ID
41776
Beschrijving
This CRF is set up in modules to be used for recording data on the ISARIC COVID-19 Core Database or for independent studies. Module 1 and Module 2 complete on the first day of presentation/admission or on first day of COVID-19 assessment. Module 2 also complete on first day of admission to ICU or high dependency unit. In addition, complete daily for as many days as resources allow up to a maximum of 14 days. Continue to follow-up patients who transfer between wards. Module 3 (Outcome) complete at discharge or death GENERAL GUIDANCE - The CRF is designed to collect data obtained through examination, interview and review of hospital notes. Data may be collected retrospectively if the patient is enrolled after the admission date. - For more detailed guidance on how to complete these forms, please refer to the CRF Completion Guideline - Participant Identification Numbers consist of a 3 digit site code and a 4 digit participant number. You can obtain a site code and registering on the data management system by contacting ISARIC. Participant numbers should be assigned sequentially for each site beginning with 0001. In the case of a single site recruiting participants on different wards, or where it is otherwise difficult to assign sequential numbers, it is acceptable to assign numbers in blocks or incorporating alpha characters. E.g. Ward X will assign numbers from 0001 or A001 onwards and Ward Y will assign numbers from 5001 or B001 onwards. Enter the Participant Identification Number at the top of every page. - Printed paper CRFs may be used for later transfer of the data onto the electronic database. - For participants who return for re-admission to the same site, start a new form with a different Participant Identification Number. Please check “YES-admitted previously” in the ONSET & ADMISSION section. Enter as 2 separate entries in the electronic database. - For participants who transfer between two sites that are both collecting data on this form, it is preferred to have the data entered by a single site as a single admission, under the same Participant Identification Number. When this is not possible, the first site should record “Transfer to other facility” as an OUTCOME, and the second site should start a new form with a new patient number and indicate “YES-transferred” in ONSET & ADMISSION. - Complete every line of every section, except for where the instructions say to skip a section based on certain responses. - Mark ‘Not done’ for any results of laboratory values that are not available, not applicable or unknown. - Avoid recording data outside of the dedicated areas. Sections are available for recording additional information. - If using paper CRFs, we recommend writing clearly in ink, using BLOCK-CAPITAL LETTERS. Place an (X) when you choose the corresponding answer. To make corrections, strike through (-------) the data you wish to delete and write the correct data above it. Please initial and date all corrections. Please keep all of the sheets for a single participant together e.g. with a staple or participant-unique folder. - ISARIC would like the centers to enter data directly into their electronic data capture system. Please contact ISARIC about access. If your site would like to collect data independently, ISARIC can support you in the estabilishment of locally hosted databases. This version may serve as a basis for locally hosted databases. - Please contact ISARIC, if you need help with databases, have comments or to let ISARIC know that you are using the CRF. - Please let us know if you find any mistakes in the MDM Portal's version. FURTHER GUIDANCE AND DEFINITIONS (from the Completion guideline) Comorbidities: Comorbidities present before the onset of COVID-19 and are still present. Do not include those that developed following the onset of COVID-19 symptoms. More detailed guidance is provided. Hospital admission: For patients who were admitted to hospital with COVID-19 or symptoms consistent with possible COVID-19 infection, please enter details for the date of hospital admission. For patients with a clear alternative diagnosis leading to admission who subsequently acquired COVID-19, original admission date should be provided, but all subsequent references to admission should be taken as referring to day COVID-19 was first clinically suspected (or within the first 24 hours after first day of suspected or confirmed COVID-19 infection). Where a patient was admitted via multiple hospital departments, count admission from the time they came to the first department during the visit that led to their admission (e.g. arrival at the Emergency Department). Oxygen therapy: Include any form of supplemental oxygen received using any methods. Invasive ventilation: Please include any mechanical ventilation delivered following intubation or via a tracheostomy. Do not include patients who are breathing independently via a tracheostomy. Non-invasive ventilation: Please include any positive-pressure treatment given via a tight-fitted mask. This can be continuous positive pressure (CPAP) or bi-level positive pressure (BIPAP). Renal replacement therapy or dialysis: Please include any form of continuous renal replacement therapy or intermittent haemodialysis. Worst result: References to ‘worst result’ refer to those furthest from the normal physiological range or laboratory normal range. Results that were rejected by the clinical team (e.g. pulse oximetry on poorly perfused extremities, haemolysed blood samples, contaminated microbiology results) should not be reported. The following measures should be considered as a single observation and entered together: Blood gas results: Please report the measures from the blood gas with the lowest pH (most acidotic). Blood pressure: Please report the systolic and diastolic blood pressure from the observation with the lowest mean arterial pressure (if mean arterial pressure has not been calculated, report the measurement with lowest systolic blood pressure). Respiratory rate: If both abnormal low and high rate observed, record the abnormally high rate. General information about ISARIC ISARIC has developed a portfolio of resources to accelerate outbreak research and response. All resources are designed to address the most critical public health questions, have undergone extensive review by international clinical experts, and are free to use. ISARIC should be acknowledged and informed if you implement the protocol. Ethical apporval of the protocol and all necessary operational and financial arrangements are the responsibility of the investigators. This form refers to the CoV CASE RECORD FORM Version 1.3 25 Aug 2020. See https://isaric.tghn.org/COVID-19-CRF/
Link
https://isaric.tghn.org/COVID-19-CRF/
Trefwoorden
Versies (1)
- 18-01-21 18-01-21 -
Houder van rechten
ISARIC on behalf of Oxford University
Geüploaded op
18 januari 2021
DOI
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Licentie
Creative Commons BY-SA 4.0
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ISARIC/WHO Novel Coronavirus (nCoV) / COVID-19 Case Report Form
MODULE 1: PRESENTATION/ADMISSION CASE REPORT FORM
- StudyEvent: ODMjoin
Beschrijving
Clinical Inclusion Criteria
Alias
- UMLS CUI-1
- C1512693
- UMLS CUI-2
- C0243161
Beschrijving
Select yes if patient has either clinically suspected or laboratory-confirmed SARS-CoV-2 /COVID-19 infection.
