ID

41778

Description

This CRF is set up in modules to be used for recording data on the ISARIC COVID-19 Core Database or for independent studies. Complete on the day of admission or first COVID-19 investigation, and on the first day of ICU admission (if different from day of admission). In addition, depending on available resources, complete every day for a maximum of 14 days, or for days when biochemical results are available. 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/

Keywords

Versions (1)
  1. 1/18/21 1/18/21 -
Copyright Holder

ISARIC on behalf of Oxford University

Uploaded on

January 18, 2021

DOI

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License

Creative Commons BY-SA 4.0
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ISARIC/WHO Novel Coronavirus (nCoV) / COVID-19 Case Report Form

English

Module 2: Daily Case Report Form (CRF)

1 forms  
Administrative documentation
Description

Administrative documentation

Alias
UMLS CUI-1
C1320722
Participant identification #
Description

Participant identification

Data type

text

Alias
UMLS CUI [1]
C3165543
Date of assessment
Description

Date of assessment

Data type

date

Alias
UMLS CUI [1]
C2985720
Signs and symptoms
Description

Signs and symptoms

Alias
UMLS CUI-1
C0037088
Temperature
Description

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).

Data type

float

Alias
UMLS CUI [1]
C0005903
Temperature unit
Description

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).

Data type

integer

Alias
UMLS CUI [1,1]
C0005903
UMLS CUI [1,2]
C1519795
Heart Rate (HR):
Description

Enter the heart rate measured in beats per minute. This may be measured manually or by electronic monitoring.

Data type

integer

Measurement units
  • beats per minute
Alias
UMLS CUI [1]
C0018810
beats per minute
Respiratory rate (RR)
Description

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.

Data type

integer

Measurement units
  • breaths per minute
Alias
UMLS CUI [1]
C0231832
breaths per minute
Systolic blood pressure
Description

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.

Data type

integer

Measurement units
  • mmHg
Alias
UMLS CUI [1]
C0871470
mmHg
Diastolic blood pressure
Description

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.

Data type

integer

Measurement units
  • mmHg
Alias
UMLS CUI [1]
C0428883
mmHg
Oxygen saturation SaO2
Description

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.

Data type

integer

Measurement units
  • Percent
Alias
UMLS CUI [1]
C0523807
Percent
Any supplemental oxygen: FiO2 (0.21-1.0)
Description

This is a key indicator to complete for all patients. If the patient received any form of supplemental oxygen through a mask or nasal cannula that delivers a known concentration of oxygen or is being ventilated, please provide the fraction of inspired oxygen (FiO2) delivered. For patients receiving oxygen through any means, such as a face mask or nasal cannula, that does not deliver a known oxygen concentration provide the maximum flow rate received on day of completion in L/min.

Data type

float

Alias
UMLS CUI [1,1]
C4534306
UMLS CUI [1,2]
C0428167
Any supplemental oxygen: FiO2 unit
Description

This is a key indicator to complete for all patients. If the patient received any form of supplemental oxygen through a mask or nasal cannula that delivers a known concentration of oxygen or is being ventilated, please provide the fraction of inspired oxygen (FiO2) delivered. For patients receiving oxygen through any means, such as a face mask or nasal cannula, that does not deliver a known oxygen concentration provide the maximum flow rate received on day of completion in L/min.

Data type

integer

Alias
UMLS CUI [1,1]
C4534306
UMLS CUI [1,2]
C0428167
UMLS CUI [1,3]
C1519795
Sternal capillary refill time >2seconds
Description

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.

Data type

integer

Alias
UMLS CUI [1]
C1714880
AVPU: Alert
Description

Alert – responding to voice – responding to pain – unresponsive: please state the least responsive condition of the patient during the calendar day (not counting normal sleep). On day of admission record the value as close to admission as possible before treatments have been administered. For daily records, if the patient is being sedated on the day of assessment record the value before the sedation.

Data type

integer

Alias
UMLS CUI [1,1]
C3665546
UMLS CUI [1,2]
C5205979
AVPU: Verbal
Description

Alert – responding to voice – responding to pain – unresponsive: please state the least responsive condition of the patient during the calendar day (not counting normal sleep). On day of admission record the value as close to admission as possible before treatments have been administered. For daily records, if the patient is being sedated on the day of assessment record the value before the sedation.

Data type

integer

Alias
UMLS CUI [1,1]
C5205979
UMLS CUI [1,2]
C3846697
AVPU: Pain
Description

Alert – responding to voice – responding to pain – unresponsive: please state the least responsive condition of the patient during the calendar day (not counting normal sleep). On day of admission record the value as close to admission as possible before treatments have been administered. For daily records, if the patient is being sedated on the day of assessment record the value before the sedation.

Data type

integer

Alias
UMLS CUI [1,1]
C5205979
UMLS CUI [1,2]
C1960712
AVPU: Unresponsive
Description

Alert – responding to voice – responding to pain – unresponsive: please state the least responsive condition of the patient during the calendar day (not counting normal sleep). On day of admission record the value as close to admission as possible before treatments have been administered. For daily records, if the patient is being sedated on the day of assessment record the value before the sedation.

Data type

integer

Alias
UMLS CUI [1,1]
C5205979
UMLS CUI [1,2]
C0857494
Glasgow Coma Score (GCS / 15)
Description

Please state the lowest GCS recorded. For intubated patients and patients with a non-fenestrated tracheostomy, give 1 point for the voice component and calculate the total as usual. Suffixes such as t for tracheostomy cannot be entered on to the database. Glasgow Coma Score: https://www.glasgowcomascale.org/downloads/GCS-Assessment-Aid-English.pdf?v=3

Data type

integer

Alias
UMLS CUI [1]
C0017594
Is the patient currently receiving, or has received (between 00:00 to 24:00 on day of assessment)
Description

Is the patient currently receiving, or has received (between 00:00 to 24:00 on day of assessment)

Alias
UMLS CUI-1
C0087111
High-flow nasal cannula oxygen therapy?
Description

High-flow nasal cannula oxygen therapy

Data type

integer

Alias
UMLS CUI [1,1]
C1960097
UMLS CUI [1,2]
C0521116
UMLS CUI [2,1]
C1960097
UMLS CUI [2,2]
C0347984
UMLS CUI [2,3]
C0220825
UMLS CUI [2,4]
C1948053
Non-invasive ventilation (Any)?
Description

Non-invasive ventilation

Data type

integer

Alias
UMLS CUI [1,1]
C1997883
UMLS CUI [1,2]
C0521116
UMLS CUI [2,1]
C1997883
UMLS CUI [2,2]
C0347984
UMLS CUI [2,3]
C0220825
UMLS CUI [2,4]
C1948053
NIV - If Yes:
Description

Non-invasive ventilation

Data type

integer

Alias
UMLS CUI [1,1]
C1997883
UMLS CUI [1,2]
C2348235
Invasive ventilation?
Description

Invasive ventilation

Data type

integer

Alias
UMLS CUI [1,1]
C1868981
UMLS CUI [1,2]
C0521116
UMLS CUI [2,1]
C1868981
UMLS CUI [2,2]
C0347984
UMLS CUI [2,3]
C0220825
UMLS CUI [2,4]
C1948053
Prone positioning?
Description

