ID

41940

Description

To be completed for patients receiving critical care on whom the data below are available, together with the RAPID CRF. RAPID COVID-19 CRF users: - Sites should select whether they complete Part A only or both Parts A & B where resources allows. - In addition always complete the RAPID CRF Module 1 on day of admission to the hospital. For patients receiving critical care complete: - PART A - Complete on every day for patients receiving critical care beginning on the day of admission to an intensive care / high dependency unit, or on the first day of deterioration to severe disease in any ward where the data below is available. Complete daily for as many days as resources allow. In addition, complete the RAPID CRF Module 2 (Daily Form). - PART B - Complete Section 1 on the day of admission to an intensive care / high dependency unit. Complete Section 2 every day during critical care. In addition, complete the RAPID CRF Module 2 (Daily Form). - Complete the RAPID CRF Module 3 on death or hospital discharge for all patients.

Keywords

Versions (1)
  1. 2/18/21 2/18/21 -
Copyright Holder

ISARIC on behalf of Oxford University

Uploaded on

February 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

COVID-19 Case Report Form Rapid Critical Care Module - Part A

1 forms  
Participant Identification Numbers
Description

Participant Identification Numbers

Alias
UMLS CUI-1
C3165543
Participant Identification Numbers
Description

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 ncov@isaric.org. 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.

Data type

text

Alias
UMLS CUI [1]
C3165543
Current admission to ICU or other High Dependency Unit (HDU)?
Description

Current admission ICU oder HDU

Data type

integer

Alias
UMLS CUI [1,1]
C0521116
UMLS CUI [1,2]
C0583239
UMLS CUI [2,1]
C0521116
UMLS CUI [2,2]
C1301858
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
C2827774
Any vasopressor/inotropic support?
Description

Any vasopressor/inotropic support during evaluation period

Data type

integer

Alias
UMLS CUI [1,1]
C0304509
UMLS CUI [1,2]
C0347984
UMLS CUI [1,3]
C0220825
UMLS CUI [1,4]
C1948053
UMLS CUI [2,1]
C0042413
UMLS CUI [2,2]
C0347984
UMLS CUI [2,3]
C0220825
UMLS CUI [2,4]
C1948053
If YES, what was the highest level of support received on the date of assessment?
Description

Highest level of support on date of assessment

Data type

integer

Alias
UMLS CUI [1,1]
C1522410
UMLS CUI [1,2]
C0042413
UMLS CUI [1,3]
C2985720
UMLS CUI [2,1]
C1522410
UMLS CUI [2,2]
C0304509
UMLS CUI [2,3]
C2985720
Prone positioning?
Description

Prone positioning during evaluation period

Data type

integer

Alias
UMLS CUI [1,1]
C0033422
UMLS CUI [1,2]
C0347984
UMLS CUI [1,3]
C0220825
UMLS CUI [1,4]
C1948053
Neuromuscular blocking agents?
Description

Neuromuscular blocking agents during evaluation period

Data type

integer

Alias
UMLS CUI [1,1]
C0027866
UMLS CUI [1,2]
C0347984
UMLS CUI [1,3]
C0220825
UMLS CUI [1,4]
C1948053
Inhaled Nitric Oxide?
Description

Inhaled Nitric Oxide during evaluation period

Data type

integer

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

Tracheostomy inserted during evaluation period

Data type

integer

Alias
UMLS CUI [1,1]
C0040590
UMLS CUI [1,2]
C0347984
UMLS CUI [1,3]
C0220825
UMLS CUI [1,4]
C1948053
Dialysis/Hemofiltration?
Description

Dialysis/Hemofiltration during evaluation period

Data type

integer

Alias
UMLS CUI [1,1]
C0011946
UMLS CUI [1,2]
C0347984
UMLS CUI [1,3]
C0220825
UMLS CUI [1,4]
C1948053
UMLS CUI [2,1]
C0019014
UMLS CUI [2,2]
C0347984
UMLS CUI [2,3]
C0220825
UMLS CUI [2,4]
C1948053
Other intervention or procedure not already recorded in this form or in the RAPID Module 2 form:
Description