Datatype
boolean
Alias
- UMLS CUI [1,1]
- C0392360
- UMLS CUI [1,2]
- C0030673
- UMLS CUI [1,3]
- C3838696
- UMLS CUI [2,1]
- C0392360
- UMLS CUI [2,2]
- C0030673
- UMLS CUI [2,3]
- C0206750
- UMLS CUI [2,4]
- C0456369
Beschrijving
Demographics
Alias
- UMLS CUI-1
- C1704791
Beschrijving
Clinical centre name
Datatype
text
Alias
- UMLS CUI [1,1]
- C1552416
- UMLS CUI [1,2]
- C0027365
Beschrijving
Country
Datatype
text
Alias
- UMLS CUI [1]
- C0454664
Beschrijving
Date of enrolment into the study or for in-patients the date COVID-19 was first assessed as suspected or confirmed by a clinician.
Datatype
date
Alias
- UMLS CUI [1,1]
- C1516879
- UMLS CUI [1,2]
- C0011008
- UMLS CUI [2,1]
- C0205435
- UMLS CUI [2,2]
- C5203670
- UMLS CUI [2,3]
- C2985720
Beschrijving
Please enter all that apply of the following choices which best describe the patient’s ethnicity or major ethnic group at birth. Please exclude nationality as nations often include many different ethnic groups (For example, Singaporean is the nationality but the ethnic grouping within Singapore could be East Asian, South Asian etc.) Cross (X) all that apply. If ‘Other’ write the full name of the ethnic group of the patient. Please do not enter a letter or number corresponding to a local/national ethnicity coding system. If the patient’s ethnicity is not known, please place a cross (X) in the ’Unknown’ box.
Datatype
boolean
Alias
- UMLS CUI [1]
- C0282540
Beschrijving
Please enter all that apply of the following choices which best describe the patient’s ethnicity or major ethnic group at birth. Please exclude nationality as nations often include many different ethnic groups (For example, Singaporean is the nationality but the ethnic grouping within Singapore could be East Asian, South Asian etc.) Cross (X) all that apply. If ‘Other’ write the full name of the ethnic group of the patient. Please do not enter a letter or number corresponding to a local/national ethnicity coding system. If the patient’s ethnicity is not known, please place a cross (X) in the ’Unknown’ box.
Datatype
boolean
Alias
- UMLS CUI [1]
- C0005680
Beschrijving
Please enter all that apply of the following choices which best describe the patient’s ethnicity or major ethnic group at birth. Please exclude nationality as nations often include many different ethnic groups (For example, Singaporean is the nationality but the ethnic grouping within Singapore could be East Asian, South Asian etc.) Cross (X) all that apply. If ‘Other’ write the full name of the ethnic group of the patient. Please do not enter a letter or number corresponding to a local/national ethnicity coding system. If the patient’s ethnicity is not known, please place a cross (X) in the ’Unknown’ box.
Datatype
boolean
Alias
- UMLS CUI [1]
- C4540996
Beschrijving
Please enter all that apply of the following choices which best describe the patient’s ethnicity or major ethnic group at birth. Please exclude nationality as nations often include many different ethnic groups (For example, Singaporean is the nationality but the ethnic grouping within Singapore could be East Asian, South Asian etc.) Cross (X) all that apply. If ‘Other’ write the full name of the ethnic group of the patient. Please do not enter a letter or number corresponding to a local/national ethnicity coding system. If the patient’s ethnicity is not known, please place a cross (X) in the ’Unknown’ box.
Datatype
boolean
Alias
- UMLS CUI [1]
- C1519427
Beschrijving
Please enter all that apply of the following choices which best describe the patient’s ethnicity or major ethnic group at birth. Please exclude nationality as nations often include many different ethnic groups (For example, Singaporean is the nationality but the ethnic grouping within Singapore could be East Asian, South Asian etc.) Cross (X) all that apply. If ‘Other’ write the full name of the ethnic group of the patient. Please do not enter a letter or number corresponding to a local/national ethnicity coding system. If the patient’s ethnicity is not known, please place a cross (X) in the ’Unknown’ box.