Prone positioning

Data type

integer

Alias
UMLS CUI [1,1]
C0033422
UMLS CUI [1,2]
C0521116
UMLS CUI [2,1]
C0033422
UMLS CUI [2,2]
C0347984
UMLS CUI [2,3]
C0220825
UMLS CUI [2,4]
C1948053
Inhaled Nitric Oxide?
Description

Inhaled Nitric Oxide

Data type

integer

Alias
UMLS CUI [1,1]
C1135443
UMLS CUI [1,2]
C0521116
UMLS CUI [2,1]
C1135443
UMLS CUI [2,2]
C0347984
UMLS CUI [2,3]
C0220825
UMLS CUI [2,4]
C1948053
Tracheostomy inserted?
Description

Tracheostomy inserted

Data type

integer

Alias
UMLS CUI [1,1]
C0040590
UMLS CUI [1,2]
C0521116
UMLS CUI [2,1]
C0040590
UMLS CUI [2,2]
C0347984
UMLS CUI [2,3]
C0220825
UMLS CUI [2,4]
C1948053
Extra corporeal life support (ECLS/ ECMO)?
Description

Extra corporeal life support (ECLS/ECMO)

Data type

integer

Alias
UMLS CUI [1,1]
C3869463
UMLS CUI [1,2]
C0521116
UMLS CUI [2,1]
C3869463
UMLS CUI [2,2]
C0347984
UMLS CUI [2,3]
C0220825
UMLS CUI [2,4]
C1948053
ECLS/ECMO - If Yes:
Description

Extra corporeal life support (ECLS) specification

Data type

integer

Alias
UMLS CUI [1,1]
C3869463
UMLS CUI [1,2]
C2348235
Renal replacement therapy (RRT) or dialysis?
Description

Renal replacement therapy (RRT) / dialysis

Data type

integer

Alias
UMLS CUI [1,1]
C0206074
UMLS CUI [1,2]
C0521116
UMLS CUI [2,1]
C0206074
UMLS CUI [2,2]
C0347984
UMLS CUI [2,3]
C0220825
UMLS CUI [2,4]
C1948053
UMLS CUI [3,1]
C0011946
UMLS CUI [3,2]
C0521116
UMLS CUI [4,1]
C0011946
UMLS CUI [4,2]
C0347984
UMLS CUI [4,3]
C0220825
UMLS CUI [4,4]
C1948053
Any vasopressor/inotropic support?
Description

Any vasopressor/inotropic support

Data type

integer

Alias
UMLS CUI [1,1]
C0304509
UMLS CUI [1,2]
C0521116
UMLS CUI [2,1]
C0304509
UMLS CUI [2,2]
C0347984
UMLS CUI [2,3]
C0220825
UMLS CUI [2,4]
C1948053
UMLS CUI [3,1]
C0042397
UMLS CUI [3,2]
C0521116
UMLS CUI [4,1]
C0042397
UMLS CUI [4,2]
C0347984
UMLS CUI [4,3]
C0220825
UMLS CUI [4,4]
C1948053
Dopamine <5μg/kg/min OR Dobutamine OR milrinone OR levosimendan:
Description

Vasopressor/inotropic support: Dopamine, Dobutamine, Milrinone , Levosimendan:

Data type

boolean

Alias
UMLS CUI [1,1]
C0013030
UMLS CUI [1,2]
C0521116
UMLS CUI [2,1]
C0013030
UMLS CUI [2,2]
C0347984
UMLS CUI [2,3]
C0220825
UMLS CUI [2,4]
C1948053
UMLS CUI [3,1]
C0012963
UMLS CUI [3,2]
C0521116
UMLS CUI [4,1]
C0012963
UMLS CUI [4,2]
C0347984
UMLS CUI [4,3]
C0220825
UMLS CUI [4,4]
C1948053
UMLS CUI [5,1]
C0128513
UMLS CUI [5,2]
C0521116
UMLS CUI [6,1]
C0128513
UMLS CUI [6,2]
C0347984
UMLS CUI [6,3]
C0220825
UMLS CUI [6,4]
C1948053
UMLS CUI [7,1]
C0246904
UMLS CUI [7,2]
C0521116
UMLS CUI [8,1]
C0246904
UMLS CUI [8,2]
C0347984
UMLS CUI [8,3]
C0220825
UMLS CUI [8,4]
C1948053
Dopamine 5-15μg/kg/min OR Epinephrine/Norepinephrine < 0.1μg/kg/min OR vasopressin OR phenylephrine:
Description

Vasopressor/inotropic support: Dopamine, Epinephrine/Norepinephrine, vasopressin, phenylephrin

Data type

boolean

Alias
UMLS CUI [1,1]
C0014563
UMLS CUI [1,2]
C0521116
UMLS CUI [2,1]
C0014563
UMLS CUI [2,2]
C0347984
UMLS CUI [2,3]
C0220825
UMLS CUI [2,4]
C1948053
UMLS CUI [3,1]
C0042413
UMLS CUI [3,2]
C0521116
UMLS CUI [4,1]
C0042413
UMLS CUI [4,2]
C0347984
UMLS CUI [4,3]
C0220825
UMLS CUI [4,4]
C1948053
UMLS CUI [5,1]
C0013030
UMLS CUI [5,2]
C0521116
UMLS CUI [6,1]
C0013030
UMLS CUI [6,2]
C0347984
UMLS CUI [6,3]
C0220825
UMLS CUI [6,4]
C1948053
UMLS CUI [7,1]
C0031469
UMLS CUI [7,2]
C0521116
UMLS CUI [8,1]
C0031469
UMLS CUI [8,2]
C0347984
UMLS CUI [8,3]
C0220825
UMLS CUI [8,4]
C1948053
Dopamine >15μg/k/min OR Epinephrine/Norepinephrine > 0.1μg/kg/min:
Description

Vasopressor/inotropic support: Dopamine, Epinephrine/Norepinephrine

Data type

boolean

Alias
UMLS CUI [1,1]
C0014563
UMLS CUI [1,2]
C0521116
UMLS CUI [2,1]
C0014563
UMLS CUI [2,2]
C0347984
UMLS CUI [2,3]
C0220825
UMLS CUI [2,4]
C1948053
UMLS CUI [3,1]
C0028351
UMLS CUI [3,2]
C0521116
UMLS CUI [4,1]
C0028351
UMLS CUI [4,2]
C0347984
UMLS CUI [4,3]
C0220825
UMLS CUI [4,4]
C1948053
UMLS CUI [5,1]
C0013030
UMLS CUI [5,2]
C0521116
UMLS CUI [6,1]
C0013030
UMLS CUI [6,2]
C0347984
UMLS CUI [6,3]
C0220825
UMLS CUI [6,4]
C1948053
Neuromuscular blocking agents?
Description

Neuromuscular blocking agents

Data type

integer

Alias
UMLS CUI [1,1]
C0027866
UMLS CUI [1,2]
C0521116
UMLS CUI [2,1]
C0027866
UMLS CUI [2,2]
C0347984
UMLS CUI [2,3]
C0220825
UMLS CUI [2,4]
C1948053
Other intervention(s) or procedure(s)?
Description