Other intervention during evaluation period

Data type

integer

Alias
UMLS CUI [1,1]
C0205394
UMLS CUI [1,2]
C0184661
UMLS CUI [1,3]
C0347984
UMLS CUI [1,4]
C0220825
UMLS CUI [1,5]
C1948053
If YES, Specify:
Description

Other intervention during evaluation period - specification

Data type

text

Alias
UMLS CUI [1,1]
C0205394
UMLS CUI [1,2]
C0184661
UMLS CUI [1,3]
C2348235
UMLS CUI [1,4]
C0347984
UMLS CUI [1,5]
C0220825
UMLS CUI [1,6]
C1948053
Record the values associated with the ‘worst’ blood gas analysis on the day of assessment. ‘Worst’ is defined as the blood gas with the lowest PaO2/FiO2 ratio.
Description

Record the values associated with the ‘worst’ blood gas analysis on the day of assessment. ‘Worst’ is defined as the blood gas with the lowest PaO2/FiO2 ratio.

Alias
UMLS CUI-1
C0037088
Any supplemental oxygen: FiO2
Description

Record the highest level of support on day of assessment. Alternatively record the next question.

Data type

float

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

Alternatively record the oxygen flow in the next item.

Data type

integer

Measurement units
  • %
Alias
UMLS CUI [1]
C0428167
UMLS CUI [2]
C4534306
%
Any supplemental oxygen: oxygen flow
Description

Any supplement oxygen: oxygen flow

Data type

integer

Measurement units
  • L/min
Alias
UMLS CUI [1]
C4534306
UMLS CUI [2]
C1960999
L/min
PaO2 (at time nearest to the FiO2 above)
Description

PaO2

Data type

float

Alias
UMLS CUI [1]
C0391840
PaO2 unit
Description

PaO2 unit

Data type

integer

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

PaO2 measurement not done

Data type

boolean

Alias
UMLS CUI [1,1]
C1283004
UMLS CUI [1,2]
C1272696
PaO2 sample type
Description

PaO2 sample type

Data type

integer

Alias
UMLS CUI [1,1]
C2347029
UMLS CUI [1,2]
C1283004
PCO2
Description

From same blood gas record as PaO2

Data type

float

Alias
UMLS CUI [1]
C1822070
PCO2 unit
Description

From same blood gas record as PaO2

Data type

integer

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

From same blood gas record as PaO2

Data type

float

Alias
UMLS CUI [1]
C0853363
HCO3
Description

From same blood gas record as PaO2

Data type

float

Measurement units
  • mEq/L
Alias
UMLS CUI [1]
C0202059
mEq/L
Base Excess
Description

From same blood gas record as PaO2

Data type

float

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

Alternatively record SAS.

Data type

integer

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

Alternatively record RASS

Data type

integer

Alias
UMLS CUI [1,1]
C0449820
UMLS CUI [1,2]
C3846158
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]
C0439673
UMLS CUI [1,2]
C0449820
UMLS CUI [1,3]
C3846158
UMLS CUI [2,1]
C0439673
UMLS CUI [2,2]
C0449820
UMLS CUI [2,3]
C4720839
Most abnormal mean arterial blood pressure
Description

Most abnormal mean arterial blood pressure

Data type

integer

Measurement units
  • mmHg
Alias
UMLS CUI [1,1]
C0205393
UMLS CUI [1,2]
C0205161
UMLS CUI [1,3]
C0428886
mmHg
Most abnormal mean arterial blood pressure unknown
Description

Most abnormal mean arterial blood pressure unknown

Data type

boolean

Alias
UMLS CUI [1,1]
C0205393
UMLS CUI [1,2]
C0205161
UMLS CUI [1,3]
C0428886
UMLS CUI [1,4]
C0439673
Urine flow rate IF patient age >18 years
Description