Datatype
boolean
Alias
- UMLS CUI [1,1]
- C0003984
- UMLS CUI [1,2]
- C0015031
Beschrijving
Please enter all that apply of the following choices which best describe the patient’s ethnicity or major ethnic group at birth. Please exclude nationality as nations often include many different ethnic groups (For example, Singaporean is the nationality but the ethnic grouping within Singapore could be East Asian, South Asian etc.) Cross (X) all that apply. If ‘Other’ write the full name of the ethnic group of the patient. Please do not enter a letter or number corresponding to a local/national ethnicity coding system. If the patient’s ethnicity is not known, please place a cross (X) in the ’Unknown’ box.
Datatype
boolean
Alias
- UMLS CUI [1]
- C1553378
Beschrijving
Please enter all that apply of the following choices which best describe the patient’s ethnicity or major ethnic group at birth. Please exclude nationality as nations often include many different ethnic groups (For example, Singaporean is the nationality but the ethnic grouping within Singapore could be East Asian, South Asian etc.) Cross (X) all that apply. If ‘Other’ write the full name of the ethnic group of the patient. Please do not enter a letter or number corresponding to a local/national ethnicity coding system. If the patient’s ethnicity is not known, please place a cross (X) in the ’Unknown’ box.
Datatype
boolean
Alias
- UMLS CUI [1]
- C0007457
Beschrijving
Please enter all that apply of the following choices which best describe the patient’s ethnicity or major ethnic group at birth. Please exclude nationality as nations often include many different ethnic groups (For example, Singaporean is the nationality but the ethnic grouping within Singapore could be East Asian, South Asian etc.) Cross (X) all that apply. If ‘Other’ write the full name of the ethnic group of the patient. Please do not enter a letter or number corresponding to a local/national ethnicity coding system. If the patient’s ethnicity is not known, please place a cross (X) in the ’Unknown’ box.
Datatype
boolean
Alias
- UMLS CUI [1]
- C0935542
Beschrijving
Please enter all that apply of the following choices which best describe the patient’s ethnicity or major ethnic group at birth. Please exclude nationality as nations often include many different ethnic groups (For example, Singaporean is the nationality but the ethnic grouping within Singapore could be East Asian, South Asian etc.) Cross (X) all that apply. If ‘Other’ write the full name of the ethnic group of the patient. Please do not enter a letter or number corresponding to a local/national ethnicity coding system. If the patient’s ethnicity is not known, please place a cross (X) in the ’Unknown’ box.
Datatype
boolean
Alias
- UMLS CUI [1,1]
- C0205394
- UMLS CUI [1,2]
- C0015031
Beschrijving
Please enter all that apply of the following choices which best describe the patient’s ethnicity or major ethnic group at birth. Please exclude nationality as nations often include many different ethnic groups (For example, Singaporean is the nationality but the ethnic grouping within Singapore could be East Asian, South Asian etc.) Cross (X) all that apply. If ‘Other’ write the full name of the ethnic group of the patient. Please do not enter a letter or number corresponding to a local/national ethnicity coding system. If the patient’s ethnicity is not known, please place a cross (X) in the ’Unknown’ box.
Datatype
text
Alias
- UMLS CUI [1,1]
- C0205394
- UMLS CUI [1,2]
- C0015031
- UMLS CUI [1,3]
- C2348235
Beschrijving
If the patient’s ethnicity is not known, please place a cross (X) in the ’Unknown’ box.
Datatype
boolean
Alias
- UMLS CUI [1,1]
- C0439673
- UMLS CUI [1,2]
- C0015031
Beschrijving
Employed as healthcare worker
Datatype
integer
Alias
- UMLS CUI [1,1]
- C0557351
- UMLS CUI [1,2]
- C0018724
Beschrijving
Employed in a microbiology laboratory
Datatype
integer
Alias
- UMLS CUI [1,1]
- C0557351
- UMLS CUI [1,2]
- C0181826
Beschrijving
Sex at birth
Datatype
integer
Alias
- UMLS CUI [1]
- C4019317
Beschrijving
Or use "estimated age in months"
Datatype
integer
Maateenheden
- Year
Alias
- UMLS CUI [1,1]
- C0750572
- UMLS CUI [1,2]
- C1510829
Beschrijving
Or use "estimated age in years"
Datatype
integer
Maateenheden
- months
Alias
- UMLS CUI [1,1]
- C0750572
- UMLS CUI [1,2]
- C1510828
Beschrijving
Pregnant
Datatype
integer
Alias
- UMLS CUI [1]
- C0549206
Beschrijving
Gestational week assessment
Datatype
integer
Maateenheden
- weeks
Alias
- UMLS CUI [1]
- C2825545
Beschrijving
Post Partum
Alias
- UMLS CUI-1
- C0032804
Beschrijving
Post-partum: Defined as within six week of delivery. If NO or Unknown skip this section
Datatype
integer
Alias
- UMLS CUI [1]
- C0032804
Beschrijving
Pregnancy Outcome
Datatype
integer
Alias
- UMLS CUI [1]
- C0032972
Beschrijving
Delivery date
Datatype
date
Alias
- UMLS CUI [1]
- C2053594
Beschrijving
Baby tested for mother's Sars-Cov-2-infection/COVID-19
Datatype
integer
Alias
- UMLS CUI [1,1]
- C0021270
- UMLS CUI [1,2]
- C0022885
- UMLS CUI [1,3]
- C0884358
- UMLS CUI [1,4]
- C5203676
Beschrijving
If the baby is positive for COVID-19 please complete a separate form for the baby as well.
