\Pressure injury of left ankle (disorder)\Pressure injury of left ankle stage II
\Finding of limb structure\Disorder of limb (disorder)\Disorder of lower limb\Disorder of soft tissue of lower limb\Pressure injury of left lower limb (disorder)\Pressure injury of left ankle (disorder)\Pressure injury of left ankle stage II
\Finding of limb structure\Disorder of limb (disorder)\Disorder of lower limb\Disorder of soft tissue of lower limb\Pressure injury of ankle (disorder)\Pressure injury of ankle stage II\Pressure injury of left ankle stage II
\Finding of limb structure\Disorder of limb (disorder)\Disorder of lower limb\Disorder of soft tissue of lower limb\Pressure injury of ankle (disorder)\Pressure injury of left ankle (disorder)\Pressure injury of left ankle stage II
\Finding of limb structure\Disorder of limb (disorder)\Disorder of lower limb\Injury of lower limb\Injury of left lower limb (disorder)\Injury of left ankle (disorder)\Pressure injury of left ankle (disorder)\Pressure injury of left ankle stage II
\Finding of limb structure\Disorder of limb (disorder)\Disorder of lower limb\Injury of lower limb\Injury of left lower limb (disorder)\Pressure injury of left lower limb (disorder)\Pressure injury of left ankle (disorder)\Pressure injury of left ankle stage II
\Finding of limb structure\Disorder of limb (disorder)\Disorder of lower limb\Injury of lower limb\Injury of free lower limb\Injury of ankle\Injury of left ankle (disorder)\Pressure injury of left ankle (disorder)\Pressure injury of left ankle stage II
\Finding of limb structure\Disorder of limb (disorder)\Disorder of lower limb\Injury of lower limb\Injury of free lower limb\Injury of ankle\Pressure injury of ankle (disorder)\Pressure injury of ankle stage II\Pressure injury of left ankle stage II
\Finding of limb structure\Disorder of limb (disorder)\Disorder of lower limb\Injury of lower limb\Injury of free lower limb\Injury of ankle\Pressure injury of ankle (disorder)\Pressure injury of left ankle (disorder)\Pressure injury of left ankle stage II
\Finding of limb structure\Disorder of limb (disorder)\Disorder of lower limb\Ulcer of lower extremity (disorder)\Ankle ulcer (disorder)\Pressure injury of ankle stage II\Pressure injury of left ankle stage II
\Finding of limb structure\Finding of lower limb\Finding of ankle or foot (finding)\Finding of ankle region\Disorder of ankle (disorder)\Ankle ulcer (disorder)\Pressure injury of ankle stage II\Pressure injury of left ankle stage II
\Finding of limb structure\Finding of lower limb\Finding of ankle or foot (finding)\Finding of ankle region\Disorder of ankle (disorder)\Injury of ankle\Injury of left ankle (disorder)\Pressure injury of left ankle (disorder)\Pressure injury of left ankle stage II
\Finding of limb structure\Finding of lower limb\Finding of ankle or foot (finding)\Finding of ankle region\Disorder of ankle (disorder)\Injury of ankle\Pressure injury of ankle (disorder)\Pressure injury of ankle stage II\Pressure injury of left ankle stage II
\Finding of limb structure\Finding of lower limb\Finding of ankle or foot (finding)\Finding of ankle region\Disorder of ankle (disorder)\Injury of ankle\Pressure injury of ankle (disorder)\Pressure injury of left ankle (disorder)\Pressure injury of left ankle stage II
\Finding of limb structure\Finding of lower limb\Disorder of lower limb\Disorder of left lower extremity (disorder)\Injury of left lower limb (disorder)\Injury of left ankle (disorder)\Pressure injury of left ankle (disorder)\Pressure injury of left ankle stage II
\Finding of limb structure\Finding of lower limb\Disorder of lower limb\Disorder of left lower extremity (disorder)\Injury of left lower limb (disorder)\Pressure injury of left lower limb (disorder)\Pressure injury of left ankle (disorder)\Pressure injury of left ankle stage II
\Finding of limb structure\Finding of lower limb\Disorder of lower limb\Disorder of free lower limb (disorder)\Injury of free lower limb\Injury of ankle\Injury of left ankle (disorder)\Pressure injury of left ankle (disorder)\Pressure injury of left ankle stage II
\Finding of limb structure\Finding of lower limb\Disorder of lower limb\Disorder of free lower limb (disorder)\Injury of free lower limb\Injury of ankle\Pressure injury of ankle (disorder)\Pressure injury of ankle stage II\Pressure injury of left ankle stage II
\Finding of limb structure\Finding of lower limb\Disorder of lower limb\Disorder of free lower limb (disorder)\Injury of free lower limb\Injury of ankle\Pressure injury of ankle (disorder)\Pressure injury of left ankle (disorder)\Pressure injury of left ankle stage II
\Finding of limb structure\Finding of lower limb\Disorder of lower limb\Disorder of free lower limb (disorder)\Disorder of ankle (disorder)\Ankle ulcer (disorder)\Pressure injury of ankle stage II\Pressure injury of left ankle stage II
\Finding of limb structure\Finding of lower limb\Disorder of lower limb\Disorder of free lower limb (disorder)\Disorder of ankle (disorder)\Injury of ankle\Injury of left ankle (disorder)\Pressure injury of left ankle (disorder)\Pressure injury of left ankle stage II
\Finding of limb structure\Finding of lower limb\Disorder of lower limb\Disorder of free lower limb (disorder)\Disorder of ankle (disorder)\Injury of ankle\Pressure injury of ankle (disorder)\Pressure injury of ankle stage II\Pressure injury of left ankle stage II
\Finding of limb structure\Finding of lower limb\Disorder of lower limb\Disorder of free lower limb (disorder)\Disorder of ankle (disorder)\Injury of ankle\Pressure injury of ankle (disorder)\Pressure injury of left ankle (disorder)\Pressure injury of left ankle stage II
\Finding of limb structure\Finding of lower limb\Disorder of lower limb\Disorder of soft tissue of lower limb\Pressure injury of left lower limb (disorder)\Pressure injury of left ankle (disorder)\Pressure injury of left ankle stage II
\Finding of limb structure\Finding of lower limb\Disorder of lower limb\Disorder of soft tissue of lower limb\Pressure injury of ankle (disorder)\Pressure injury of ankle stage II\Pressure injury of left ankle stage II
\Finding of limb structure\Finding of lower limb\Disorder of lower limb\Disorder of soft tissue of lower limb\Pressure injury of ankle (disorder)\Pressure injury of left ankle (disorder)\Pressure injury of left ankle stage II
\Finding of limb structure\Finding of lower limb\Disorder of lower limb\Injury of lower limb\Injury of left lower limb (disorder)\Injury of left ankle (disorder)\Pressure injury of left ankle (disorder)\Pressure injury of left ankle stage II
\Finding of limb structure\Finding of lower limb\Disorder of lower limb\Injury of lower limb\Injury of left lower limb (disorder)\Pressure injury of left lower limb (disorder)\Pressure injury of left ankle (disorder)\Pressure injury of left ankle stage II
\Finding of limb structure\Finding of lower limb\Disorder of lower limb\Injury of lower limb\Injury of free lower limb\Injury of ankle\Injury of left ankle (disorder)\Pressure injury of left ankle (disorder)\Pressure injury of left ankle stage II
\Finding of limb structure\Finding of lower limb\Disorder of lower limb\Injury of lower limb\Injury of free lower limb\Injury of ankle\Pressure injury of ankle (disorder)\Pressure injury of ankle stage II\Pressure injury of left ankle stage II
\Finding of limb structure\Finding of lower limb\Disorder of lower limb\Injury of lower limb\Injury of free lower limb\Injury of ankle\Pressure injury of ankle (disorder)\Pressure injury of left ankle (disorder)\Pressure injury of left ankle stage II
\Finding of limb structure\Finding of lower limb\Disorder of lower limb\Ulcer of lower extremity (disorder)\Ankle ulcer (disorder)\Pressure injury of ankle stage II\Pressure injury of left ankle stage II