Urine flow rate IF patient age >18 years

Data type

integer

Measurement units
  • mL/24 hours
Alias
UMLS CUI [1,1]
C0429783
UMLS CUI [1,2]
C0001675
mL/24 hours
Urine flow rate IF patient age >18 years: Check if estimated
Description

Estimated urine flow rate If patient age >18 years

Data type

boolean

Alias
UMLS CUI [1,1]
C0750572
UMLS CUI [1,2]
C0429783
UMLS CUI [1,3]
C0001675
Urine flow rate IF patient age >18 years: unknown
Description

Unknown urine flow rate if patient age >18 years

Data type

boolean

Alias
UMLS CUI [1,1]
C0429783
UMLS CUI [1,2]
C0001675
UMLS CUI [1,3]
C0439673
Urine flow rate IF patient age <18 years
Description

Urine flow rate IF patient age <18 years

Data type

integer

Measurement units
  • mL/kg/24hrs
Alias
UMLS CUI [1,1]
C0429783
UMLS CUI [1,2]
C0026193
mL/kg/24hrs
Urine flow rate IF patient age <18 years: Check if estimated
Description

Estimated urine flow rate If patient age <18 years

Data type

boolean

Alias
UMLS CUI [1,1]
C0750572
UMLS CUI [1,2]
C0429783
UMLS CUI [1,3]
C0026193
Urine flow rate IF patient age <18 years: unknown
Description

Unknown urine flow rate if patient age <18 years

Data type

boolean

Alias
UMLS CUI [1,1]
C0429783
UMLS CUI [1,2]
C0026193
UMLS CUI [1,3]
C0439673
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Similar models