Datatype
integer
Alias
- UMLS CUI [1,1]
- C0021270
- UMLS CUI [1,2]
- C1254360
- UMLS CUI [1,3]
- C5203676
Beschrijving
Infant – Less than 1 year old
Alias
- UMLS CUI-1
- C0021270
Beschrijving
If No skip this section
Datatype
boolean
Alias
- UMLS CUI [1]
- C0021270
Beschrijving
Birth weight
Datatype
float
Alias
- UMLS CUI [1]
- C0005612
Beschrijving
Birth weight Unit/Unknown
Datatype
integer
Alias
- UMLS CUI [1,1]
- C0005612
- UMLS CUI [1,2]
- C0439148
- UMLS CUI [2,1]
- C0005612
- UMLS CUI [2,2]
- C0439673
- UMLS CUI [3,1]
- C0005612
- UMLS CUI [3,2]
- C0439148
- UMLS CUI [3,3]
- C0439673
Beschrijving
Gestational outcome
Datatype
integer
Alias
- UMLS CUI [1]
- C1286282
Beschrijving
Breastfed
Datatype
integer
Alias
- UMLS CUI [1]
- C0006147
Beschrijving
Vaccinations appropriate for age/country
Datatype
integer
Alias
- UMLS CUI [1,1]
- C1443394
- UMLS CUI [1,2]
- C1548787
- UMLS CUI [1,3]
- C0001779
- UMLS CUI [2,1]
- C1443394
- UMLS CUI [2,2]
- C1548787
- UMLS CUI [2,3]
- C0454664
Beschrijving
Onset and admission
Alias
- UMLS CUI-1
- C0277793
- UMLS CUI-2
- C0184666
Beschrijving
Please provide the date of patient reported onset of the first symptom that you clinically believe was related to this episode of COVID-19 infection.
Datatype
date
Alias
- UMLS CUI [1,1]
- C0574845
- UMLS CUI [1,2]
- C0205435
- UMLS CUI [1,3]
- C1457887
Beschrijving
Where a patient was admitted via multiple hospital departments, count admission from the time they came to the first department during the visit that led to their admission (e.g. arrival at the Emergency Department). For patients with a clear alternative diagnosis leading to admission who subsequently acquired COVID-19 report the date of admission as the day they were admitted to the healthcare facility.
Datatype
date
Alias
- UMLS CUI [1]
- C1302393
Beschrijving
For participants who return for re-admission to the same site, start a new form with the same Participant Identification Number. Please check “YES-admitted previously to this facility”. Enter as 2 separate entries in the electronic database. For participants who transfer between two sites that are both collecting data on this form, it is preferred to have the data entered by a single site as a single admission, under the same Participant Identification Number. When this is not possible, the first site should record “Transfer to other facility” as an OUTCOME, and the second site should start a new form with a new patient number and indicate “YES-transferred from other facility” in ONSET & ADMISSION.
Datatype
integer
Alias
- UMLS CUI [1]
- C4264524
Beschrijving
Participant ID at transferring facility
Datatype
integer
Alias
- UMLS CUI [1,1]
- C3165543
- UMLS CUI [1,2]
- C4264524
Beschrijving
Participant ID at transferring facility
Datatype
text
Alias
- UMLS CUI [1,1]
- C3165543
- UMLS CUI [1,2]
- C4264524
- UMLS CUI [1,3]
- C2348235
Beschrijving
Signs and symptoms at hospital admission
Alias
- UMLS CUI-1
- C0037088
- UMLS CUI-2
- C0184666
Beschrijving
Please enter the peripheral body temperature (rectal if < 3 months) in the space provided and indicate the unit of measurement, either degrees Celsius (°C) or Fahrenheit (°F). For all items in this group: Please provide details of clinical observations made as close to presentation/admission, or within 24 hours of admission. For observations not made immediately at admission, please record the first available data (patient reported and/or from medical records) within 24 hours of admission. For patients with a clear alternative diagnosis leading to admission who subsequently acquired COVID-19, complete these observations for the 24 hours after onset of symptoms of suspected or confirmed COVID-19 infection.
Datatype
float
Alias
- UMLS CUI [1]
- C0005903
Beschrijving
Please enter the peripheral body temperature (rectal if < 3 months) in the space provided and indicate the unit of measurement, either degrees Celsius (°C) or Fahrenheit (°F).
Datatype
integer
Alias
- UMLS CUI [1,1]
- C0005903
- UMLS CUI [1,2]
- C1519795
Beschrijving
Enter the heart rate measured in beats per minute. This may be measured manually or by electronic monitoring.