\General finding of soft tissue\Disorder of soft tissue\...

\Injury of soft tissue (disorder)\Pressure injury\...

\Pressure injury of left lower limb (disorder)\Pressure injury of left ankle (disorder)\Pressure injury of left ankle stage II

\Pressure injury stage II (disorder)\Pressure injury of ankle stage II\Pressure injury of left ankle stage II

\Pressure injury of ankle (disorder)\Pressure injury of ankle stage II\Pressure injury of left ankle stage II
\Pressure injury of ankle (disorder)\Pressure injury of left ankle (disorder)\Pressure injury of left ankle stage II

\Disorder of soft tissue of limb\Disorder of soft tissue of lower limb\...

\Pressure injury of left lower limb (disorder)\Pressure injury of left ankle (disorder)\Pressure injury of left ankle stage II

\Pressure injury of ankle (disorder)\Pressure injury of ankle stage II\Pressure injury of left ankle stage II
\Pressure injury of ankle (disorder)\Pressure injury of left ankle (disorder)\Pressure injury of left ankle stage II

\Lesion of soft tissue (disorder)\Pressure injury\...

\Pressure injury of left lower limb (disorder)\Pressure injury of left ankle (disorder)\Pressure injury of left ankle stage II

\Pressure injury stage II (disorder)\Pressure injury of ankle stage II\Pressure injury of left ankle stage II

\Pressure injury of ankle (disorder)\Pressure injury of ankle stage II\Pressure injury of left ankle stage II
\Pressure injury of ankle (disorder)\Pressure injury of left ankle (disorder)\Pressure injury of left ankle stage II

