CDE Detailed Report

Disease: Stroke
Sub-Domain: General Health History
CRF: Prior Functional Status

Displaying 1 - 9 of 9
CDE ID CDE Name Variable Name Definition Short Description Additional Notes (Question Text) Permissible Values Description Data Type Disease Specific Instructions Disease Specific Reference Population Classification (e.g., Core) Version Number Version Date CRF Name (CRF Module / Guideline) Sub Domain Name Domain Name Size Input Restrictions Min Value Max Value Measurement Type External Id Loinc External Id Snomed External Id caDSR External Id CDISC
C05130 Therapy or rehabilitation type TherpyRehabTyp Type of therapy or rehabilitation services received by the participant/subject. Type of therapy or rehabilitation services received by the participant/subject. Specialized therapies and services Speech therapy;Occupational therapy;Physical therapy;Sensory integration therapy;Social skills training;Adaptive physical education;Behavior support plan;Crisis management plan;Other, specify Speech therapy;Occupational therapy;Physical therapy;Sensory integration therapy;Social skills training;Adaptive physical education;Behavior support plan;Crisis management plan;Other, specify Alphanumeric

Choose all that apply. This element can be collected to describe the participant/ subject prior to the stroke event and also to assess the participant/ subject at subsequent time points after the stroke event.

International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM): https://www.cdc.gov/nchs/icd/icd10cm.htm Adult;Pediatric Supplemental 3.00 2013-07-20 10:21:25.65 Prior Functional Status General Health History Participant History and Family History

Multiple Pre-Defined Values Selected

C06005 Data collected date and time DataCollDateTime Date (and time, if applicable and known) the data were collected. This may be the date/time a particular examination or procedure was performed. Date (and time, if applicable and known) the data were collected. This may be the date/time a particular examination or procedure was performed. Date information collected Date or Date & Time

Record the date/time according to the ISO 8601, the International Standard for the representation of dates and times (http://www.iso.org/iso/home.html). The date/time should be recorded to the level of granularity known (e.g., year, year and month, complete date plus hours and minutes, etc.).

No references available Adult;Pediatric Supplemental 3.00 2013-07-24 21:00:23.88 Prior Functional Status General Health History Participant History and Family History

Free-Form Entry

C11084 Developmental and academic history type DevelopmentalAcademicHistTyp Specific aspects of the participant's/subject's pre-morbid developmental status and academic function Specific aspects of the participant's/subject's pre-morbid developmental status and academic function Does/did the participant/ subject have any of the following Attention Deficit Hyperactivity Disorder (ADHD);Attention Deficit Disorder (ADD);Delayed acquisition of motor milestones, diagnosed by a pediatrician or neurologist;Social delay;Hand preference before twelve months of age;Abnormality of gait noted by parent or physician at the time the child began walking;Received or receives special education;Other, specify;Delayed acquisition of language milestones, diagnosed by a health care provider or educator;Delayed acquisition of cognitive milestones, diagnosed by a health care provider or educator Attention Deficit Hyperactivity Disorder (ADHD);Attention Deficit Disorder (ADD);Delayed acquisition of motor milestones, diagnosed by a pediatrician or neurologist;Social delay;Hand preference before twelve months of age;Abnormality of gait noted by parent or physician at the time the child began walking;Received or receives special education;Other, specify;Delayed acquisition of language milestones, diagnosed by a health care provider or educator;Delayed acquisition of cognitive milestones, diagnosed by a health care provider or educator Alphanumeric

For each history type indicate whether or not the participant/subject has a history

International Pediatric Stroke Study (IPSS) Pediatric Supplemental 3.00 2013-07-10 11:37:29.993 Prior Functional Status General Health History Participant History and Family History

Multiple Pre-Defined Values Selected

C11085 Developmental and academic history indicator DevelopmentalAcacdemicHistInd Whether the participant/subject has a history of the specific aspect of the pre-morbid developmental status or academic function Whether the participant/subject has a history of the specific aspect of the pre-morbid developmental status or academic function Does/did the participant/ subject have any of the following Yes;No;Unknown History reported and/or confirmed in medical record;History NOT reported and NOT confirmed in medical record;History reported as unknown or could not be collected Alphanumeric

For each history type indicate whether or not the participant/subject has a history. Choose one for each history type.