Datatype
integer
Maateenheden
- beats per minute
Alias
- UMLS CUI [1]
- C0018810
Beschrijving
Enter the respiratory rate in breaths per minute. Manual rather than electronic measurement is preferred where possible (this is achieved by counting the number of breaths for one minute, counting how many times the chest rises within this time period). Record the highest respiratory rate documented on admission.
Datatype
integer
Maateenheden
- breaths per minute
Alias
- UMLS CUI [1]
- C0231832
Beschrijving
Please enter the systolic blood pressure measured in millimetres of mercury (mmHg), in the relevant sections. For example, if the blood pressure is 120/85 mmHg, enter 120 in the section marked ‘systolic BP’. Use any recognised method for measuring blood pressure.
Datatype
integer
Maateenheden
- mmHg
Alias
- UMLS CUI [1]
- C0871470
Beschrijving
Please enter the diastolic blood pressure measured in millimetres of mercury (mmHg), in the relevant sections. For example, if the blood pressure is 120/85 mmHg, enter 85 in the section marked ‘diastolic BP’. Use any recognised method for measuring blood pressure.
Datatype
integer
Maateenheden
- mmHg
Alias
- UMLS CUI [1]
- C0428883
Beschrijving
For all patients, irrespective of ventilation or supplemental oxygen requirement, please enter the percentage oxygen saturation (the percentage of haemoglobin binding sites in the bloodstream occupied by oxygen) at the time of admission. This may be measured by pulse oximetry or by arterial blood gas analysis.
Datatype
integer
Maateenheden
- %
Alias
- UMLS CUI [1]
- C0523807
Beschrijving
Oxygen saturation condition
Datatype
integer
Alias
- UMLS CUI [1,1]
- C0523807
- UMLS CUI [1,2]
- C0449438
Beschrijving
Sternal capillary refill time is measured by pressing on the sternum for five seconds with a finger or thumb until the underlying skin turns white and then noting the time in seconds needed for the colour to return once the pressure is released.
Datatype
integer
Alias
- UMLS CUI [1]
- C1714880
Beschrijving
Height
Datatype
integer
Maateenheden
- cm
Alias
- UMLS CUI [1]
- C0005890
Beschrijving
Weight
Datatype
integer
Maateenheden
- kg
Alias
- UMLS CUI [1]
- C0005910
Beschrijving
Admission signs and symptoms
Alias
- UMLS CUI-1
- C0037088
- UMLS CUI-2
- C0184666
Beschrijving
History of fever
Datatype
integer
Alias
- UMLS CUI [1,1]
- C0015967
- UMLS CUI [1,2]
- C0019664
Beschrijving
Cough
Datatype
integer
Alias
- UMLS CUI [1]
- C0010200
Beschrijving
Sore throat
Datatype
integer
Alias
- UMLS CUI [1]
- C0242429
Beschrijving
Rhinorrhoea
Datatype
integer
Alias
- UMLS CUI [1]
- C1260880
Beschrijving
Wheezing
Datatype
integer
Alias
- UMLS CUI [1]
- C0043144
Beschrijving
Shortness of breath
Datatype
integer
Alias
- UMLS CUI [1]
- C0013404
Beschrijving
Lower chest wall indrawing
Datatype
integer
Alias
- UMLS CUI [1,1]
- C0205076
- UMLS CUI [1,2]
- C0425469
Beschrijving
Chest pain
Datatype
integer
Alias
- UMLS CUI [1]
- C0008031
Beschrijving
Conjunctivitis
Datatype
integer
Alias
- UMLS CUI [1]
- C0009763
Beschrijving
Lymphadenopathy
Datatype
integer
Alias
- UMLS CUI [1]
- C0497156
Beschrijving
Headache
Datatype
integer
Alias
- UMLS CUI [1]
- C0018681
Beschrijving
Loss of smell (Anosmia)
Datatype
integer
Alias
- UMLS CUI [1]
- C0003126
Beschrijving
Loss of taste (Ageusia)
Datatype
integer
Alias
- UMLS CUI [1]
- C2364111
Beschrijving
Seizures
Datatype
integer
Alias
- UMLS CUI [1]
- C0036572
Beschrijving
Fatigue / Malaise
Datatype
integer
Alias
- UMLS CUI [1]
- C0024528
Beschrijving
Anorexia
Datatype
integer
Alias
- UMLS CUI [1]
- C0003123
Beschrijving
Altered consciousness/confusion
Datatype
integer
Alias
- UMLS CUI [1]
- C0150450
- UMLS CUI [2]
- C0009676
Beschrijving
Muscle aches
Datatype
integer
Alias
- UMLS CUI [1]
- C0231528
Beschrijving
Joint pain
Datatype
integer
Alias
- UMLS CUI [1]
- C0003862
Beschrijving
Inability to walk
Datatype
integer
Alias
- UMLS CUI [1]
- C0560046
Beschrijving
Abdominal pain
Datatype
integer
Alias
- UMLS CUI [1]
- C0000737
Beschrijving
Diarrhoea
Datatype
integer
Alias
- UMLS CUI [1]
- C0011991
Beschrijving
Vomiting / Nausea
Datatype
integer
Alias
- UMLS CUI [1]
- C0027497
- UMLS CUI [2]
- C0042963
Beschrijving
Skin rash
Datatype
integer
Alias
- UMLS CUI [1]
- C0015230
Beschrijving
Haemorrhage
Datatype
integer
Alias
- UMLS CUI [1]
- C0019080
Beschrijving
Haemorrhage Site
Datatype
text
Alias
- UMLS CUI [1,1]
- C0019080
- UMLS CUI [1,2]
- C1515974
Beschrijving
Other symptom(s)
Datatype
integer
Alias
- UMLS CUI [1,1]
- C1457887
- UMLS CUI [1,2]
- C0205394
Beschrijving
Other symptom(s)
Datatype
text
Alias
- UMLS CUI [1,1]
- C1457887
- UMLS CUI [1,2]
- C0205394
Beschrijving
Pre-admission medication (taken within 14 days of admission/presentation at healthcare facility)
Alias
- UMLS CUI-1
- C0559269
- UMLS CUI-2
- C0013227
- UMLS CUI-3
- C0332285
- UMLS CUI-4
- C5142984
Beschrijving
Include alacepril, captopril, zefnopril, enalapril, ramipril, quinapril, perindopril, lisinopril, benazepril, imidapril, trandolapril, and cilazapril.