\Disease\Disorder of joint region\Disorder of ankle (disorder)\Ankle ulcer (disorder)\Pressure injury of ankle stage II\Pressure injury of left ankle stage II
\Disease\Disorder of joint region\Disorder of ankle (disorder)\Injury of ankle\Injury of left ankle (disorder)\Pressure injury of left ankle (disorder)\Pressure injury of left ankle stage II
\Disease\Disorder of joint region\Disorder of ankle (disorder)\Injury of ankle\Pressure injury of ankle (disorder)\Pressure injury of ankle stage II\Pressure injury of left ankle stage II
\Disease\Disorder of joint region\Disorder of ankle (disorder)\Injury of ankle\Pressure injury of ankle (disorder)\Pressure injury of left ankle (disorder)\Pressure injury of left ankle stage II
\Disease\Ulcer (disorder)\Pressure injury stage II (disorder)\Pressure injury of ankle stage II\Pressure injury of left ankle stage II
\Disease\Ulcer (disorder)\Ulcer of lower extremity (disorder)\Ankle ulcer (disorder)\Pressure injury of ankle stage II\Pressure injury of left ankle stage II
\Disease\Traumatic or non-traumatic injury (disorder)\Injury of soft tissue (disorder)\Pressure injury\Pressure injury of left lower limb (disorder)\Pressure injury of left ankle (disorder)\Pressure injury of left ankle stage II
\Disease\Traumatic or non-traumatic injury (disorder)\Injury of soft tissue (disorder)\Pressure injury\Pressure injury stage II (disorder)\Pressure injury of ankle stage II\Pressure injury of left ankle stage II
\Disease\Traumatic or non-traumatic injury (disorder)\Injury of soft tissue (disorder)\Pressure injury\Pressure injury of ankle (disorder)\Pressure injury of ankle stage II\Pressure injury of left ankle stage II
\Disease\Traumatic or non-traumatic injury (disorder)\Injury of soft tissue (disorder)\Pressure injury\Pressure injury of ankle (disorder)\Pressure injury of left ankle (disorder)\Pressure injury of left ankle stage II
\Disease\Traumatic or non-traumatic injury (disorder)\Injury of lower limb\Injury of left lower limb (disorder)\Injury of left ankle (disorder)\Pressure injury of left ankle (disorder)\Pressure injury of left ankle stage II
\Disease\Traumatic or non-traumatic injury (disorder)\Injury of lower limb\Injury of left lower limb (disorder)\Pressure injury of left lower limb (disorder)\Pressure injury of left ankle (disorder)\Pressure injury of left ankle stage II
\Disease\Traumatic or non-traumatic injury (disorder)\Injury of lower limb\Injury of free lower limb\Injury of ankle\Injury of left ankle (disorder)\Pressure injury of left ankle (disorder)\Pressure injury of left ankle stage II
\Disease\Traumatic or non-traumatic injury (disorder)\Injury of lower limb\Injury of free lower limb\Injury of ankle\Pressure injury of ankle (disorder)\Pressure injury of ankle stage II\Pressure injury of left ankle stage II
\Disease\Traumatic or non-traumatic injury (disorder)\Injury of lower limb\Injury of free lower limb\Injury of ankle\Pressure injury of ankle (disorder)\Pressure injury of left ankle (disorder)\Pressure injury of left ankle stage II
\Disease\Disorder of limb (disorder)\Disorder of soft tissue of limb\Disorder of soft tissue of lower limb\Pressure injury of left lower limb (disorder)\Pressure injury of left ankle (disorder)\Pressure injury of left ankle stage II
\Disease\Disorder of limb (disorder)\Disorder of soft tissue of limb\Disorder of soft tissue of lower limb\Pressure injury of ankle (disorder)\Pressure injury of ankle stage II\Pressure injury of left ankle stage II
\Disease\Disorder of limb (disorder)\Disorder of soft tissue of limb\Disorder of soft tissue of lower limb\Pressure injury of ankle (disorder)\Pressure injury of left ankle (disorder)\Pressure injury of left ankle stage II
\Disease\Disorder of limb (disorder)\Disorder of lower limb\Disorder of left lower extremity (disorder)\Injury of left lower limb (disorder)\Injury of left ankle (disorder)\Pressure injury of left ankle (disorder)\Pressure injury of left ankle stage II
\Disease\Disorder of limb (disorder)\Disorder of lower limb\Disorder of left lower extremity (disorder)\Injury of left lower limb (disorder)\Pressure injury of left lower limb (disorder)\Pressure injury of left ankle (disorder)\Pressure injury of left ankle stage II
\Disease\Disorder of limb (disorder)\Disorder of lower limb\Disorder of free lower limb (disorder)\Injury of free lower limb\Injury of ankle\Injury of left ankle (disorder)\Pressure injury of left ankle (disorder)\Pressure injury of left ankle stage II
\Disease\Disorder of limb (disorder)\Disorder of lower limb\Disorder of free lower limb (disorder)\Injury of free lower limb\Injury of ankle\Pressure injury of ankle (disorder)\Pressure injury of ankle stage II\Pressure injury of left ankle stage II
\Disease\Disorder of limb (disorder)\Disorder of lower limb\Disorder of free lower limb (disorder)\Injury of free lower limb\Injury of ankle\Pressure injury of ankle (disorder)\Pressure injury of left ankle (disorder)\Pressure injury of left ankle stage II
\Disease\Disorder of limb (disorder)\Disorder of lower limb\Disorder of free lower limb (disorder)\Disorder of ankle (disorder)\Ankle ulcer (disorder)\Pressure injury of ankle stage II\Pressure injury of left ankle stage II
