CDE Detailed Report
Disease: Stroke
Subdomain Name: Clinical Event End Points
CRF: Stroke Adjudication Form
Displaying 1 - 27 of 27
Subdomain Name: Clinical Event End Points
CRF: Stroke Adjudication Form
Displaying 1 - 27 of 27
| CDE ID | CDE Name | Variable Name | Definition | Short Description | 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 / Guidance) | Subdomain Name | Domain Name | Size | Input Restrictions | Min Value | Max Value | Measurement Type | External Id Loinc | External Id Snomed | External Id caDSR | External Id CDISC |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| C18887 | Stroke Adjudication Worksheet - ischemic infarction hemorrhagic transformation etiology other text | StrokeAdjudWkIsInfrHemTfEtiOTH | The free-text field related to 'Stroke Adjudication Worksheet - ischemic infarction hemorrhagic transformation etiology type' specifying other text. The type of etiology of the hemorrhage | The free-text field related to 'Stroke Adjudication Worksheet - ischemic infarction hemorrhagic transformation etiology type' specifying other text. The type of etiology of the hemorrhag | Other, specify | Alphanumeric |
Only answer if 'Hemorrhagic' was answered for Stroke/TIA subtype. |
Howard VJ, Cushman M, Pulley L, Gomez CR, Go RC, Prineas RJ, Graham A, Moy CS, Howard G. The REasons for Geographic and Racial Differences in Stroke study: objectives and design. Neuroepidemiology. 2005; 25:135-143. | Adult | Supplemental | 3.00 | 2013-06-21 00:00:00.0 | Stroke Adjudication Form | Clinical Event End Points | Outcomes and End Points | 4000 |
Free-Form Entry |
|||||||||
| C13470 | Stroke Adjudication Worksheet - neuroimaging type | StrokeAdjudWksNeuroimagTyp | Type of neuro-imaging done for the stroke event | Type of neuro-imaging done for the stroke event | Please specify type of image | Single brain CT;Multiple brain CTs separated in time;MRI;DWI | Single brain CT;Multiple brain CTs separated in time;MRI;DWI | Alphanumeric |
Choose all that apply. If 'Single brain CT' is answered, go to question 4.1.1. If 'Multiple brain CTs separated in time' is answered, go to question 4.1.2. If 'MRI' is answered, go to question 4.1.3. If 'DWI' is answered, go to question 4.1.4. |
Howard VJ, Cushman M, Pulley L, Gomez CR, Go RC, Prineas RJ, Graham A, Moy CS, Howard G. The REasons for Geographic and Racial Differences in Stroke study: objectives and design. Neuroepidemiology. 2005; 25:135-143. | Adult | Supplemental | 3.00 | 2013-06-21 00:00:00.0 | Stroke Adjudication Form | Clinical Event End Points | Outcomes and End Points |
Multiple Pre-Defined Values Selected |
||||||||
| C13481 | Stroke Adjudication Worksheet - ischemic infarction hemorrhagic transformation anatomic site | StrokeAdjudWkIsInfrHmTfAntSite | The anatomic location(s) of the hemorrhagic transformation during ischemic infarction | Location(s) of the hemorrhagic stroke | What was the location | Right lobal;Right basal ganglia;Brainstem;Intraventricular involvement;Left lobar;Left basal ganglia;Cerebellum;Other, specify;Unknown | Right lobal;Right basal ganglia;Brainstem;Intraventricular involvement;Left lobar;Left basal ganglia;Cerebellum;Other, specify;Unknown | Alphanumeric |
Choose all that apply. Only answer if 'Hemorrhagic' was answered for Stroke/TIA subtype. |
Howard VJ, Cushman M, Pulley L, Gomez CR, Go RC, Prineas RJ, Graham A, Moy CS, Howard G. The REasons for Geographic and Racial Differences in Stroke study: objectives and design. Neuroepidemiology. 2005; 25:135-143. | Adult | Supplemental | 3.00 | 2013-06-21 00:00:00.0 | Stroke Adjudication Form | Clinical Event End Points | Outcomes and End Points |
