Body Height
Item
1. Height
float
C0005890 (UMLS CUI [1,1])
C0031809 (UMLS CUI [1,2])
Body Weight
Item
2. Weight
float
C0005910 (UMLS CUI [1,1])
C0031809 (UMLS CUI [1,2])
Abdominal girth
Item
3. Abdominal girth (Waist Circumference)
float
C0232501 (UMLS CUI [1,1])
C0031809 (UMLS CUI [1,2])
Systolic Blood Pressure
Item
4. Blood pressure systolic after 5 minutes sitting/supine
float
C0871470 (UMLS CUI [1,1])
C0031809 (UMLS CUI [1,2])
Diastolic Blood Pressure
Item
4. Blood pressure diastolic after 5 minutes sitting/supine
float
C0428883 (UMLS CUI [1,1])
C0031809 (UMLS CUI [1,2])
Item
5. Blood pressure position
integer
C1828063 (UMLS CUI [1,1])
C0031809 (UMLS CUI [1,2])
Code List
5. Blood pressure position
Heart rate
Item
6. Heart rate
float
C0018810 (UMLS CUI [1,1])
C0031809 (UMLS CUI [1,2])
Item
7. Negative
integer
C0205160 (UMLS CUI [1,1])
C0032976 (UMLS CUI [1,2])
Item
8. Positive (patient is NOT eligible for trial)
integer
C1446409 (UMLS CUI [1,1])
C0032976 (UMLS CUI [1,2])
Code List
8. Positive (patient is NOT eligible for trial)
Item
9. Not applicable (patient is male, or female who is post-menopausal or surgically sterilised)
integer
C1272460 (UMLS CUI [1,1])
C0032976 (UMLS CUI [1,2])
Code List
9. Not applicable (patient is male, or female who is post-menopausal or surgically sterilised)
ECG perfomance
Item
10. Has an ECG been performed?
boolean
Pathological Q waves
Item
11. Are there any pathological Q waves?
boolean
Item
if Yes, in which leads (indicate all that apply)
integer
Code List
if Yes, in which leads (indicate all that apply)
ECG shows LVH
Item
12. Does the ECG show left ventricular hypertrophy (LVH)?
boolean
Modified Cornell Criteria
Item
13. If Yes, was this confirmed by the Modified Cornell Criteria (see facing page)?
boolean
Item
1a. Level of consciousness
integer
C3482252 (UMLS CUI [1])
Code List
1a. Level of consciousness
CL Item
Stuporous (requires repeated stimuli) (2)
CL Item
Comatose (Reflex responses only) (3)
Item
1b. LOC questions (Month, age)
integer
Code List
1b. LOC questions (Month, age)
Item
1c. LOC commands (Open, close eyes, make fist, let go)
integer
Code List
1c. LOC commands (Open, close eyes, make fist, let go)
CL Item
Obeys one correctly (1)
Item
2. Best gaze (Eyes open patient follows examiner´s finger or face)
integer
Code List
2. Best gaze (Eyes open patient follows examiner´s finger or face)
CL Item
Partial gaze palsy (1)
CL Item
Forced deviation (2)
Item
3. Visual (Introduce visual stimulus/threat to patient´s visual field quadrants)
integer
Code List
3. Visual (Introduce visual stimulus/threat to patient´s visual field quadrants)
CL Item
Partial hemianopia (1)
CL Item
Complete hemianopia (2)
CL Item
Bilateral hemianopia (3)
Item
4. Facial Palsy (Show teeth, raise eyebrows and squeeze eyes shut)
integer
Code List
4. Facial Palsy (Show teeth, raise eyebrows and squeeze eyes shut)
CL Item
Minor asymmetry (1)
CL Item
Partial (lower face paralysis) (2)
Item
5a. Motor Arm-Left (Elevate extremity 90° and score drift/movement)
integer
Code List
5a. Motor Arm-Left (Elevate extremity 90° and score drift/movement)
CL Item
Some effort against gravity (2)
CL Item
No effort against gravity (3)
CL Item
Amputation, joint fusion (5)
Item
5b. Motor Arm-Right (Elevate extremity 90° and score drift/movement)
integer
Code List
5b. Motor Arm-Right (Elevate extremity 90° and score drift/movement)
CL Item
Some effort against gravity (2)
CL Item
No effort against gravity (3)
CL Item
Amputation, joint fusion (5)
Item
6a. Motor Leg-Left (Elevate extremity 30° and score drift/movement)
integer
Code List
6a. Motor Leg-Left (Elevate extremity 30° and score drift/movement)
CL Item
Some effort against gravity (2)
CL Item
No effort against gravity (3)
CL Item
Amputation, joint fusion (5)
Item
6b. Motor Leg-Right (Elevate extremity 30° and score drift/movement)
integer
Code List
6b. Motor Leg-Right (Elevate extremity 30° and score drift/movement)
CL Item
Some effort against gravity (2)
CL Item
No effort against gravity (3)
CL Item
Amputation, joint fusion (5)
Item
7. Limb ataxia (Finger-nose, heel down shin)
integer
Code List
7. Limb ataxia (Finger-nose, heel down shin)
CL Item
Present in upper or lower (1)
CL Item
Present in both (2)
Item
8. Sensory (Pin prick to face, arm, trunk, and leg compare side to side)
integer
Code List
8. Sensory (Pin prick to face, arm, trunk, and leg compare side to side)
Item
9. Best language (Name items, describe a picture and read sentences)
integer
Code List
9. Best language (Name items, describe a picture and read sentences)
CL Item
Mild-moderate aphasia (1)
CL Item
Severe aphasia (2)
Item
10. Dysarthria (Evaluate speech clarity by patient repeating listed words)
integer
Code List
10. Dysarthria (Evaluate speech clarity by patient repeating listed words)
CL Item
Normal articulation (0)
CL Item
Mild-moderate slurring (1)
CL Item
Severe, nearly intelligible or worse (2)
Item
11. Extinction and Inattention (Use information from prior to testing to identify neglect or double stimuli testing)
integer
Code List
11. Extinction and Inattention (Use information from prior to testing to identify neglect or double stimuli testing)
CL Item
Partial neglect (1)
CL Item
Profound neglect (2)
Item
12. For the qualifying ischemic stroke, please fill in the current Modified Rankin Scale below. (Indicate only one)
integer
Code List
12. For the qualifying ischemic stroke, please fill in the current Modified Rankin Scale below. (Indicate only one)