Inglés

Assessment of Suspected Pulmonary Embolism

1 formularios  
Administrative data
Descripción

Administrative data

Alias
UMLS CUI-1
C1320722
Country No.
Descripción

Country No.

Tipo de datos

integer

Alias
UMLS CUI [1,1]
C0454664
UMLS CUI [1,2]
C0600091
Centre No.
Descripción

Centre No.

Tipo de datos

integer

Alias
UMLS CUI [1,1]
C1301943
UMLS CUI [1,2]
C0600091
Subject No.
Descripción

Clinical Trial Subject Unique Identifier

Tipo de datos

integer

Alias
UMLS CUI [1]
C2348585
Subject Initials
Descripción

Subject Initials

Tipo de datos

text

Alias
UMLS CUI [1,1]
C1997894
UMLS CUI [1,2]
C2986440
General Pulmonary Embolism Information
Descripción

General Pulmonary Embolism Information

Alias
UMLS CUI-1
C1508263
UMLS CUI-2
C0034065
Date of first clinical signs/symptoms of PE
Descripción

Date of first PE signs/symptoms

Tipo de datos

date

Alias
UMLS CUI [1,1]
C0034065
UMLS CUI [1,2]
C0574845
UMLS CUI [1,3]
C0037088
Perfusion and/or Ventilation Lung Scan
Descripción

Perfusion and/or Ventilation Lung Scan

Alias
UMLS CUI-1
C0203702
PE Assessment Imaging Modality
Descripción

If test performed, record date.

Tipo de datos

text

Alias
UMLS CUI [1,1]
C0034065
UMLS CUI [1,2]
C0220825
UMLS CUI [1,3]
C1275506
Date of PE Assessment
Descripción

Date of PE Assessment

Tipo de datos

date

Alias
UMLS CUI [1,1]
C0034065
UMLS CUI [1,2]
C0220825
UMLS CUI [1,3]
C0011008
Result
Descripción

High probability defect(s) is taken as evidence of PE. Study treatment if ongoing, must be discontinued. Non-high probability defect(s): If the mandatory venography has not yet been done: perform first an Ultrasonography. If negative, continue study drug until mandatory venography. If positive, confirm diagnosis with a venography or a pulmonary angiography. If the mandatory venography has been done: perform a venography or a pulmonary angiography. If no defect(s), the subject should continue study treatment if still ongoing

Tipo de datos

text

Alias
UMLS CUI [1,1]
C0034065
UMLS CUI [1,2]
C0220825
UMLS CUI [1,3]
C1274040
Ultrasonography
Descripción

Ultrasonography

Alias
UMLS CUI-1
C0041618
Not done
Descripción

If done, record date

Tipo de datos

boolean

Alias
UMLS CUI [1,1]
C0041618
UMLS CUI [1,2]
C1272696
Date performed
Descripción

Ultrasonography date

Tipo de datos

date

Alias
UMLS CUI [1,1]
C0041618
UMLS CUI [1,2]
C0011008
Ultrasonography Result of Left Common Femoral
Descripción

Ultrasonography Result of Left Common Femoral

Tipo de datos

text

Alias
UMLS CUI [1,1]
C0041618
UMLS CUI [1,2]
C1275667
UMLS CUI [1,3]
C0205091
UMLS CUI [1,4]
C1274040
Ultrasonography Result of Left Popliteal
Descripción

Ultrasonography Result of Left Popliteal

Tipo de datos

text

Alias
UMLS CUI [1,1]
C0041618
UMLS CUI [1,2]
C0032652
UMLS CUI [1,3]
C0205091
UMLS CUI [1,4]
C1274040
Ultrasonography Result of Right Common Femoral
Descripción

Ultrasonography Result of Right Common Femoral

Tipo de datos

text

Alias
UMLS CUI [1,1]
C0041618
UMLS CUI [1,2]
C1275667
UMLS CUI [1,3]
C0205090
UMLS CUI [1,4]
C1274040
Ultrasonography Result of Right Popliteal
Descripción

Ultrasonography Result of Right Popliteal

Tipo de datos

text

Alias
UMLS CUI [1,1]
C0041618
UMLS CUI [1,2]
C0032652
UMLS CUI [1,3]
C0205090
UMLS CUI [1,4]
C1274040
Venography
Descripción

Venography

Alias
UMLS CUI-1
C0031545
Venography Type
Descripción

For bilateral/left leg/right leg, record date in next item. For not done/left leg/right leg, record primary reason.