Datatype
integer
Alias
- UMLS CUI [1]
- C0003015
Beschrijving
Examples include losartan, irbesartan, olmesartan, candesartan, valsartan, fimasartan, azilsartan, saprisartan and telmisartan
Datatype
integer
Alias
- UMLS CUI [1]
- C0521942
Beschrijving
Examples include aspirin, ibuprofen, naproxen, celecoxib, diclofenac, diflunisal, etodolac, indomethacin, ketoprofen, ketorolac, nabumetone, oxaprozin, piroxicam, salsalate, sulindac, tolmetin
Datatype
integer
Alias
- UMLS CUI [1]
- C0003211
Beschrijving
Examples include prednisolone, betamethasone, dexamethasone, hydrocortisone, methylprednisolone, deflazacort and fludrocortisone. Only list medications taken orally. Please list generic names.
Datatype
integer
Alias
- UMLS CUI [1,1]
- C0038317
- UMLS CUI [1,2]
- C1527415
Beschrijving
Examples include prednisolone, betamethasone, dexamethasone, hydrocortisone, methylprednisolone, deflazacort and fludrocortisone. Only list medications taken orally. Please list generic names.
Datatype
text
Alias
- UMLS CUI [1,1]
- C0038317
- UMLS CUI [1,2]
- C1527415
- UMLS CUI [1,3]
- C2348235
Beschrijving
Examples include tofacitinib, cyclosporine, tacrolimus, sirolimus, everolimus, azathioprine, leflunomide, mycophenolate and biologics such as abatacept, adalimumab, anakinra, certolizumab, etanercept, adalimumab, infliximab and rituximab. Please list generic names.
Datatype
integer
Alias
- UMLS CUI [1,1]
- C0021081
- UMLS CUI [1,2]
- C0205394
Beschrijving
Examples include tofacitinib, cyclosporine, tacrolimus, sirolimus, everolimus, azathioprine, leflunomide, mycophenolate and biologics such as abatacept, adalimumab, anakinra, certolizumab, etanercept, adalimumab, infliximab and rituximab. Please list generic names.
Datatype
text
Alias
- UMLS CUI [1,1]
- C0021081
- UMLS CUI [1,2]
- C0205394
- UMLS CUI [1,3]
- C2348235
Beschrijving
Examples include ribavirin, lopinavir, ritonavir, remdesivir, oseltamivir, zanamivir, acyclovir, ganciclovir, and interferons. Please list generic names. Topical preparations should not be recorded.
Datatype
integer
Alias
- UMLS CUI [1]
- C0003451
Beschrijving
Examples include ribavirin, lopinavir, ritonavir, remdesivir, oseltamivir, zanamivir, acyclovir, ganciclovir, and interferons. Please list generic names. Topical preparations should not be recorded.
Datatype
text
Alias
- UMLS CUI [1,1]
- C0003451
- UMLS CUI [1,2]
- C2348235
Beschrijving
‘Antibiotic’ refers to any agent(s) that selectively target bacteria. Please list generic names. Topical preparations should not be recorded.
Datatype
integer
Alias
- UMLS CUI [1]
- C0003232
Beschrijving
‘Antibiotic’ refers to any agent(s) that selectively target bacteria. Please list generic names. Topical preparations should not be recorded.
Datatype
text
Alias
- UMLS CUI [1,1]
- C0003232
- UMLS CUI [1,2]
- C2348235
Beschrijving
Includes for example: chloroquine, hydroxychloroquine, Interferon antibodies, convalescent plasma or any other COVID-19 therapeutics not included in the categories listed above. Please list generic names.