Other intervention or procedure

Data type

integer

Alias
UMLS CUI [1,1]
C0205394
UMLS CUI [1,2]
C0184661
UMLS CUI [1,3]
C0521116
UMLS CUI [2,1]
C0205394
UMLS CUI [2,2]
C0184661
UMLS CUI [2,3]
C0347984
UMLS CUI [2,4]
C0220825
UMLS CUI [2,5]
C1948053
UMLS CUI [3,1]
C0205394
UMLS CUI [3,2]
C0087111
UMLS CUI [3,3]
C0521116
UMLS CUI [4,1]
C0205394
UMLS CUI [4,2]
C0087111
UMLS CUI [4,3]
C0347984
UMLS CUI [4,4]
C0220825
UMLS CUI [4,5]
C1948053
If "Yes", specify the other intervention or procedure the patient received or is receiving:
Description

Other intervention or procedure Specification

Data type

text

Alias
UMLS CUI [1,1]
C0205394
UMLS CUI [1,2]
C0184661
UMLS CUI [1,3]
C2348235
UMLS CUI [2,1]
C0205394
UMLS CUI [2,2]
C0087111
UMLS CUI [2,3]
C2348235
Record the worst value on day of assessment
Description

Record the worst value on day of assessment

Alias
UMLS CUI-1
C0037088
Current admission to ICU/ITU/IMC/HDU?
Description

If the patient has been admitted to an intensive care, intensive therapy, intermediate care or high dependency unit please tick ‘yes’. If the patient is on a general care ward then select ‘no’ or ‘Unknown’.

Data type

integer

Alias
UMLS CUI [1,1]
C0521116
UMLS CUI [1,2]
C0583239
UMLS CUI [2,1]
C0521116
UMLS CUI [2,2]
C4489279
UMLS CUI [2,3]
C0184666
UMLS CUI [3,1]
C0521116
UMLS CUI [3,2]
C1301858
PaO2 (at time nearest to the FiO2 recorded at top of page):
Description

PaO2 (partial pressure of oxygen in blood) as determined by arterial/ capillary blood gas analysis. This PaO2 must correspond with the oxygen therapy documented in the FiO2 field. Please fill in the lowest value in either mmHg or kPa depending on the output of your blood gas analyser. If the PaO2 is not known, place NA in the data field.

Data type

integer

Alias
UMLS CUI [1]
C0391840
PaO2 unit
Description

PaO2 unit

Data type

integer

Alias
UMLS CUI [1,1]
C0391840
UMLS CUI [1,2]
C1519795
PaO2 not done
Description

PaO2 not done

Data type

boolean

Alias
UMLS CUI [1,1]
C0391840
UMLS CUI [1,2]
C0347984
UMLS CUI [1,3]
C0428167
UMLS CUI [1,4]
C1272696
PaO2 sample type
Description

PaO2 sample type

Data type

integer

Alias
UMLS CUI [1,1]
C0391840
UMLS CUI [1,2]
C2347029
From same blood gas record as PaO2: PCO2
Description

PaCO2 is the partial pressure of carbon dioxide measured in the sample. pH is the measure of the activity of the (solvated) hydrogen ion (H+) measured in the sample. HCO3- refers to the bicarbonate measured in the blood gas sample. Base excess refers to standardised base excess (SBE). If standardised base excess is not reported, enter the base excess value presented, this can be either a positive or negative value.

Data type

integer

Alias
UMLS CUI [1]
C1822070
PCO2 unit
Description

PCO2 unit

Data type

integer

Alias
UMLS CUI [1,1]
C1822070
UMLS CUI [1,2]
C1519795
pH
Description

pH

Data type

float

Alias
UMLS CUI [1]
C0020283
Bicarbonate
Description

Bicarbonate

Data type

integer

Measurement units
  • mEq/L
Alias
UMLS CUI [1]
C0005367
mEq/L
Base excess
Description

Record the worst value (within the previous 24 hours (if Not Available write ‘N/A’). Base excess refers to standardised base excess (SBE). If standardised base excess is not reported, enter the base excess value presented, this can be either a positive or negative value.

Data type

integer

Measurement units
  • mmol/L
Alias
UMLS CUI [1]
C0201985
mmol/L
Richmond Agitation-Sedation Scale (RASS)
Description

RASS – If done, enter the lowest calculated value (between -5 and 4) on the date of assessment. Alternatively record SAS.

Data type

integer

Alias
UMLS CUI [1,1]
C4720839
UMLS CUI [1,2]
C0449820
Riker Sedation-Agitation Scale
Description

SAS - If done, enter the lowest calculated value (between 1 and 7) on the date of assessment. Alternatively record RASS

Data type

integer

Alias
UMLS CUI [1,1]
C3846158
UMLS CUI [1,2]
C0449820
Richmond Sedation-Agitation Scale or Riker Sedation-Agitation Scale: score unknown
Description

SAS or RASS score unknown

Data type

boolean

Alias
UMLS CUI [1,1]
C4720839
UMLS CUI [1,2]
C0449820
UMLS CUI [1,3]
C0439673
UMLS CUI [2,1]
C3846158
UMLS CUI [2,2]
C0449820
UMLS CUI [2,3]
C0439673
Mean Arterial Blood Pressure value
Description

Record the worst value (within the previous 24 hours)

Data type

integer

Measurement units
  • mmHg
Alias
UMLS CUI [1]
C0428886
mmHg
Mean Arterial Blood Pressure unknown
Description

Mean Arterial Blood Pressure unknown

Data type

boolean

Alias
UMLS CUI [1,1]
C0428886
UMLS CUI [1,2]
C0439673
Urin flow rate
Description

Record the worst value (within the previous 24 hours)

Data type

integer

Measurement units
  • mL/24 hours
Alias
UMLS CUI [1]
C1287804
mL/24 hours
Urin flow rate estimated or unknown
Description

Urinary flow rate estimated or unknown

Data type

integer

Alias
UMLS CUI [1,1]
C0429783
UMLS CUI [1,2]
C0439673
UMLS CUI [2,1]
C0429783
UMLS CUI [2,2]
C0750572
Laboratory Results (on admission, on any admission to ICU, then daily) – complete every line
Description

Laboratory Results (on admission, on any admission to ICU, then daily) – complete every line

Alias
UMLS CUI-1
C1254595
Date of assessment
Description

To all following items: Please record all laboratory results available on day of admission, or the day that COVID-19 was first clinically suspected in patients already admitted to hospital, and on day of admission to ICU/HDU. For daily records: record the date of assessment as the day the blood sample/s were taken.. If the unit of measurement is not shown on the paper form it will likely appear in the dropdown list in the eCRF. If you cannot find the correct unit on the eCRF please use a unit converter, such as: http://unitslab.com/ or equivalent or email ncov@isaric.org to let us know. ‘Worst value’ refers to values furthest from the normal physiological range or laboratory normal range. Results that were rejected by the clinical team (e.g. haemolysed blood samples, contaminated microbiology results) should not be reported.

Data type

date

Alias
UMLS CUI [1]
C2985720
Haemoglobin
Description

Haemoglobin (Hb or Hgb) refers to haemoglobin concentration measurement in blood.

