ID

44682

Beskrivning

Head injury admission form converted to ODM format. Routine documentation of University Hospital of Münster.

Nyckelord

Versioner (2)
  1. 2017-01-02 2017-01-02 -
  2. 2021-09-27 2021-09-27 -
Rättsinnehavare

UKM

Uppladdad den

27 september 2021

DOI

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Licens

Creative Commons BY-NC 3.0
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Pediatric surgery UKM

Tysk Engelsk

Head injury admission form

1 Formulär  
Patient identification
Beskrivning

Patient identification

Name
Beskrivning

Patient name

Datatyp

integer

Alias
UMLS CUI [1]
C1299487
Patient date of birth
Beskrivning

Patient date of birth

Datatyp

date

Alias
UMLS CUI [1]
C0421451
Health insurance
Beskrivning

Health insurance

Datatyp

integer

Alias
UMLS CUI [1]
C0021682
Gender
Beskrivning

Gender

Datatyp

integer

Alias
UMLS CUI [1]
C0079399
Glasgow coma scale
Beskrivning

Glasgow coma scale

Eye response
Beskrivning

Eye response

Datatyp

integer

Alias
UMLS CUI [1]
C4086337
Verbal response
Beskrivning

Verbal response

Datatyp

integer

Alias
UMLS CUI [1]
C2830372
Motor response
Beskrivning

Motor response

Datatyp

integer

Alias
UMLS CUI [1]
C0559290
Glasgow coma score finding
Beskrivning

Glasgow coma score finding

Datatyp

integer

Alias
UMLS CUI [1]
C1271007
General assessment
Beskrivning

General assessment

Contusion frontal surface of scalp
Beskrivning

Contusion frontal surface of scalp

Datatyp

boolean

Alias
UMLS CUI [1]
C2104819
Contusion mark temporal
Beskrivning

Contusion mark temporal

Datatyp

boolean

Alias
UMLS CUI [1]
C1393928
Contusion region parietal
Beskrivning

Contusion region parietal

Datatyp

boolean

Alias
UMLS CUI [1]
C1393911
Contusion region occipital
Beskrivning

Contusion region occipital

Datatyp

boolean

Alias
UMLS CUI [1]
C1393907
Coma
Beskrivning

Coma

Datatyp

boolean

Alias
UMLS CUI [1]
C0041657
Neurology examination finding NAD
Beskrivning

Neurology examination finding NAD

Datatyp

boolean

Alias
UMLS CUI [1,1]
C0438117
UMLS CUI [1,2]
C0559229
Pupil motoric
Beskrivning

Pupil motoric

Datatyp

boolean

Alias
UMLS CUI [1]
C0946327
Anisocoria
Beskrivning

Anisocoria

Datatyp

boolean

Alias
UMLS CUI [1]
C0003079
Liquorrhea
Beskrivning

Liquorrhea

Datatyp

boolean

Alias
UMLS CUI [1]
C0860578
Haematotympanum
Beskrivning

Haematotympanum

Datatyp

boolean

Alias
UMLS CUI [1]
C0019125
Mental health
Beskrivning

Mental health

Datatyp

boolean

Alias
UMLS CUI [1]
C0025353
Vomiting
Beskrivning

Vomiting

Datatyp

boolean

Alias
UMLS CUI [1]
C0042963
Headache
Beskrivning

Headache

Datatyp

boolean

Alias
UMLS CUI [1]
C0018681
Hospital admission
Beskrivning

Hospital admission

Datatyp

boolean

Alias
UMLS CUI [1]
C0420279
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Similar models

Head injury admission form

1 Formulär
Name
Typ
Description | Question | Decode (Coded Value)
Datatyp
Alias
Item Group
Patient identification
Patient name
Item
Name
integer
C1299487 (UMLS CUI [1])
Patient date of birth
Item
Patient date of birth
date
C0421451 (UMLS CUI [1])
Health insurance
Item
Health insurance
integer
C0021682 (UMLS CUI [1])
Item
Gender
integer
C0079399 (UMLS CUI [1])
Gender
Code List
Gender
CL Item
m (1)
C0086582 (UMLS CUI-1)
CL Item
f (2)
C0086287 (UMLS CUI-1)
Item Group
Glasgow coma scale
Item
Eye response
integer
C4086337 (UMLS CUI [1])
Eye response
Code List
Eye response
CL Item
Does not open eyes  (1)
C0551549 (UMLS CUI-1)
CL Item
Opens eyes in response to painful stimuli  (2)
C0551549 (UMLS CUI-1)
CL Item
Opens eyes in response to voice  (3)
C0551549 (UMLS CUI-1)
CL Item
Opens eyes spontaneously (4)
C0551549 (UMLS CUI-1)
Item
Verbal response
integer
C2830372 (UMLS CUI [1])
Verbal response
Code List
Verbal response
CL Item
Makes no sounds  (1)
C2012060 (UMLS CUI-1)
CL Item
Incomprehensible sounds  (2)
C2012057 (UMLS CUI-1)
CL Item
Utters incoherent words (3)
C2012058 (UMLS CUI-1)
CL Item
Confused, disoriented  (4)
C2012056 (UMLS CUI-1)
CL Item
Oriented, converses normally (5)
C2012059 (UMLS CUI-1)
Item
Motor response
integer
C0559290 (UMLS CUI [1])
Motor response
Code List
Motor response
CL Item
Makes no movements  (1)
C2012054 (UMLS CUI-1)
CL Item
Extension to painful stimuli (decerebrate response)  (2)
C2012050 (UMLS CUI-1)
CL Item
Abnormal flexion to painful stimuli (decorticate response)  (3)
C2012051 (UMLS CUI-1)
CL Item
Flexion / Withdrawal to painful stimuli  (4)
C2012052 (UMLS CUI-1)
CL Item
Localizes painful stimuli  (5)
C2012055 (UMLS CUI-1)
CL Item
Obeys commands (6)
C2012055 (UMLS CUI-1)
Glasgow coma score finding
Item
Glasgow coma score finding
integer
C1271007 (UMLS CUI [1])
Item Group
General assessment
Contusion frontal surface of scalp
Item
Contusion frontal surface of scalp
boolean
C2104819 (UMLS CUI [1])
Contusion mark temporal
Item
Contusion mark temporal
boolean
C1393928 (UMLS CUI [1])
Contusion region parietal
Item
Contusion region parietal
boolean
C1393911 (UMLS CUI [1])
Contusion region occipital
Item
Contusion region occipital
boolean
C1393907 (UMLS CUI [1])
Coma
Item
Coma
boolean
C0041657 (UMLS CUI [1])
Neurology examination finding NAD
Item
Neurology examination finding NAD
boolean
C0438117 (UMLS CUI [1,1])
C0559229 (UMLS CUI [1,2])
Pupil motoric
Item
Pupil motoric
boolean
C0946327 (UMLS CUI [1])
Anisocoria
Item
Anisocoria
boolean
C0003079 (UMLS CUI [1])
Liquorrhea
Item
Liquorrhea
boolean
C0860578 (UMLS CUI [1])
Haematotympanum
Item
Haematotympanum
boolean
C0019125 (UMLS CUI [1])
Mental health
Item
Mental health
boolean
C0025353 (UMLS CUI [1])
Vomiting
Item
Vomiting
boolean
C0042963 (UMLS CUI [1])
Headache
Item
Headache
boolean
C0018681 (UMLS CUI [1])
Hospital admission
Item
Hospital admission
boolean
C0420279 (UMLS CUI [1])
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