\Disease\Disorder of limb (disorder)\Disorder of lower limb\Disorder of free lower limb (disorder)\Disorder of ankle (disorder)\Injury of ankle\Injury of left ankle (disorder)\Pressure injury of left ankle (disorder)\Pressure injury of left ankle stage II
\Disease\Disorder of limb (disorder)\Disorder of lower limb\Disorder of free lower limb (disorder)\Disorder of ankle (disorder)\Injury of ankle\Pressure injury of ankle (disorder)\Pressure injury of ankle stage II\Pressure injury of left ankle stage II
\Disease\Disorder of limb (disorder)\Disorder of lower limb\Disorder of free lower limb (disorder)\Disorder of ankle (disorder)\Injury of ankle\Pressure injury of ankle (disorder)\Pressure injury of left ankle (disorder)\Pressure injury of left ankle stage II
\Disease\Disorder of limb (disorder)\Disorder of lower limb\Disorder of soft tissue of lower limb\Pressure injury of left lower limb (disorder)\Pressure injury of left ankle (disorder)\Pressure injury of left ankle stage II
\Disease\Disorder of limb (disorder)\Disorder of lower limb\Disorder of soft tissue of lower limb\Pressure injury of ankle (disorder)\Pressure injury of ankle stage II\Pressure injury of left ankle stage II
\Disease\Disorder of limb (disorder)\Disorder of lower limb\Disorder of soft tissue of lower limb\Pressure injury of ankle (disorder)\Pressure injury of left ankle (disorder)\Pressure injury of left ankle stage II
\Disease\Disorder of limb (disorder)\Disorder of lower limb\Injury of lower limb\Injury of left lower limb (disorder)\Injury of left ankle (disorder)\Pressure injury of left ankle (disorder)\Pressure injury of left ankle stage II
\Disease\Disorder of limb (disorder)\Disorder of lower limb\Injury of lower limb\Injury of left lower limb (disorder)\Pressure injury of left lower limb (disorder)\Pressure injury of left ankle (disorder)\Pressure injury of left ankle stage II
\Disease\Disorder of limb (disorder)\Disorder of lower limb\Injury of lower limb\Injury of free lower limb\Injury of ankle\Injury of left ankle (disorder)\Pressure injury of left ankle (disorder)\Pressure injury of left ankle stage II
\Disease\Disorder of limb (disorder)\Disorder of lower limb\Injury of lower limb\Injury of free lower limb\Injury of ankle\Pressure injury of ankle (disorder)\Pressure injury of ankle stage II\Pressure injury of left ankle stage II
\Disease\Disorder of limb (disorder)\Disorder of lower limb\Injury of lower limb\Injury of free lower limb\Injury of ankle\Pressure injury of ankle (disorder)\Pressure injury of left ankle (disorder)\Pressure injury of left ankle stage II
\Disease\Disorder of limb (disorder)\Disorder of lower limb\Ulcer of lower extremity (disorder)\Ankle ulcer (disorder)\Pressure injury of ankle stage II\Pressure injury of left ankle stage II
\Disease\Disorder of soft tissue\Injury of soft tissue (disorder)\Pressure injury\Pressure injury of left lower limb (disorder)\Pressure injury of left ankle (disorder)\Pressure injury of left ankle stage II
\Disease\Disorder of soft tissue\Injury of soft tissue (disorder)\Pressure injury\Pressure injury stage II (disorder)\Pressure injury of ankle stage II\Pressure injury of left ankle stage II
\Disease\Disorder of soft tissue\Injury of soft tissue (disorder)\Pressure injury\Pressure injury of ankle (disorder)\Pressure injury of ankle stage II\Pressure injury of left ankle stage II
\Disease\Disorder of soft tissue\Injury of soft tissue (disorder)\Pressure injury\Pressure injury of ankle (disorder)\Pressure injury of left ankle (disorder)\Pressure injury of left ankle stage II
\Disease\Disorder of soft tissue\Disorder of soft tissue of limb\Disorder of soft tissue of lower limb\Pressure injury of left lower limb (disorder)\Pressure injury of left ankle (disorder)\Pressure injury of left ankle stage II
\Disease\Disorder of soft tissue\Disorder of soft tissue of limb\Disorder of soft tissue of lower limb\Pressure injury of ankle (disorder)\Pressure injury of ankle stage II\Pressure injury of left ankle stage II
\Disease\Disorder of soft tissue\Disorder of soft tissue of limb\Disorder of soft tissue of lower limb\Pressure injury of ankle (disorder)\Pressure injury of left ankle (disorder)\Pressure injury of left ankle stage II
\Disease\Disorder of soft tissue\Lesion of soft tissue (disorder)\Pressure injury\Pressure injury of left lower limb (disorder)\Pressure injury of left ankle (disorder)\Pressure injury of left ankle stage II
\Disease\Disorder of soft tissue\Lesion of soft tissue (disorder)\Pressure injury\Pressure injury stage II (disorder)\Pressure injury of ankle stage II\Pressure injury of left ankle stage II
\Disease\Disorder of soft tissue\Lesion of soft tissue (disorder)\Pressure injury\Pressure injury of ankle (disorder)\Pressure injury of ankle stage II\Pressure injury of left ankle stage II
\Disease\Disorder of soft tissue\Lesion of soft tissue (disorder)\Pressure injury\Pressure injury of ankle (disorder)\Pressure injury of left ankle (disorder)\Pressure injury of left ankle stage II