Data type

integer

Measurement units
  • g/L
Alias
UMLS CUI [1]
C0518015
g/L
Haemoglobin measurement not done
Description

Haemoglobin measurement not done

Data type

boolean

Alias
UMLS CUI [1,1]
C0518015
UMLS CUI [1,2]
C1272696
WBC count
Description

WBC count is the total white blood cell count in blood. Record units if different from those listed

Data type

integer

Measurement units
  • x10^9/L
Alias
UMLS CUI [1]
C0023508
x10^9/L
WBC count not done
Description

WBC count not done

Data type

boolean

Alias
UMLS CUI [1,1]
C0023508
UMLS CUI [1,2]
C1272696
Lymphocyte count
Description

Record units if different from those listed

Data type

integer

Measurement units
  • 10^9/L
Alias
UMLS CUI [1]
C0200635
10^9/L
Lymphocyte count not done
Description

Lymphocyte count not done

Data type

boolean

Alias
UMLS CUI [1,1]
C0200635
UMLS CUI [1,2]
C1272696
Neutrophil count
Description

Record units if different from those listed.

Data type

integer

Measurement units
  • cells/ μL
Alias
UMLS CUI [1]
C0200633
cells/ μL
Neutrophil count not done
Description

Neutrophil count not done

Data type

boolean

Alias
UMLS CUI [1,1]
C0200633
UMLS CUI [1,2]
C1272696
Haematocrit value
Description

Haematocrit (Ht or HCT), also known as packed cell volume (PCV) or erythrocyte volume fraction (EVF), is the volume percentage (%) of red blood cells in blood. Record units if different from those listed.

Data type

integer

Measurement units
  • Percentage
Alias
UMLS CUI [1]
C0518014
Percentage
Haematocrit not done
Description

Haematocrit measurement not done

Data type

boolean

Alias
UMLS CUI [1,1]
C0018935
UMLS CUI [1,2]
C1272696
Platelets value
Description

Record the worst value between 00:00 to 24:00 on day of assessment

Data type

integer

Alias
UMLS CUI [1]
C0032181
Platelets not done
Description

Platelets refers to the platelet count in blood.

Data type

boolean

Alias
UMLS CUI [1,1]
C0032181
UMLS CUI [1,2]
C1272696
APTT
Description

APTT is the activated partial thromboplastin time. Record the highest value. Record units if different from those listed.

Data type

integer

Measurement units
  • seconds
Alias
UMLS CUI [1]
C0030605
seconds
APTT measurement not done
Description

APTT measurement not done

Data type

boolean

Alias
UMLS CUI [1,1]
C0030605
UMLS CUI [1,2]
C1272696
APTR
Description

APTR is the activated partial thromboplastin ratio. Record the highest value.

Data type

integer

Alias
UMLS CUI [1]
C1272061
APTR measurement not done
Description

APTR measurement not done

Data type

boolean

Alias
UMLS CUI [1,1]
C1272061
UMLS CUI [1,2]
C1272696
PT
Description

PT is the prothrombin time. Record the highest value. Record units if different from those listed.

Data type

integer

Measurement units
  • seconds
Alias
UMLS CUI [1]
C0491338
seconds
PT measurement not done
Description

PT measurement not done

Data type

boolean

Alias
UMLS CUI [1,1]
C0491338
UMLS CUI [1,2]
C1272696
INR
Description

INR is the international normalised ratio. Record the highest value. Record units if different from those listed.

Data type

integer

Alias
UMLS CUI [1]
C0525032
INR measurement not done
Description

INR measurement not done

Data type

boolean

Alias
UMLS CUI [1,1]
C0525032
UMLS CUI [1,2]
C1272696
ALT/SGPT
Description

ALT is alanine transaminase (also called serum glutamic pyruvate transaminase, SGPT). Record the highest value. Record units if different from those listed.

Data type

integer

Measurement units
  • U/L
Alias
UMLS CUI [1]
C0201836
U/L
ALT/SGPT measurement not done
Description

ALT/SGPT measurement not done

Data type

boolean

Alias
UMLS CUI [1,1]
C0201836
UMLS CUI [1,2]
C1272696
Total Bilirubin value
Description

Total Bilirubin refers to total bilirubin measured in the blood. Record the highest value. Record units if different from those listed.

Data type

integer

Measurement units
  • μmol/L
Alias
UMLS CUI [1]
C0201913
μmol/L
Total Bilirubin measurement not done
Description

Total Bilirubin measurement not done

Data type

boolean

Alias
UMLS CUI [1,1]
C0201913
UMLS CUI [1,2]
C1272696
AST/SGOT
Description

AST/SGOT is aspartate transaminase (also called serum glutamic oxaloacetic transaminase, SGOT). Record the highest value.

Data type

integer

Measurement units
  • U/L
Alias
UMLS CUI [1]
C0201899
U/L
AST/SGOT measurement not done
Description

AST/SGOT measurement not done

Data type

boolean

Alias
UMLS CUI [1,1]
C0201899
UMLS CUI [1,2]
C1272696
Glucose value
Description

Record units if different from those listed.

Data type

integer

Measurement units
  • mmol/l
Alias
UMLS CUI [1]
C0202042
mmol/l
Glucose measurement not done
Description

Glucose measurement not done

Data type

boolean

Alias
UMLS CUI [1,1]
C0202042
UMLS CUI [1,2]
C1272696
Blood Urea Nitrogen (urea)
Description

Blood urea nitrogen is also known as ‘urea’, measured in a blood sample. Record the highest value. Record units if different from those listed.

Data type

integer

Alias
UMLS CUI [1]
C0005845
Blood Urea Nitrogen (urea) measurement not done
Description

Blood Urea Nitrogen (urea) measurement not done

Data type

boolean

Alias
UMLS CUI [1,1]
C0005845
UMLS CUI [1,2]
C1272696
Lactate
Description

Lactate refers to blood lactate. Record the highest value. Record units if different from those listed.

Data type

integer

Measurement units
  • mmol/L
Alias
UMLS CUI [1]
C0428446
mmol/L
Lactate measurement not done
Description

Lactate measurement not done

Data type

boolean

Alias
UMLS CUI [1,1]
C0428446
UMLS CUI [1,2]
C1272696
Creatinine value
Description

Creatinine refers to serum creatinine. Record the highest value. Record units if different from those listed.

Data type

integer

Measurement units
  • μmol/L
Alias
UMLS CUI [1]
C0201976
μmol/L
Creatinine measurement not done
Description

Creatinine measurement not done

Data type

boolean

Alias
UMLS CUI [1,1]
C0201976
UMLS CUI [1,2]
C1272696
Sodium value
Description

Record units if different from those listed.

Data type

integer

Measurement units
  • mmol/L
Alias
UMLS CUI [1]
C0337443
mmol/L
Sodium measurement not done
Description

Sodium refers to blood sodium.

Data type

boolean

Alias
UMLS CUI [1,1]
C0337443
UMLS CUI [1,2]
C1272696
Potassium value
Description

Record units if different from those listed.

Data type

float

Measurement units
  • mmol/L
Alias
UMLS CUI [1]
C0202194
mmol/L
Potassium measurement not done
Description

Potassium refers to blood potassium.

Data type

boolean

Alias
UMLS CUI [1,1]
C0202194
UMLS CUI [1,2]
C1272696
Procalcitonin value
Description

Procalcitonin or PCT refers to blood procalcitonin. Record the highest value. Record units if different from those listed.