Datatype
integer
Alias
- UMLS CUI [1,1]
- C0205394
- UMLS CUI [1,2]
- C5203670
- UMLS CUI [1,3]
- C0013227
Beschrijving
Includes for example: chloroquine, hydroxychloroquine, Interferon antibodies, convalescent plasma or any other COVID-19 therapeutics not included in the categories listed above. Please list generic names.
Datatype
text
Alias
- UMLS CUI [1,1]
- C0205394
- UMLS CUI [1,2]
- C5203670
- UMLS CUI [1,3]
- C0013227
- UMLS CUI [1,4]
- C2348235
Beschrijving
Co-morbidities and risk factors
Alias
- UMLS CUI-1
- C0009488
- UMLS CUI-2
- C0035648
Beschrijving
Please include any of coronary artery disease, heart failure, congenital heart disease, cardiomyopathy, rheumatic heart disease. For all items in this group: Please record if any of these comorbidities existed prior to admission. In general, do not include past comorbidities that are no longer ongoing. Additional details are given below. Where example conditions are given, these are not intended to be exhaustive and other conditions of equivalent severity should be included.
Datatype
integer
Alias
- UMLS CUI [1]
- C1290386
Beschrijving
Elevated arterial blood pressure diagnosed clinically, >140mmHg systolic or >90mmHg diastolic.
Datatype
integer
Alias
- UMLS CUI [1]
- C0020538
Beschrijving
Please include any of chronic obstructive pulmonary disease (chronic bronchitis, emphysema), cystic fibrosis, bronchiectasis, interstitial lung disease, pre-existing requirement for long term oxygen therapy. Do not include asthma.
Datatype
integer
Alias
- UMLS CUI [1,1]
- C0746102
- UMLS CUI [1,2]
- C0332300
- UMLS CUI [1,3]
- C0004096
Beschrijving
Clinician-diagnosed asthma
Datatype
integer
Alias
- UMLS CUI [1]
- C0004096
Beschrijving
Please include any of clinician-diagnosed chronic kidney disease, chronic estimated glomerular filtration rate < 60 mL/min/1.73 squaremetre , history of kidney transplantation
Datatype
integer
Alias
- UMLS CUI [1]
- C1561643
Beschrijving
This is defined as cirrhosis with portal hypertension, with or without bleeding or a history of variceal bleeding
Datatype
integer
Alias
- UMLS CUI [1,1]
- C0023895
- UMLS CUI [1,2]
- C0205081
- UMLS CUI [2,1]
- C0205082
- UMLS CUI [2,2]
- C0023895
Beschrijving
This is defined as cirrhosis without portal hypertension or chronic hepatitis
Datatype
integer
Alias
- UMLS CUI [1,1]
- C2945599
- UMLS CUI [1,2]
- C0023895
Beschrijving
Please include any of splenectomy, non-functional spleen, and congenital asplenia.
Datatype
integer
Alias
- UMLS CUI [1]
- C3810472
Beschrijving
Please include any of cerebral palsy, multiple sclerosis, motor neurone disease, muscular dystrophy, myasthenia gravis, Parkinson’s disease, stroke, severe learning difficulty
Datatype
integer
Alias
- UMLS CUI [1,1]
- C0027765
- UMLS CUI [1,2]
- C0008679
Beschrijving
Current solid organ or haematological malignancy. Please do not include malignancies that have been declared ‘cured’ ≥5 years ago with no evidence of ongoing disease. Do not include non- melanoma skin cancers. Do not include benign growths or dysplasia.
Datatype
integer
Alias
- UMLS CUI [1]
- C0006826
Beschrijving
Any long-term disorder of the red or white blood cells, platelets or coagulation system requiring regular or intermittent treatment. Do not include leukaemia, lymphoma or myeloma, which should be entered under malignancy. Do not include iron-deficiency anaemia which is explained by diet or chronic blood loss.
Datatype
integer
Alias
- UMLS CUI [1]
- C1275398
Beschrijving
History of laboratory-confirmed HIV infection.
Datatype
integer
Alias
- UMLS CUI [1]
- C0019693
- UMLS CUI [2]
- C0001175
Beschrijving
This refers to patients for whom an attending clinician has assessed them to be obese - ideally but not necessarily with an objective measurement of obesity, such as calculation of the body mass index (BMI of 30 or more) or measurement of abdominal girth.
Datatype
integer
Alias
- UMLS CUI [1]
- C0028754
Beschrijving
Type 1 or Type 2 diabetes mellitus requiring oral or subcutaneous treatment. Please indicate whether type 1 or type 2.
Datatype
integer
Alias
- UMLS CUI [1]
- C0011849
Beschrijving
This is defined as an inflammatory and degenerative diseases of connective tissue structures. It includes chronic arthropathies and arthritis, connective tissue disorders and vasculitides.
Datatype
integer
Alias
- UMLS CUI [1,1]
- C0035452
- UMLS CUI [1,2]
- C0012634
Beschrijving
This is defined as clinical diagnosis of dementia
Datatype
integer
Alias
- UMLS CUI [1]
- C0497327
Beschrijving
Patients currently receiving treatment for tuberculosis. Do not include latent tuberculosis.