Status: current, Sufficiently defined by necessary conditions definition status (core metadata concept). Date: 30-Nov 2021. Module: SNOMED CT core

Descriptions:

Id Description Lang Type Status Case? Module

4668357015 Pressure injury of left ankle stage II en Synonym (core metadata concept) Active Only initial character case insensitive (core metadata concept) SNOMED CT core

4668358013 Pressure ulcer of left ankle stage 2 en Synonym (core metadata concept) Active Entire term case insensitive (core metadata concept) SNOMED CT core

4668359017 Pressure injury of left ankle stage II (disorder) en Fully specified name Active Only initial character case insensitive (core metadata concept) SNOMED CT core

4668360010 Pressure injury of left ankle stage 2 en Synonym (core metadata concept) Active Entire term case insensitive (core metadata concept) SNOMED CT core

Expanded Value Set

Outbound Relationships	Type	Target	Active	Characteristic	Refinability	Group	Values
Pressure injury of left ankle stage II	Is a	Pressure injury of left ankle (disorder)	true	Inferred relationship	Some
Pressure injury of left ankle stage II	Finding site	Structure of soft tissue of left ankle (body structure)	true	Inferred relationship	Some	1
Pressure injury of left ankle stage II	Associated morphology	Pressure injury stage II	true	Inferred relationship	Some	1
Pressure injury of left ankle stage II	Is a	Pressure injury of ankle stage II	true	Inferred relationship	Some

Inbound Relationships

Type

Active

Source

Characteristic

Refinability

Group

This concept is not in any reference sets