Data type

float

Measurement units
  • ng/mL
Alias
UMLS CUI [1]
C1535922
ng/mL
Procalcitonin measurement not done
Description

Procalcitonin measurement not done

Data type

boolean

Alias
UMLS CUI [1,1]
C1535922
UMLS CUI [1,2]
C1272696
CRP value
Description

CRP is C-reactive protein and refers to the blood (serum or plasma) CRP level. Record the highest value. Record units if different from those listed.

Data type

integer

Measurement units
  • mg/L
Alias
UMLS CUI [1]
C0201657
mg/L
CRP measurement not done
Description

CRP measurement not done

Data type

boolean

Alias
UMLS CUI [1,1]
C0201657
UMLS CUI [1,2]
C1272696
LDH
Description

LDH is lactate dehydrogenase. Record the highest value. Record units if different from those listed.

Data type

integer

Measurement units
  • U/L
Alias
UMLS CUI [1]
C0202113
U/L
LDH measurement not done
Description

Record units if different from those listed.

Data type

boolean

Alias
UMLS CUI [1,1]
C0202113
UMLS CUI [1,2]
C1272696
Creatine kinase measurement
Description

Creatine kinase (CK, or creatine phosphokinase, CPK) refers to total creatine kinase measured in the blood. Record the highest value. Record units if different from those listed.

Data type

integer

Measurement units
  • U/L
Alias
UMLS CUI [1]
C0201973
U/L
Creatine kinase measurement not done
Description

Record units if different from those listed.

Data type

boolean

Alias
UMLS CUI [1,1]
C0201973
UMLS CUI [1,2]
C1272696
Troponin I measurement
Description

Record the highest value. Record units if different from those listed.

Data type

integer

Measurement units
  • ng/mL
Alias
UMLS CUI [1]
C0920210
ng/mL
Troponin I measurement not done
Description

Record units if different from those listed.

Data type

boolean

Alias
UMLS CUI [1,1]
C0920210
UMLS CUI [1,2]
C1272696
D-dimer measurement
Description

Record the highest value. Record units if different from those listed.

Data type

integer

Measurement units
  • mg/L
Alias
UMLS CUI [1]
C2826333
mg/L
D-dimer measurement not done
Description

Record units if different from those listed.

Data type

boolean

Alias
UMLS CUI [1,1]
C2826333
UMLS CUI [1,2]
C1272696
Ferritin measurement
Description

Record the highest value. Record units if different from those listed.

Data type

integer

Measurement units
  • ng/mL
Alias
UMLS CUI [1]
C0373607
ng/mL
Ferritin measurement not done
Description

Record units if different from those listed.

Data type

boolean

Alias
UMLS CUI [1,1]
C0373607
UMLS CUI [1,2]
C1272696
IL-6 measurement
Description

IL-6 is Interleukin 6. Record the highest value. Record units if different from those listed.

Data type

integer

Measurement units
  • pg/mL
Alias
UMLS CUI [1]
C0919829
pg/mL
IL-6 measurement not done
Description

Record units if different from those listed.

Data type

boolean

Alias
UMLS CUI [1,1]
C0919829
UMLS CUI [1,2]
C1272696
Fibrinogen measurement
Description

Record units if different from those listed.

Data type

integer

Measurement units
  • mg/dl
Alias
UMLS CUI [1]
C0016006
mg/dl
Fibrinogen measurement not done
Description

Record units if different from those listed.

Data type

boolean

Alias
UMLS CUI [1,1]
C0016006
UMLS CUI [1,2]
C1272696
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Similar models

Module 2: Daily Case Report Form (CRF)