Multiple Pre-Defined Values Selected |
||||||||
| C13471 | Stroke Adjudication Worksheet - neuroimaging DWI stroke finding indicator | StrokeAdjudWksNroimagDWIStFInd | Whether the DWI was positive for this stroke event | Whether the DWI was positive for this stroke event | Was it positive for this event | Yes;No;Result not available | Yes;No;Result not available | Alphanumeric |
The related forms contains the template stroke adjudication form from the Reasons for Geographic And Racial Differences in Stroke (REGARDS) study. The form provides a systematic way to collect data on stroke presence and subtype for an epidemiological study. (Examples of CDEs included: Presenting Symptoms; Stroke according to WHO definition; and Ischemic stroke subtype) |
Howard VJ, Cushman M, Pulley L, Gomez CR, Go RC, Prineas RJ, Graham A, Moy CS, Howard G. The REasons for Geographic and Racial Differences in Stroke study: objectives and design. Neuroepidemiology. 2005; 25:135-143. | Adult | Supplemental | 3.00 | 2013-06-21 00:00:00.0 | Stroke Adjudication Form | Clinical Event End Points | Outcomes and End Points |
Single Pre-Defined Value Selected |
||||||||
| C13482 | Stroke Adjudication Worksheet - ischemic infarction hemorrhagic transformation etiology type | StrokeAdjudWkIsInfrHemTfEtiTyp | The type of etiology of the hemorrhage | The type of etiology of the hemorrhag | What was the etiology of the hemorrhage | Hypertension;Illicit drug Use;Vasculitis;Subarachnoid hemorrhage;Amyloid;Anticoagulant;Coagulopathy;Arteriovenous malformation;Other, specify Unknown | Hypertension;Illicit drug Use;Vasculitis;Subarachnoid hemorrhage;Amyloid;Anticoagulant;Coagulopathy;Arteriovenous malformation (AVM);Other, specify Unknown | Alphanumeric |
Only answer if 'Hemorrhagic' was answered for Stroke/TIA subtype. |
Howard VJ, Cushman M, Pulley L, Gomez CR, Go RC, Prineas RJ, Graham A, Moy CS, Howard G. The REasons for Geographic and Racial Differences in Stroke study: objectives and design. Neuroepidemiology. 2005; 25:135-143. | Adult | Supplemental | 3.00 | 2013-06-21 00:00:00.0 | Stroke Adjudication Form | Clinical Event End Points | Outcomes and End Points |
Multiple Pre-Defined Values Selected |
||||||||
| C13472 | Stroke Adjudication Worksheet - WHO definition indicator | StrokeAdjudWkWHODefInd | The indicator of whether the event is a stroke according to the WHO definition. World Health Organization definition = Rapidly developing clinical signs of focal, at times global, disturbance of cerebral function, lasting more than 24 hours or leading to death with no apparent cause other than that of vascular origin | The indicator of whether the event is a stroke according to the WHO definition. World Health Organization definition = Rapidly developing clinical signs of focal, at times global, disturbance of cerebral function, lasting more than 24 hours or leading to death with no apparent cause other than that of vascular origi | Is the event a stroke according to the WHO definition | Yes;No;Unknown | Yes;No;Unknown | Alphanumeric |
If 'Yes' is answered, skip to question 8. If 'No' is answered, go to question 6. |
Howard VJ, Cushman M, Pulley L, Gomez CR, Go RC, Prineas RJ, Graham A, Moy CS, Howard G. The REasons for Geographic and Racial Differences in Stroke study: objectives and design. Neuroepidemiology. 2005; 25:135-143. | Adult | Supplemental | 3.00 | 2013-06-21 00:00:00.0 | Stroke Adjudication Form | Clinical Event End Points | Outcomes and End Points |
Single Pre-Defined Value Selected |
||||||||