COVID-19 Case Report Form Rapid Critical Care Module - Part A

1 forms
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Participant Identification Numbers
C3165543 (UMLS CUI-1)
Participant Identification Numbers
Item
Participant Identification Numbers
text
C3165543 (UMLS CUI [1])
Item
Current admission to ICU or other High Dependency Unit (HDU)?
integer
C0521116 (UMLS CUI [1,1])
C0583239 (UMLS CUI [1,2])
C0521116 (UMLS CUI [2,1])
C1301858 (UMLS CUI [2,2])
Current admission ICU oder HDU
Code List
Current admission to ICU or other High Dependency Unit (HDU)?
CL Item
Yes - ICU (1)
CL Item
Yes - HDU (2)
CL Item
No (3)
CL Item
Unknown (4)
Item Group
Is the patient currently receiving, or has received (between 00:00 to 24:00 on day of assessment)
C2827774 (UMLS CUI-1)
Item
Any vasopressor/inotropic support?
integer
C0304509 (UMLS CUI [1,1])
C0347984 (UMLS CUI [1,2])
C0220825 (UMLS CUI [1,3])
C1948053 (UMLS CUI [1,4])
C0042413 (UMLS CUI [2,1])
C0347984 (UMLS CUI [2,2])
C0220825 (UMLS CUI [2,3])
C1948053 (UMLS CUI [2,4])
Any vasopressor/inotropic support
Code List
Any vasopressor/inotropic support?
CL Item
Yes (1)
CL Item
No  (2)
CL Item
Unknown (3)
Item
If YES, what was the highest level of support received on the date of assessment?
integer
C1522410 (UMLS CUI [1,1])
C0042413 (UMLS CUI [1,2])
C2985720 (UMLS CUI [1,3])
C1522410 (UMLS CUI [2,1])
C0304509 (UMLS CUI [2,2])
C2985720 (UMLS CUI [2,3])
Highest level of support on date of assessment
Code List
If YES, what was the highest level of support received on the date of assessment?
CL Item
Dopamine <5μg/kg/min OR Dobutamine OR milrinone OR levosimendan (1)
CL Item
Dopamine 5-15μg/kg/min OR Epinephrine/Norepinephrine < 0.1μg/kg/min OR vasopressin OR phenylephrine (2)
CL Item
Dopamine >15μg/kg/min OR Epinephrine/Norepinephrine > 0.1μg/kg/min (3)
CL Item
Unknown (4)
Item
Prone positioning?
integer
C0033422 (UMLS CUI [1,1])
C0347984 (UMLS CUI [1,2])
C0220825 (UMLS CUI [1,3])
C1948053 (UMLS CUI [1,4])
Highest level of support on date of assessment
Code List
Prone positioning?
CL Item
Yes (1)
CL Item
No (2)
CL Item
Unknown (3)
Item
Neuromuscular blocking agents?
integer
C0027866 (UMLS CUI [1,1])
C0347984 (UMLS CUI [1,2])
C0220825 (UMLS CUI [1,3])
C1948053 (UMLS CUI [1,4])
Neuromuscular blocking agents
Code List
Neuromuscular blocking agents?
CL Item
Yes (1)
CL Item
No (2)
CL Item
Unknown (3)
Item
Inhaled Nitric Oxide?
integer
C1135443 (UMLS CUI [1,1])
C0347984 (UMLS CUI [1,2])
C0220825 (UMLS CUI [1,3])
C1948053 (UMLS CUI [1,4])
Neuromuscular blocking agents
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])
C0347984 (UMLS CUI [1,2])
C0220825 (UMLS CUI [1,3])
C1948053 (UMLS CUI [1,4])
Tracheostomy inserted
Code List
Tracheostomy inserted?
CL Item
Yes (1)
CL Item
No (2)
CL Item
Unknown (3)
Item
Dialysis/Hemofiltration?
integer
C0011946 (UMLS CUI [1,1])
C0347984 (UMLS CUI [1,2])
C0220825 (UMLS CUI [1,3])
C1948053 (UMLS CUI [1,4])
C0019014 (UMLS CUI [2,1])
C0347984 (UMLS CUI [2,2])
C0220825 (UMLS CUI [2,3])
C1948053 (UMLS CUI [2,4])
Highest level of support on date of assessment
Code List
Dialysis/Hemofiltration?
CL Item
Yes (1)
CL Item
No (2)
CL Item
Unknown (3)
Item
Other intervention or procedure not already recorded in this form or in the RAPID Module 2 form:
integer
C0205394 (UMLS CUI [1,1])
C0184661 (UMLS CUI [1,2])
C0347984 (UMLS CUI [1,3])
C0220825 (UMLS CUI [1,4])
C1948053 (UMLS CUI [1,5])
Tracheostomy inserted
Code List
Other intervention or procedure not already recorded in this form or in the RAPID Module 2 form:
CL Item
Yes (1)
CL Item
No (2)
CL Item
Unknown (3)