1 forms
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Administrative documentation
C1320722 (UMLS CUI-1)
Participant identification
Item
Participant identification #
text
C3165543 (UMLS CUI [1])
Date of assessment
Item
Date of assessment
date
C2985720 (UMLS CUI [1])
Item Group
Signs and symptoms
C0037088 (UMLS CUI-1)
Body temperature
Item
Temperature
float
C0005903 (UMLS CUI [1])
Item
Temperature unit
integer
C0005903 (UMLS CUI [1,1])
C1519795 (UMLS CUI [1,2])
Temperature unit
Code List
Temperature unit
CL Item
Celsius (1)
CL Item
Fahrenheit (2)
Heart Rate
Item
Heart Rate (HR):
integer
C0018810 (UMLS CUI [1])
Respiratory rate
Item
Respiratory rate (RR)
integer
C0231832 (UMLS CUI [1])
Systolic BP
Item
Systolic blood pressure
integer
C0871470 (UMLS CUI [1])
Diastolic BP
Item
Diastolic blood pressure
integer
C0428883 (UMLS CUI [1])
Oxygen saturation
Item
Oxygen saturation SaO2
integer
C0523807 (UMLS CUI [1])
Any supplemental oxygen
Item
Any supplemental oxygen: FiO2 (0.21-1.0)
float
C4534306 (UMLS CUI [1,1])
C0428167 (UMLS CUI [1,2])
Item
Any supplemental oxygen: FiO2 unit
integer
C4534306 (UMLS CUI [1,1])
C0428167 (UMLS CUI [1,2])
C1519795 (UMLS CUI [1,3])
FiO2 - Unit
Code List
Any supplemental oxygen: FiO2 unit
CL Item
No unit (relative value) (1)
CL Item
Percent (2)
CL Item
L/min (3)
Item
Sternal capillary refill time >2seconds
integer
C1714880 (UMLS CUI [1])
FiO2 - Unit
Code List
Sternal capillary refill time >2seconds
CL Item
Yes (1)
CL Item
No (2)
CL Item
Unknown (3)
AVPU: Alert
Item
AVPU: Alert
integer
C3665546 (UMLS CUI [1,1])
C5205979 (UMLS CUI [1,2])
AVPU: Verbal
Item
AVPU: Verbal
integer
C5205979 (UMLS CUI [1,1])
C3846697 (UMLS CUI [1,2])
AVPU: Pain
Item
AVPU: Pain
integer
C5205979 (UMLS CUI [1,1])
C1960712 (UMLS CUI [1,2])
AVPU: Unresponsive
Item
AVPU: Unresponsive
integer
C5205979 (UMLS CUI [1,1])
C0857494 (UMLS CUI [1,2])
GCS
Item
Glasgow Coma Score (GCS / 15)
integer
C0017594 (UMLS CUI [1])
Item Group
Is the patient currently receiving, or has received (between 00:00 to 24:00 on day of assessment)
C0087111 (UMLS CUI-1)
Item
High-flow nasal cannula oxygen therapy?
integer
C1960097 (UMLS CUI [1,1])
C0521116 (UMLS CUI [1,2])
C1960097 (UMLS CUI [2,1])
C0347984 (UMLS CUI [2,2])
C0220825 (UMLS CUI [2,3])
C1948053 (UMLS CUI [2,4])
Urin flow rate
Code List
High-flow nasal cannula oxygen therapy?
CL Item
Yes (1)
CL Item
No (2)
CL Item
Unknown (3)
Item
Non-invasive ventilation (Any)?
integer
C1997883 (UMLS CUI [1,1])
C0521116 (UMLS CUI [1,2])
C1997883 (UMLS CUI [2,1])
C0347984 (UMLS CUI [2,2])
C0220825 (UMLS CUI [2,3])
C1948053 (UMLS CUI [2,4])
Urin flow rate
Code List
Non-invasive ventilation (Any)?
CL Item
Yes (1)
CL Item
No (2)
CL Item
Unknown (3)
Item
NIV - If Yes:
integer
C1997883 (UMLS CUI [1,1])
C2348235 (UMLS CUI [1,2])
Urin flow rate
Code List
NIV - If Yes:
CL Item
BIPAP  (1)
CL Item
CPAP  (2)
CL Item
Other  (3)
CL Item
Unknown (4)
Item
Invasive ventilation?
integer
C1868981 (UMLS CUI [1,1])
C0521116 (UMLS CUI [1,2])
C1868981 (UMLS CUI [2,1])
C0347984 (UMLS CUI [2,2])
C0220825 (UMLS CUI [2,3])
C1948053 (UMLS CUI [2,4])
Urin flow rate
Code List
Invasive ventilation?
CL Item
Yes (1)
CL Item
No (2)
CL Item
Unknown (3)
Item
Prone positioning?
integer
C0033422 (UMLS CUI [1,1])
C0521116 (UMLS CUI [1,2])
C0033422 (UMLS CUI [2,1])
C0347984 (UMLS CUI [2,2])
C0220825 (UMLS CUI [2,3])
C1948053 (UMLS CUI [2,4])
Urin flow rate
Code List
Prone positioning?
CL Item
Yes (1)
CL Item
No (2)
CL Item
Unknown (3)
Item
Inhaled Nitric Oxide?
integer
C1135443 (UMLS CUI [1,1])
C0521116 (UMLS CUI [1,2])
C1135443 (UMLS CUI [2,1])
C0347984 (UMLS CUI [2,2])
C0220825 (UMLS CUI [2,3])
C1948053 (UMLS CUI [2,4])
Urin flow rate
Code List
Inhaled Nitric Oxide?
CL Item
Yes (1)
CL Item
No (2)
CL Item
Unknown (3)
Item
Tracheostomy inserted?
integer
C0040590 (UMLS CUI [1,1])
C0521116 (UMLS CUI [1,2])
C0040590 (UMLS CUI [2,1])
C0347984 (UMLS CUI [2,2])
C0220825 (UMLS CUI [2,3])
C1948053 (UMLS CUI [2,4])
Urin flow rate
Code List
Tracheostomy inserted?
CL Item
Yes (1)
CL Item
No (2)
CL Item
Unknown (3)
Item
Extra corporeal life support (ECLS/ ECMO)?
integer
C3869463 (UMLS CUI [1,1])
C0521116 (UMLS CUI [1,2])
C3869463 (UMLS CUI [2,1])
C0347984 (UMLS CUI [2,2])
C0220825 (UMLS CUI [2,3])
C1948053 (UMLS CUI [2,4])
Urin flow rate
Code List
Extra corporeal life support (ECLS/ ECMO)?
CL Item
Yes (1)
CL Item
No (2)
CL Item
Unknown (3)
Item
ECLS/ECMO - If Yes:
integer
C3869463 (UMLS CUI [1,1])
C2348235 (UMLS CUI [1,2])
Urin flow rate
Code List
ECLS/ECMO - If Yes:
CL Item
VV (1)
CL Item
AV (2)
CL Item
Central (3)
CL Item
Unknown (4)
Item
Renal replacement therapy (RRT) or dialysis?
integer
C0206074 (UMLS CUI [1,1])
C0521116 (UMLS CUI [1,2])
C0206074 (UMLS CUI [2,1])
C0347984 (UMLS CUI [2,2])
C0220825 (UMLS CUI [2,3])
C1948053 (UMLS CUI [2,4])
C0011946 (UMLS CUI [3,1])
C0521116 (UMLS CUI [3,2])
C0011946 (UMLS CUI [4,1])
C0347984 (UMLS CUI [4,2])
C0220825 (UMLS CUI [4,3])
C1948053 (UMLS CUI [4,4])
Urin flow rate
Code List
Renal replacement therapy (RRT) or dialysis?
CL Item
Yes (1)
CL Item
No (2)
CL Item
Unknown (3)
Item
Any vasopressor/inotropic support?
integer
C0304509 (UMLS CUI [1,1])
C0521116 (UMLS CUI [1,2])
C0304509 (UMLS CUI [2,1])
C0347984 (UMLS CUI [2,2])
C0220825 (UMLS CUI [2,3])
C1948053 (UMLS CUI [2,4])
C0042397 (UMLS CUI [3,1])
C0521116 (UMLS CUI [3,2])
C0042397 (UMLS CUI [4,1])
C0347984 (UMLS CUI [4,2])
C0220825 (UMLS CUI [4,3])
C1948053 (UMLS CUI [4,4])
Urin flow rate
Code List
Any vasopressor/inotropic support?
CL Item
Yes (1)
CL Item
No (If NO, select NO for the next 3 questions) (2)
CL Item
Unknown (3)
Vasopressor/inotropic support: Dopamine, Dobutamine, Milrinone , Levosimendan:
Item