Tipo de datos

text

Alias
UMLS CUI [1,1]
C0031545
UMLS CUI [1,2]
C0332307
Date performed
Descripción

Venography Date

Tipo de datos

date

Alias
UMLS CUI [1,1]
C0031545
UMLS CUI [1,2]
C0011008
If NOT BILATERAL or NOT DONE, select the primary reason
Descripción

if other reason, specify in next item

Tipo de datos

text

Alias
UMLS CUI [1,1]
C1549995
UMLS CUI [1,2]
C0031545
UMLS CUI [1,3]
C1272696
UMLS CUI [2,1]
C1549995
UMLS CUI [2,2]
C0205092
UMLS CUI [2,3]
C0031545
Specify other reason venography not done/not bilateral
Descripción

if applicable

Tipo de datos

text

Alias
UMLS CUI [1,1]
C1521902
UMLS CUI [1,2]
C3840932
UMLS CUI [1,3]
C0031545
UMLS CUI [1,4]
C1272696
UMLS CUI [2,1]
C1521902
UMLS CUI [2,2]
C3840932
UMLS CUI [2,3]
C0205092
UMLS CUI [2,4]
C0031545
Angiography
Descripción

Angiography

Alias
UMLS CUI-1
C0002978
Not done
Descripción

if done, record date

Tipo de datos

boolean

Alias
UMLS CUI [1,1]
C1272696
UMLS CUI [1,2]
C0002978
Date performed
Descripción

Angiography date

Tipo de datos

date

Alias
UMLS CUI [1,1]
C0002978
UMLS CUI [1,2]
C0011008
Spiral CT scan
Descripción

Spiral CT scan

Alias
UMLS CUI-1
C0860888
Not done
Descripción

if done, record date

Tipo de datos

boolean

Alias
UMLS CUI [1,1]
C1272696
UMLS CUI [1,2]
C0860888
Date performed
Descripción

Spiral CT date

Tipo de datos

date

Alias
UMLS CUI [1,1]
C0860888
UMLS CUI [1,2]
C0011008
Other tests
Descripción

Other tests

Alias
UMLS CUI-1
C0039593
UMLS CUI-2
C0205394
Not done
Descripción

if done, record type of test and date

Tipo de datos

boolean

Alias
UMLS CUI [1,1]
C1272696
UMLS CUI [1,2]
C0039593
UMLS CUI [1,3]
C0205394
Other test, specify
Descripción

Specify other test

Tipo de datos

text

Alias
UMLS CUI [1,1]
C1521902
UMLS CUI [1,2]
C0039593
UMLS CUI [1,3]
C0205394
Date performed
Descripción

Other test date

Tipo de datos

date

Alias
UMLS CUI [1,1]
C0039593
UMLS CUI [1,2]
C0205394
UMLS CUI [1,3]
C0011008
Treatment
Descripción

Treatment

Alias
UMLS CUI-1
C0087111
Based on signs and symptoms, and all above detailed examinations, was medication given to treat PE?
Descripción

If medication was given, record in the medication form

Tipo de datos

boolean

Alias
UMLS CUI [1,1]
C0013216
UMLS CUI [1,2]
C0034065
UMLS CUI [1,3]
C0566251
UMLS CUI [1,4]
C0037088
UMLS CUI [2,1]
C0013216
UMLS CUI [2,2]
C0034065
UMLS CUI [2,3]
C0566251
UMLS CUI [2,4]
C0220825
Suspected PE fatal
Descripción

Suspected PE fatal

Alias
UMLS CUI-1
C0034065
UMLS CUI-2
C1302234
UMLS CUI-3
C0750491
Was the suspected PE fatal?
Descripción

If yes, specify date of death

Tipo de datos

boolean

Alias
UMLS CUI [1,1]
C0034065
UMLS CUI [1,2]
C1302234
UMLS CUI [1,3]
C0750491
If yes, specify date of death
Descripción

Date of death if fatal PE

Tipo de datos

date

Alias
UMLS CUI [1,1]
C1148348
UMLS CUI [1,2]
C0034065
UMLS CUI [1,3]
C1302234
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Similar models