Datatype
integer
Alias
- UMLS CUI [1]
- C0041296
Beschrijving
Any clinically identified deficiency in intake, either of total energy or of specific nutrients that led to a dietetic intervention or referral prior to the onset of COVID-19 symptoms. Do not include people who needed supplementary nutrition solely due to reduced intake during their current illness episode.
Datatype
integer
Alias
- UMLS CUI [1]
- C0162429
Beschrijving
Smoking at least one cigarette, cigar, pipe or equivalent per day before the onset of the current illness. Do not include smoke-free tobacco products such as chewed tobacco or electronic nicotine delivery devices.
Datatype
integer
Alias
- UMLS CUI [1]
- C1519386
Beschrijving
List any significant risk factors or comorbidities that existed prior to admission, are ongoing, that are not already listed.
Datatype
integer
Alias
- UMLS CUI [1,1]
- C0035648
- UMLS CUI [1,2]
- C0205394
Beschrijving
List any significant risk factors or comorbidities that existed prior to admission, are ongoing, that are not already listed.
Datatype
text
Alias
- UMLS CUI [1,1]
- C0035648
- UMLS CUI [1,2]
- C0205394
- UMLS CUI [1,3]
- C2348235
Similar models
MODULE 1: PRESENTATION/ADMISSION CASE REPORT FORM
- StudyEvent: ODMjoin
C0243161 (UMLS CUI-2)
C0030673 (UMLS CUI [1,2])
C3838696 (UMLS CUI [1,3])
C0392360 (UMLS CUI [2,1])
C0030673 (UMLS CUI [2,2])
C0206750 (UMLS CUI [2,3])
C0456369 (UMLS CUI [2,4])
C0027365 (UMLS CUI [1,2])
C0011008 (UMLS CUI [1,2])
C0205435 (UMLS CUI [2,1])
C5203670 (UMLS CUI [2,2])
C2985720 (UMLS CUI [2,3])
C0015031 (UMLS CUI [1,2])
C0015031 (UMLS CUI [1,2])
C0015031 (UMLS CUI [1,2])
C2348235 (UMLS CUI [1,3])
C0015031 (UMLS CUI [1,2])
C0018724 (UMLS CUI [1,2])
C0181826 (UMLS CUI [1,2])
C1510829 (UMLS CUI [1,2])
C1510828 (UMLS CUI [1,2])
C0022885 (UMLS CUI [1,2])
C0884358 (UMLS CUI [1,3])
C5203676 (UMLS CUI [1,4])
C1254360 (UMLS CUI [1,2])
C5203676 (UMLS CUI [1,3])
C0439148 (UMLS CUI [1,2])
C0005612 (UMLS CUI [2,1])
C0439673 (UMLS CUI [2,2])
C0005612 (UMLS CUI [3,1])
C0439148 (UMLS CUI [3,2])
C0439673 (UMLS CUI [3,3])
C1548787 (UMLS CUI [1,2])
C0001779 (UMLS CUI [1,3])
C1443394 (UMLS CUI [2,1])
C1548787 (UMLS CUI [2,2])
C0454664 (UMLS CUI [2,3])
C0205435 (UMLS CUI [1,2])
C1457887 (UMLS CUI [1,3])
C4264524 (UMLS CUI [1,2])
C4264524 (UMLS CUI [1,2])
C2348235 (UMLS CUI [1,3])
C0184666 (UMLS CUI-2)
C0449438 (UMLS CUI [1,2])
C0184666 (UMLS CUI-2)
C0425469 (UMLS CUI [1,2])
C0009676 (UMLS CUI [2])
C1515974 (UMLS CUI [1,2])
C0205394 (UMLS CUI [1,2])
C0013227 (UMLS CUI-2)
C0332285 (UMLS CUI-3)
C5142984 (UMLS CUI-4)
C1527415 (UMLS CUI [1,2])
C2348235 (UMLS CUI [1,3])
C0205394 (UMLS CUI [1,2])
C0205394 (UMLS CUI [1,2])
C2348235 (UMLS CUI [1,3])
C2348235 (UMLS CUI [1,2])
C2348235 (UMLS CUI [1,2])
C5203670 (UMLS CUI [1,2])
C0013227 (UMLS CUI [1,3])
C5203670 (UMLS CUI [1,2])
C0013227 (UMLS CUI [1,3])
C2348235 (UMLS CUI [1,4])
C0035648 (UMLS CUI-2)
C0332300 (UMLS CUI [1,2])
C0004096 (UMLS CUI [1,3])
C0205081 (UMLS CUI [1,2])
C0205082 (UMLS CUI [2,1])
C0023895 (UMLS CUI [2,2])
C0023895 (UMLS CUI [1,2])
C0008679 (UMLS CUI [1,2])
C0012634 (UMLS CUI [1,2])
C0205394 (UMLS CUI [1,2])
C0205394 (UMLS CUI [1,2])
C2348235 (UMLS CUI [1,3])