Dopamine <5μg/kg/min OR Dobutamine OR milrinone OR levosimendan:
boolean
C0013030 (UMLS CUI [1,1])
C0521116 (UMLS CUI [1,2])
C0013030 (UMLS CUI [2,1])
C0347984 (UMLS CUI [2,2])
C0220825 (UMLS CUI [2,3])
C1948053 (UMLS CUI [2,4])
C0012963 (UMLS CUI [3,1])
C0521116 (UMLS CUI [3,2])
C0012963 (UMLS CUI [4,1])
C0347984 (UMLS CUI [4,2])
C0220825 (UMLS CUI [4,3])
C1948053 (UMLS CUI [4,4])
C0128513 (UMLS CUI [5,1])
C0521116 (UMLS CUI [5,2])
C0128513 (UMLS CUI [6,1])
C0347984 (UMLS CUI [6,2])
C0220825 (UMLS CUI [6,3])
C1948053 (UMLS CUI [6,4])
C0246904 (UMLS CUI [7,1])
C0521116 (UMLS CUI [7,2])
C0246904 (UMLS CUI [8,1])
C0347984 (UMLS CUI [8,2])
C0220825 (UMLS CUI [8,3])
C1948053 (UMLS CUI [8,4])
Vasopressor/inotropic support: Dopamine, Epinephrine/Norepinephrine, vasopressin, phenylephrin
Item
Dopamine 5-15μg/kg/min OR Epinephrine/Norepinephrine < 0.1μg/kg/min OR vasopressin OR phenylephrine:
boolean
C0014563 (UMLS CUI [1,1])
C0521116 (UMLS CUI [1,2])
C0014563 (UMLS CUI [2,1])
C0347984 (UMLS CUI [2,2])
C0220825 (UMLS CUI [2,3])
C1948053 (UMLS CUI [2,4])
C0042413 (UMLS CUI [3,1])
C0521116 (UMLS CUI [3,2])
C0042413 (UMLS CUI [4,1])
C0347984 (UMLS CUI [4,2])
C0220825 (UMLS CUI [4,3])
C1948053 (UMLS CUI [4,4])
C0013030 (UMLS CUI [5,1])
C0521116 (UMLS CUI [5,2])
C0013030 (UMLS CUI [6,1])
C0347984 (UMLS CUI [6,2])
C0220825 (UMLS CUI [6,3])
C1948053 (UMLS CUI [6,4])
C0031469 (UMLS CUI [7,1])
C0521116 (UMLS CUI [7,2])
C0031469 (UMLS CUI [8,1])
C0347984 (UMLS CUI [8,2])
C0220825 (UMLS CUI [8,3])
C1948053 (UMLS CUI [8,4])
Vasopressor/inotropic support: Dopamine, Epinephrine/Norepinephrine
Item
Dopamine >15μg/k/min OR Epinephrine/Norepinephrine > 0.1μg/kg/min:
boolean
C0014563 (UMLS CUI [1,1])
C0521116 (UMLS CUI [1,2])
C0014563 (UMLS CUI [2,1])
C0347984 (UMLS CUI [2,2])
C0220825 (UMLS CUI [2,3])
C1948053 (UMLS CUI [2,4])
C0028351 (UMLS CUI [3,1])
C0521116 (UMLS CUI [3,2])
C0028351 (UMLS CUI [4,1])
C0347984 (UMLS CUI [4,2])
C0220825 (UMLS CUI [4,3])
C1948053 (UMLS CUI [4,4])
C0013030 (UMLS CUI [5,1])
C0521116 (UMLS CUI [5,2])
C0013030 (UMLS CUI [6,1])
C0347984 (UMLS CUI [6,2])
C0220825 (UMLS CUI [6,3])
C1948053 (UMLS CUI [6,4])
Item
Neuromuscular blocking agents?
integer
C0027866 (UMLS CUI [1,1])
C0521116 (UMLS CUI [1,2])
C0027866 (UMLS CUI [2,1])
C0347984 (UMLS CUI [2,2])
C0220825 (UMLS CUI [2,3])
C1948053 (UMLS CUI [2,4])
Urin flow rate
Code List
Neuromuscular blocking agents?
CL Item
Yes (1)
CL Item
No (2)
CL Item
Unknown (3)
Item
Other intervention(s) or procedure(s)?
integer
C0205394 (UMLS CUI [1,1])
C0184661 (UMLS CUI [1,2])
C0521116 (UMLS CUI [1,3])
C0205394 (UMLS CUI [2,1])
C0184661 (UMLS CUI [2,2])
C0347984 (UMLS CUI [2,3])
C0220825 (UMLS CUI [2,4])
C1948053 (UMLS CUI [2,5])
C0205394 (UMLS CUI [3,1])
C0087111 (UMLS CUI [3,2])
C0521116 (UMLS CUI [3,3])
C0205394 (UMLS CUI [4,1])
C0087111 (UMLS CUI [4,2])
C0347984 (UMLS CUI [4,3])
C0220825 (UMLS CUI [4,4])
C1948053 (UMLS CUI [4,5])
Urin flow rate
Code List
Other intervention(s) or procedure(s)?
CL Item
Yes (1)
CL Item
No (2)
CL Item
Unknown (3)
Other intervention or procedure Specification
Item
If "Yes", specify the other intervention or procedure the patient received or is receiving:
text
C0205394 (UMLS CUI [1,1])
C0184661 (UMLS CUI [1,2])
C2348235 (UMLS CUI [1,3])
C0205394 (UMLS CUI [2,1])
C0087111 (UMLS CUI [2,2])
C2348235 (UMLS CUI [2,3])
Item Group
Record the worst value on day of assessment
C0037088 (UMLS CUI-1)
Item
Current admission to ICU/ITU/IMC/HDU?
integer
C0521116 (UMLS CUI [1,1])
C0583239 (UMLS CUI [1,2])
C0521116 (UMLS CUI [2,1])
C4489279 (UMLS CUI [2,2])
C0184666 (UMLS CUI [2,3])
C0521116 (UMLS CUI [3,1])
C1301858 (UMLS CUI [3,2])
ICU/ITU/IMC/HDU admission
Code List
Current admission to ICU/ITU/IMC/HDU?
CL Item
Yes (1)
CL Item
No (2)
CL Item
Unknown (9)
PaO2
Item
PaO2 (at time nearest to the FiO2 recorded at top of page):
integer
C0391840 (UMLS CUI [1])
Item
PaO2 unit
integer
C0391840 (UMLS CUI [1,1])
C1519795 (UMLS CUI [1,2])
PaO2 unit
Code List
PaO2 unit
CL Item
kPa (1)
CL Item
mmHg (2)
PaO2 not done
Item
PaO2 not done
boolean
C0391840 (UMLS CUI [1,1])
C0347984 (UMLS CUI [1,2])
C0428167 (UMLS CUI [1,3])
C1272696 (UMLS CUI [1,4])
Item
PaO2 sample type
integer
C0391840 (UMLS CUI [1,1])
C2347029 (UMLS CUI [1,2])
PaO2 unit
Code List
PaO2 sample type
CL Item
Arterial (1)
CL Item
Capillary (2)
CL Item
Unknown  (3)
PCO2
Item
From same blood gas record as PaO2: PCO2
integer
C1822070 (UMLS CUI [1])
Item
PCO2 unit
integer
C1822070 (UMLS CUI [1,1])
C1519795 (UMLS CUI [1,2])
PCO2 unit
Code List
PCO2 unit
CL Item
kPa (1)
CL Item
mmHg (2)
pH
Item
pH
float
C0020283 (UMLS CUI [1])
Bicarbonate
Item
Bicarbonate
integer
C0005367 (UMLS CUI [1])
Base excess
Item
Base excess
integer
C0201985 (UMLS CUI [1])
RASS score
Item
Richmond Agitation-Sedation Scale (RASS)
integer
C4720839 (UMLS CUI [1,1])
C0449820 (UMLS CUI [1,2])
SAS score
Item
Riker Sedation-Agitation Scale
integer
C3846158 (UMLS CUI [1,1])
C0449820 (UMLS CUI [1,2])
SAS or RASS score unknown
Item
Richmond Sedation-Agitation Scale or Riker Sedation-Agitation Scale: score unknown
boolean
C4720839 (UMLS CUI [1,1])
C0449820 (UMLS CUI [1,2])
C0439673 (UMLS CUI [1,3])
C3846158 (UMLS CUI [2,1])
C0449820 (UMLS CUI [2,2])
C0439673 (UMLS CUI [2,3])
Mean Arterial Blood Pressure value
Item
Mean Arterial Blood Pressure value
integer
C0428886 (UMLS CUI [1])
Mean Arterial Blood Pressure unknown
Item
Mean Arterial Blood Pressure unknown
boolean
C0428886 (UMLS CUI [1,1])
C0439673 (UMLS CUI [1,2])
Urinary flow rate
Item
Urin flow rate
integer
C1287804 (UMLS CUI [1])
Item
Urin flow rate estimated or unknown
integer
C0429783 (UMLS CUI [1,1])
C0439673 (UMLS CUI [1,2])
C0429783 (UMLS CUI [2,1])