Other intervention during evaluation period - specification
Item
If YES, Specify:
text
C0205394 (UMLS CUI [1,1])
C0184661 (UMLS CUI [1,2])
C2348235 (UMLS CUI [1,3])
C0347984 (UMLS CUI [1,4])
C0220825 (UMLS CUI [1,5])
C1948053 (UMLS CUI [1,6])
Item Group
Record the values associated with the ‘worst’ blood gas analysis on the day of assessment. ‘Worst’ is defined as the blood gas with the lowest PaO2/FiO2 ratio.
C0037088 (UMLS CUI-1)
Any supplemental oxygen: FiO2
Item
Any supplemental oxygen: FiO2
float
C0428167 (UMLS CUI [1])
C4534306 (UMLS CUI [2])
FiO2 in percentage
Item
Any supplemental oxygen: FiO2
integer
C0428167 (UMLS CUI [1])
C4534306 (UMLS CUI [2])
Any supplement oxygen: oxygen flow
Item
Any supplemental oxygen: oxygen flow
integer
C4534306 (UMLS CUI [1])
C1960999 (UMLS CUI [2])
PaO2
Item
PaO2 (at time nearest to the FiO2 above)
float
C0391840 (UMLS CUI [1])
Item
PaO2 unit
integer
C1519795 (UMLS CUI [1,1])
C0391840 (UMLS CUI [1,2])
PaO2 unit
Code List
PaO2 unit
CL Item
kPa (1)
CL Item
mmHg (2)
PaO2 measurement not done
Item
PaO2 measurement not done
boolean
C1283004 (UMLS CUI [1,1])
C1272696 (UMLS CUI [1,2])
Item
PaO2 sample type
integer
C2347029 (UMLS CUI [1,1])
C1283004 (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
PCO2
float
C1822070 (UMLS CUI [1])
Item
PCO2 unit
integer
C1519795 (UMLS CUI [1,1])
C1822070 (UMLS CUI [1,2])
PCO2 unit
Code List
PCO2 unit
CL Item
kPa (1)
CL Item
mmHg (2)
pH
Item
pH
float
C0853363 (UMLS CUI [1])
HCO3
Item
HCO3
float
C0202059 (UMLS CUI [1])
Base Excess
Item
Base Excess
float
C0201985 (UMLS CUI [1])
RASS score
Item
Richmond Agitation-Sedation Scale (RASS)
integer
C0449820 (UMLS CUI [1,1])
C4720839 (UMLS CUI [1,2])
SAS score
Item
Riker Sedation-Agitation Scale
integer
C0449820 (UMLS CUI [1,1])
C3846158 (UMLS CUI [1,2])
SAS or RASS score unknown
Item
Richmond Sedation-Agitation Scale or Riker Sedation-Agitation Scale: score unknown
boolean
C0439673 (UMLS CUI [1,1])
C0449820 (UMLS CUI [1,2])
C3846158 (UMLS CUI [1,3])
C0439673 (UMLS CUI [2,1])
C0449820 (UMLS CUI [2,2])
C4720839 (UMLS CUI [2,3])
Most abnormal mean arterial blood pressure
Item
Most abnormal mean arterial blood pressure
integer
C0205393 (UMLS CUI [1,1])
C0205161 (UMLS CUI [1,2])
C0428886 (UMLS CUI [1,3])
Most abnormal mean arterial blood pressure unknown
Item
Most abnormal mean arterial blood pressure unknown
boolean
C0205393 (UMLS CUI [1,1])
C0205161 (UMLS CUI [1,2])
C0428886 (UMLS CUI [1,3])
C0439673 (UMLS CUI [1,4])
Urine flow rate IF patient age >18 years
Item
Urine flow rate IF patient age >18 years
integer
C0429783 (UMLS CUI [1,1])
C0001675 (UMLS CUI [1,2])
Estimated urine flow rate If patient age >18 years
Item
Urine flow rate IF patient age >18 years: Check if estimated
boolean
C0750572 (UMLS CUI [1,1])
C0429783 (UMLS CUI [1,2])
C0001675 (UMLS CUI [1,3])
Unknown urine flow rate if patient age >18 years
Item
Urine flow rate IF patient age >18 years: unknown
boolean
C0429783 (UMLS CUI [1,1])
C0001675 (UMLS CUI [1,2])
C0439673 (UMLS CUI [1,3])
Urine flow rate IF patient age <18 years
Item
Urine flow rate IF patient age <18 years
integer
C0429783 (UMLS CUI [1,1])
C0026193 (UMLS CUI [1,2])
Estimated urine flow rate If patient age <18 years
Item
Urine flow rate IF patient age <18 years: Check if estimated
boolean
C0750572 (UMLS CUI [1,1])
C0429783 (UMLS CUI [1,2])
C0026193 (UMLS CUI [1,3])
Unknown urine flow rate if patient age <18 years
Item
Urine flow rate IF patient age <18 years: unknown
boolean
C0429783 (UMLS CUI [1,1])
C0026193 (UMLS CUI [1,2])
C0439673 (UMLS CUI [1,3])
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