Assessment of Suspected Pulmonary Embolism

1 formularios
Name
Tipo
Description | Question | Decode (Coded Value)
Tipo de datos
Alias
Item Group
Administrative data
C1320722 (UMLS CUI-1)
Country No.
Item
Country No.
integer
C0454664 (UMLS CUI [1,1])
C0600091 (UMLS CUI [1,2])
Centre No.
Item
Centre No.
integer
C1301943 (UMLS CUI [1,1])
C0600091 (UMLS CUI [1,2])
Clinical Trial Subject Unique Identifier
Item
Subject No.
integer
C2348585 (UMLS CUI [1])
Subject Initials
Item
Subject Initials
text
C1997894 (UMLS CUI [1,1])
C2986440 (UMLS CUI [1,2])
Item Group
General Pulmonary Embolism Information
C1508263 (UMLS CUI-1)
C0034065 (UMLS CUI-2)
Date of first PE signs/symptoms
Item
Date of first clinical signs/symptoms of PE
date
C0034065 (UMLS CUI [1,1])
C0574845 (UMLS CUI [1,2])
C0037088 (UMLS CUI [1,3])
Item Group
Perfusion and/or Ventilation Lung Scan
C0203702 (UMLS CUI-1)
Item
PE Assessment Imaging Modality
text
C0034065 (UMLS CUI [1,1])
C0220825 (UMLS CUI [1,2])
C1275506 (UMLS CUI [1,3])
PE Assessment Imaging Modality
Code List
PE Assessment Imaging Modality
CL Item
Not done (Not done)
CL Item
V/Q scan (V/Q scan)
CL Item
Perfusion scan (Perfusion scan)
CL Item
Ventilation scan (Ventilation scan)
Date of PE Assessment
Item
Date of PE Assessment
date
C0034065 (UMLS CUI [1,1])
C0220825 (UMLS CUI [1,2])
C0011008 (UMLS CUI [1,3])
Item
Result
text
C0034065 (UMLS CUI [1,1])
C0220825 (UMLS CUI [1,2])
C1274040 (UMLS CUI [1,3])
Results
Code List
Result
CL Item
High probability defect(s) (High probability defect(s))
CL Item
Non high probability defect(s) (Non high probability defect(s))
CL Item
No defect(s) (No defect(s))
Item Group
Ultrasonography
C0041618 (UMLS CUI-1)
Ultrasonography not done
Item
Not done
boolean
C0041618 (UMLS CUI [1,1])
C1272696 (UMLS CUI [1,2])
Ultrasonography date
Item
Date performed
date
C0041618 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
Item
Ultrasonography Result of Left Common Femoral
text
C0041618 (UMLS CUI [1,1])
C1275667 (UMLS CUI [1,2])
C0205091 (UMLS CUI [1,3])
C1274040 (UMLS CUI [1,4])
Ultrasonography, Common Femoral vein, left, Result
Code List
Ultrasonography Result of Left Common Femoral
CL Item
Fully compressible/Normal (Fully compressible/Normal)
CL Item
Non compressible (Non compressible)
CL Item
Inadequate (Inadequate)
CL Item
Not done (Not done)
Item
Ultrasonography Result of Left Popliteal
text
C0041618 (UMLS CUI [1,1])
C0032652 (UMLS CUI [1,2])
C0205091 (UMLS CUI [1,3])
C1274040 (UMLS CUI [1,4])
Ultrasonography, Common Femoral vein, left, Result
Code List
Ultrasonography Result of Left Popliteal
CL Item
Fully compressible/Normal (Fully compressible/Normal)
CL Item
Non compressible (Non compressible)
CL Item
Inadequate (Inadequate)
CL Item
Not done (Not done)
Item
Ultrasonography Result of Right Common Femoral
text
C0041618 (UMLS CUI [1,1])
C1275667 (UMLS CUI [1,2])
C0205090 (UMLS CUI [1,3])
C1274040 (UMLS CUI [1,4])
Ultrasonography, Common Femoral vein, left, Result
Code List
Ultrasonography Result of Right Common Femoral
CL Item
Fully compressible/Normal (Fully compressible/Normal)
CL Item
Non compressible (Non compressible)
CL Item
Inadequate (Inadequate)
CL Item
Not done (Not done)
Item
Ultrasonography Result of Right Popliteal
text
C0041618 (UMLS CUI [1,1])
C0032652 (UMLS CUI [1,2])
C0205090 (UMLS CUI [1,3])