C0750572 (UMLS CUI [2,2])
Urin flow rate
Code List
Urin flow rate estimated or unknown
CL Item
Check if estimated (1)
CL Item
Unknown (2)
Item Group
Laboratory Results (on admission, on any admission to ICU, then daily) – complete every line
C1254595 (UMLS CUI-1)
Date of assessment
Item
Date of assessment
date
C2985720 (UMLS CUI [1])
Haemoglobin
Item
Haemoglobin
integer
C0518015 (UMLS CUI [1])
Haemoglobin measurement not done
Item
Haemoglobin measurement not done
boolean
C0518015 (UMLS CUI [1,1])
C1272696 (UMLS CUI [1,2])
WBC count
Item
WBC count
integer
C0023508 (UMLS CUI [1])
WBC count not done
Item
WBC count not done
boolean
C0023508 (UMLS CUI [1,1])
C1272696 (UMLS CUI [1,2])
Lymphocyte count
Item
Lymphocyte count
integer
C0200635 (UMLS CUI [1])
Lymphocyte count not done
Item
Lymphocyte count not done
boolean
C0200635 (UMLS CUI [1,1])
C1272696 (UMLS CUI [1,2])
Neutrophil count
Item
Neutrophil count
integer
C0200633 (UMLS CUI [1])
Neutrophil count not done
Item
Neutrophil count not done
boolean
C0200633 (UMLS CUI [1,1])
C1272696 (UMLS CUI [1,2])
Haematocrit value
Item
Haematocrit value
integer
C0518014 (UMLS CUI [1])
Haematocrit measurement not done
Item
Haematocrit not done
boolean
C0018935 (UMLS CUI [1,1])
C1272696 (UMLS CUI [1,2])
Platelets value
Item
Platelets value
integer
C0032181 (UMLS CUI [1])
Platelets count not done
Item
Platelets not done
boolean
C0032181 (UMLS CUI [1,1])
C1272696 (UMLS CUI [1,2])
APTT
Item
APTT
integer
C0030605 (UMLS CUI [1])
APTT measurement not done
Item
APTT measurement not done
boolean
C0030605 (UMLS CUI [1,1])
C1272696 (UMLS CUI [1,2])
APTR
Item
APTR
integer
C1272061 (UMLS CUI [1])
APTR measurement not done
Item
APTR measurement not done
boolean
C1272061 (UMLS CUI [1,1])
C1272696 (UMLS CUI [1,2])
PT
Item
PT
integer
C0491338 (UMLS CUI [1])
PT measurement not done
Item
PT measurement not done
boolean
C0491338 (UMLS CUI [1,1])
C1272696 (UMLS CUI [1,2])
INR
Item
INR
integer
C0525032 (UMLS CUI [1])
INR measurement not done
Item
INR measurement not done
boolean
C0525032 (UMLS CUI [1,1])
C1272696 (UMLS CUI [1,2])
ALT/SGPT
Item
ALT/SGPT
integer
C0201836 (UMLS CUI [1])
ALT/SGPT measurement not done
Item
ALT/SGPT measurement not done
boolean
C0201836 (UMLS CUI [1,1])
C1272696 (UMLS CUI [1,2])
Total Bilirubin value
Item
Total Bilirubin value
integer
C0201913 (UMLS CUI [1])
Total Bilirubin measurement not done
Item
Total Bilirubin measurement not done
boolean
C0201913 (UMLS CUI [1,1])
C1272696 (UMLS CUI [1,2])
AST/SGOT
Item
AST/SGOT
integer
C0201899 (UMLS CUI [1])
AST/SGOT measurement not done
Item
AST/SGOT measurement not done
boolean
C0201899 (UMLS CUI [1,1])
C1272696 (UMLS CUI [1,2])
Glucose value
Item
Glucose value
integer
C0202042 (UMLS CUI [1])
Glucose measurement not done
Item
Glucose measurement not done
boolean
C0202042 (UMLS CUI [1,1])
C1272696 (UMLS CUI [1,2])
Blood Urea Nitrogen (urea) value
Item
Blood Urea Nitrogen (urea)
integer
C0005845 (UMLS CUI [1])
Blood Urea Nitrogen (urea) measurement not done
Item
Blood Urea Nitrogen (urea) measurement not done
boolean
C0005845 (UMLS CUI [1,1])
C1272696 (UMLS CUI [1,2])
Lactate
Item
Lactate
integer
C0428446 (UMLS CUI [1])
Lactate measurement not done
Item
Lactate measurement not done
boolean
C0428446 (UMLS CUI [1,1])
C1272696 (UMLS CUI [1,2])
Creatinine value
Item
Creatinine value
integer
C0201976 (UMLS CUI [1])
Creatinine measurement not done
Item
Creatinine measurement not done
boolean
C0201976 (UMLS CUI [1,1])
C1272696 (UMLS CUI [1,2])
Sodium
Item
Sodium value
integer
C0337443 (UMLS CUI [1])
Sodium measurement not done
Item
Sodium measurement not done
boolean
C0337443 (UMLS CUI [1,1])
C1272696 (UMLS CUI [1,2])
Potassium
Item
Potassium value
float
C0202194 (UMLS CUI [1])
Potassium measurement not done
Item
Potassium measurement not done
boolean
C0202194 (UMLS CUI [1,1])
C1272696 (UMLS CUI [1,2])
Procalcitonin value
Item
Procalcitonin value
float
C1535922 (UMLS CUI [1])
Procalcitonin measurement not done
Item
Procalcitonin measurement not done
boolean
C1535922 (UMLS CUI [1,1])
C1272696 (UMLS CUI [1,2])
CRP
Item
CRP value
integer
C0201657 (UMLS CUI [1])
CRP measurement not done
Item
CRP measurement not done
boolean
C0201657 (UMLS CUI [1,1])
C1272696 (UMLS CUI [1,2])
LDH
Item
LDH
integer
C0202113 (UMLS CUI [1])
LDH measurement not done
Item
LDH measurement not done
boolean
C0202113 (UMLS CUI [1,1])
C1272696 (UMLS CUI [1,2])
Creatine kinase measurement
Item
Creatine kinase measurement
integer
C0201973 (UMLS CUI [1])
Creatine kinase measurement not done
Item
Creatine kinase measurement not done
boolean
C0201973 (UMLS CUI [1,1])
C1272696 (UMLS CUI [1,2])
Troponin I measurement
Item
Troponin I measurement
integer
C0920210 (UMLS CUI [1])
Troponin I measurement not done
Item
Troponin I measurement not done
boolean
C0920210 (UMLS CUI [1,1])
C1272696 (UMLS CUI [1,2])
D-dimer measurement
Item
D-dimer measurement
integer
C2826333 (UMLS CUI [1])
D-dimer measurement not done
Item
D-dimer measurement not done
boolean
C2826333 (UMLS CUI [1,1])
C1272696 (UMLS CUI [1,2])
Ferritin measurement
Item
Ferritin measurement
integer
C0373607 (UMLS CUI [1])
Ferritin measurement not done
Item
Ferritin measurement not done
boolean
C0373607 (UMLS CUI [1,1])
C1272696 (UMLS CUI [1,2])
IL-6 measurement
Item
IL-6 measurement
integer
C0919829 (UMLS CUI [1])
IL-6 measurement not done
Item
IL-6 measurement not done
boolean
C0919829 (UMLS CUI [1,1])
C1272696 (UMLS CUI [1,2])
Fibrinogen measurement
Item
Fibrinogen measurement
integer
C0016006 (UMLS CUI [1])
Fibrinogen measurement not done
Item
Fibrinogen measurement not done
boolean
C0016006 (UMLS CUI [1,1])
C1272696 (UMLS CUI [1,2])
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