Signs and symptoms
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).
float
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).
integer
Enter the heart rate measured in beats per minute. This may be measured manually or by electronic monitoring.
integer
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.
integer
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.
integer
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.
integer
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.
integer
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.
float
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.
integer
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.
integer
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.
integer
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.
integer
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.
integer
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.
integer
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
integer
Is the patient currently receiving, or has received (between 00:00 to 24:00 on day of assessment)
High-flow nasal cannula oxygen therapy
integer
Non-invasive ventilation
integer
Non-invasive ventilation
integer
Invasive ventilation
integer
Prone positioning
integer
Inhaled Nitric Oxide
integer
Tracheostomy inserted
integer
Extra corporeal life support (ECLS/ECMO)
integer
Extra corporeal life support (ECLS) specification
integer
Renal replacement therapy (RRT) / dialysis
integer
Any vasopressor/inotropic support
integer
Vasopressor/inotropic support: Dopamine, Dobutamine, Milrinone , Levosimendan:
boolean
Vasopressor/inotropic support: Dopamine, Epinephrine/Norepinephrine, vasopressin, phenylephrin
boolean
Vasopressor/inotropic support: Dopamine, Epinephrine/Norepinephrine
boolean
Neuromuscular blocking agents
integer
Other intervention or procedure
integer
Other intervention or procedure Specification
text
Record the worst value on day of assessment
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’.
integer
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.
integer
PaO2 unit
integer
PaO2 not done
boolean
PaO2 sample type
integer
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.
integer
PCO2 unit
integer
pH
float
Bicarbonate
integer
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.
integer
RASS – If done, enter the lowest calculated value (between -5 and 4) on the date of assessment. Alternatively record SAS.
integer
SAS - If done, enter the lowest calculated value (between 1 and 7) on the date of assessment. Alternatively record RASS
integer
SAS or RASS score unknown
boolean
Record the worst value (within the previous 24 hours)
integer
Mean Arterial Blood Pressure unknown
boolean
Record the worst value (within the previous 24 hours)
integer
Urinary flow rate estimated or unknown
integer
Laboratory Results (on admission, on any admission to ICU, then daily) – complete every line
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.
date
Haemoglobin (Hb or Hgb) refers to haemoglobin concentration measurement in blood.
integer
Haemoglobin measurement not done
boolean
WBC count is the total white blood cell count in blood. Record units if different from those listed
integer
WBC count not done
boolean
Record units if different from those listed
integer
Lymphocyte count not done
boolean
Record units if different from those listed.
integer
Neutrophil count not done
boolean
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.
integer
Haematocrit measurement not done
boolean
Record the worst value between 00:00 to 24:00 on day of assessment
integer
Platelets refers to the platelet count in blood.
boolean
APTT is the activated partial thromboplastin time. Record the highest value. Record units if different from those listed.
integer
APTT measurement not done
boolean
APTR is the activated partial thromboplastin ratio. Record the highest value.
integer
APTR measurement not done
boolean
PT is the prothrombin time. Record the highest value. Record units if different from those listed.
integer
PT measurement not done
boolean
INR is the international normalised ratio. Record the highest value. Record units if different from those listed.
integer
INR measurement not done
boolean
ALT is alanine transaminase (also called serum glutamic pyruvate transaminase, SGPT). Record the highest value. Record units if different from those listed.
integer
ALT/SGPT measurement not done
boolean
Total Bilirubin refers to total bilirubin measured in the blood. Record the highest value. Record units if different from those listed.
integer
Total Bilirubin measurement not done
boolean
AST/SGOT is aspartate transaminase (also called serum glutamic oxaloacetic transaminase, SGOT). Record the highest value.
integer
AST/SGOT measurement not done
boolean
Record units if different from those listed.
integer
Glucose measurement not done
boolean
Blood urea nitrogen is also known as ‘urea’, measured in a blood sample. Record the highest value. Record units if different from those listed.
integer
Blood Urea Nitrogen (urea) measurement not done
boolean
Lactate refers to blood lactate. Record the highest value. Record units if different from those listed.
integer
Lactate measurement not done
boolean
Creatinine refers to serum creatinine. Record the highest value. Record units if different from those listed.
integer
Creatinine measurement not done
boolean
Record units if different from those listed.
integer
Sodium refers to blood sodium.
boolean
Record units if different from those listed.
float
Potassium refers to blood potassium.
boolean
Procalcitonin or PCT refers to blood procalcitonin. Record the highest value. Record units if different from those listed.
float
Procalcitonin measurement not done
boolean
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.
integer
CRP measurement not done
boolean
LDH is lactate dehydrogenase. Record the highest value. Record units if different from those listed.
integer
Record units if different from those listed.
boolean
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.
integer
Record units if different from those listed.
boolean
Record the highest value. Record units if different from those listed.
integer
Record units if different from those listed.
boolean
Record the highest value. Record units if different from those listed.
integer
Record units if different from those listed.
boolean
Record the highest value. Record units if different from those listed.
integer
Record units if different from those listed.
boolean
IL-6 is Interleukin 6. Record the highest value. Record units if different from those listed.
integer
Record units if different from those listed.
boolean
Record units if different from those listed.
integer
Record units if different from those listed.
boolean