C1274040 (UMLS CUI [1,4])
Ultrasonography, Common Femoral vein, left, Result
Code List
Ultrasonography Result of Right Popliteal
CL Item
Fully compressible/Normal (Fully compressible/Normal)
CL Item
Non compressible (Non compressible)
CL Item
Inadequate (Inadequate)
CL Item
Not done (Not done)
Item Group
Venography
C0031545 (UMLS CUI-1)
Item
Venography Type
text
C0031545 (UMLS CUI [1,1])
C0332307 (UMLS CUI [1,2])
Venography Type
Code List
Venography Type
CL Item
Not done (ND)
CL Item
Bilateral (BI)
CL Item
Left leg (L)
CL Item
Right leg (R)
Venography Date
Item
Date performed
date
C0031545 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
Item
If NOT BILATERAL or NOT DONE, select the primary reason
text
C1549995 (UMLS CUI [1,1])
C0031545 (UMLS CUI [1,2])
C1272696 (UMLS CUI [1,3])
C1549995 (UMLS CUI [2,1])
C0205092 (UMLS CUI [2,2])
C0031545 (UMLS CUI [2,3])
Venography; Indication
Code List
If NOT BILATERAL or NOT DONE, select the primary reason
CL Item
Failed venous access (Failed venous access)
CL Item
Subject refused/withdrew consent (Subject refused/withdrew consent)
CL Item
Subject amputee (Subject amputee)
CL Item
Other, specify (Other, specify)
Specify other reason venography not done/unilateral
Item
Specify other reason venography not done/not bilateral
text
C1521902 (UMLS CUI [1,1])
C3840932 (UMLS CUI [1,2])
C0031545 (UMLS CUI [1,3])
C1272696 (UMLS CUI [1,4])
C1521902 (UMLS CUI [2,1])
C3840932 (UMLS CUI [2,2])
C0205092 (UMLS CUI [2,3])
C0031545 (UMLS CUI [2,4])
Item Group
Angiography
C0002978 (UMLS CUI-1)
Angiography not done?
Item
Not done
boolean
C1272696 (UMLS CUI [1,1])
C0002978 (UMLS CUI [1,2])
Angiography date
Item
Date performed
date
C0002978 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
Item Group
Spiral CT scan
C0860888 (UMLS CUI-1)
Spiral CT scan not done?
Item
Not done
boolean
C1272696 (UMLS CUI [1,1])
C0860888 (UMLS CUI [1,2])
Spiral CT date
Item
Date performed
date
C0860888 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
Item Group
Other tests
C0039593 (UMLS CUI-1)
C0205394 (UMLS CUI-2)
Other tests not done?
Item
Not done
boolean
C1272696 (UMLS CUI [1,1])
C0039593 (UMLS CUI [1,2])
C0205394 (UMLS CUI [1,3])
Specify other test
Item
Other test, specify
text
C1521902 (UMLS CUI [1,1])
C0039593 (UMLS CUI [1,2])
C0205394 (UMLS CUI [1,3])
Other test date
Item
Date performed
date
C0039593 (UMLS CUI [1,1])
C0205394 (UMLS CUI [1,2])
C0011008 (UMLS CUI [1,3])
Item Group
Treatment
C0087111 (UMLS CUI-1)
Medication for PE treatment given due to signs/symptoms/examinations?
Item
Based on signs and symptoms, and all above detailed examinations, was medication given to treat PE?
boolean
C0013216 (UMLS CUI [1,1])
C0034065 (UMLS CUI [1,2])
C0566251 (UMLS CUI [1,3])
C0037088 (UMLS CUI [1,4])
C0013216 (UMLS CUI [2,1])
C0034065 (UMLS CUI [2,2])
C0566251 (UMLS CUI [2,3])
C0220825 (UMLS CUI [2,4])
Item Group
Suspected PE fatal
C0034065 (UMLS CUI-1)
C1302234 (UMLS CUI-2)
C0750491 (UMLS CUI-3)
Suspected PE fatal?
Item
Was the suspected PE fatal?
boolean
C0034065 (UMLS CUI [1,1])
C1302234 (UMLS CUI [1,2])
C0750491 (UMLS CUI [1,3])
Date of death if fatal PE
Item
If yes, specify date of death
date
C1148348 (UMLS CUI [1,1])
C0034065 (UMLS CUI [1,2])
C1302234 (UMLS CUI [1,3])
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