International Pediatric Stroke Study (IPSS) Pediatric Supplemental 3.00 2013-07-10 11:37:29.993 Prior Functional Status General Health History Participant History and Family History

Single Pre-Defined Value Selected

C11086 School placement type SchoolPlacementTyp The description of the type of education the participant/subject receives with details of being with or without assistance. The description of the type of education the participant/subject receives with details of being with or without assistance. School placement Full-time regular education without aide;Full-time regular education with one to one aide;Regular education with pull-out for certain areas;Special education w/minimal inclusion (e.g., lunch);Full time special education with no inclusion;Special (MR/DD) school;Home-schooled;Not in school;Other, specify Full-time regular education without aide;Full-time regular education with one to one aide;Regular education with pull-out for certain areas;Special education w/minimal inclusion (e.g., lunch);Full time special education with no inclusion;Special (MR/DD) school;Home-schooled;Not in school;Other, specify Alphanumeric

This element can be collected to describe the participant/ subject prior to the stroke event and also to assess the participant/ subject at subsequent time points after the stroke event.

No references available Pediatric Supplemental 3.00 2013-07-11 15:03:49.2 Prior Functional Status General Health History Participant History and Family History

Single Pre-Defined Value Selected

C14639 Ambulatory status AmbulatStatus Status that reflects the participant's/subject's ability to walk Status that reflects the participant's/subject's ability to walk Ambulatory status Able to ambulate independently (no help from another person) w/ or w/o device;With assistance (from person);Unable to ambulate;Unknown Patient ambulating without assistance (no help from another person) with or without a device. This means Patient is able to ambulate without help from another person. The use of a device, such as a cane, still meets this definition.;Patient ambulating with assistance of another person.;Patient is on bed rest. Patient is only getting out of bed to the bedside commode (or up in chair) and is primarily in the bed (or immobile).;Unknown or not documented. It is unable to determine from documentation. Alphanumeric

Choose one that describes the participant's/subject's ability prior to the qualifying stroke event.

Get With The Guidelines (GWTG) Stroke Patient Management Tool Coding Instructions (Updated on 11/4/2009); Paul Coverdell National Acute Stroke Registry SPS3 Adult;Pediatric Core 3.00 2013-06-21 00:00:00.0 Prior Functional Status General Health History Participant History and Family History

Single Pre-Defined Value Selected

C18768 Therapy or rehabilitation other text TherpyRehabOTH The free-text field related to 'Therapy or rehabilitation type' specifying other text. Type of therapy or rehabilitation services received by the participant/subject The free-text field related to 'Therapy or rehabilitation type' specifying other text. Type of therapy or rehabilitation services received by the participant/subject Other, specify Alphanumeric

Choose all that apply. This element can be collected to describe the participant/ subject prior to the stroke event and also to assess the participant/ subject at subsequent time points after the stroke event.

International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM): https://www.cdc.gov/nchs/icd/icd10cm.htm Adult;Pediatric Supplemental 1.00 2014-05-27 13:34:46.0 Prior Functional Status General Health History Participant History and Family History 4000

Free-Form Entry

C18820 Developmental and academic history other text DevelopmentalAcademicHistOTH The free-text field related to 'Developmental and academic history type' specifying other text. Specific aspects of the participant's/subject's pre-morbid developmental status and academic function The free-text field related to 'Developmental and academic history type' specifying other text. Specific aspects of the participant's/subject's pre-morbid developmental status and academic function Other, specify Alphanumeric

For each history type indicate whether or not the participant/subject has a history

International Pediatric Stroke Study (IPSS) Pediatric Supplemental 3.00 2013-07-10 11:37:29.993 Prior Functional Status General Health History Participant History and Family History 4000

Free-Form Entry

C18821 School placement other text SchoolPlacementOTH The free-text field related to 'School placement type' specifying other text. The description of the type of education the participant/subject receives with details of being with or without assistance. The free-text field related to 'School placement type' specifying other text. The description of the type of education the participant/subject receives with details of being with or without assistance. Other, specify Alphanumeric

This element can be collected to describe the participant/ subject prior to the stroke event and also to assess the participant/ subject at subsequent time points after the stroke event.

No references available Pediatric Supplemental 3.00 2013-07-11 15:03:49.2 Prior Functional Status General Health History Participant History and Family History 4000

Free-Form Entry

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