| C13483 | Stroke Adjudication Worksheet - hospitalized indicator | StrokeAdjudWksHospInd | Is this case a hospitalization for chest pain, heart failure, acute MI or coronary revascularization? | Is this case a hospitalization for chest pain, heart failure, acute MI or coronary revascularization? | Is this case a hospitalization for chest pain, heart failure, acute MI or coronary revascularization | Yes;No;Unknown | Yes;No;Unknown | Alphanumeric |
Choose only one |
Howard VJ, Cushman M, Pulley L, Gomez CR, Go RC, Prineas RJ, Graham A, Moy CS, Howard G. The REasons for Geographic and Racial Differences in Stroke study: objectives and design. Neuroepidemiology. 2005; 25:135-143. | Adult | Supplemental | 3.00 | 2013-06-21 00:00:00.0 | Stroke Adjudication Form | Clinical Event End Points | Outcomes and End Points |
Single Pre-Defined Value Selected |
||||||||
| C13473 | Stroke Adjudication Worksheet - not meet WHO definition indicator | StrokeAdjudWksNotMeetWHODefInd | The indicator of whether the event is not a stroke according to the WHO definition | The indicator of whether the event is not a stroke according to the WHO definitio | Is this a clinical stroke that does not meet the WHO criteria | Yes;No;Unknown | Yes;No;Unknown | Alphanumeric |
If 'Yes' is answered, skip to question 8. If 'No' is answered, go to question 7. |
Howard VJ, Cushman M, Pulley L, Gomez CR, Go RC, Prineas RJ, Graham A, Moy CS, Howard G. The REasons for Geographic and Racial Differences in Stroke study: objectives and design. Neuroepidemiology. 2005; 25:135-143. | Adult | Supplemental | 3.00 | 2013-06-21 00:00:00.0 | Stroke Adjudication Form | Clinical Event End Points | Outcomes and End Points |
Single Pre-Defined Value Selected |
||||||||
| C13484 | Stroke Adjudication Worksheet - death indicator | StrokeAdjudWksDeathInd | The indicator if person died during hospitalization after stroke | The indicator if person died during hospitalization after strok | Did this person die during hospitalization | Yes;No;Unknown | Yes;No;Unknown | Alphanumeric |
When date/time data are prepared for aggregation or sharing they should be converted to the format specified by ISO 8601, YYYY-MM-DDThh:mm:ss. |
Howard VJ, Cushman M, Pulley L, Gomez CR, Go RC, Prineas RJ, Graham A, Moy CS, Howard G. The REasons for Geographic and Racial Differences in Stroke study: objectives and design. Neuroepidemiology. 2005; 25:135-143. | Adult | Supplemental | 3.00 | 2013-06-21 00:00:00.0 | Stroke Adjudication Form | Clinical Event End Points | Outcomes and End Points |
Single Pre-Defined Value Selected |
||||||||
| C13474 | Stroke Adjudication Worksheet - TIA indicator | StrokeAdjudWksTIAInd | The indicator whether this event a transient ischemic attack (TIA) | The indicator whether this event a transient ischemic attack (TIA | Is this event a transient ischemic attack (TIA) | Yes;No;Unknown | Yes;No;Unknown | Alphanumeric |
If 'Yes' is answered, go to question 8. If 'No' is answered, skip to question 9. |
Howard VJ, Cushman M, Pulley L, Gomez CR, Go RC, Prineas RJ, Graham A, Moy CS, Howard G. The REasons for Geographic and Racial Differences in Stroke study: objectives and design. Neuroepidemiology. 2005; 25:135-143. | Adult | Supplemental | 3.00 | 2013-06-21 00:00:00.0 | Stroke Adjudication Form | Clinical Event End Points | Outcomes and End Points |
Single Pre-Defined Value Selected |
||||||||
| C14053 | Stroke Adjudication Worksheet - neuroimaging single CT stroke finding indicator | StrokAdjudWkNimgSingCTStrkFInd | Whether the single brain CT scan was positive for this stroke event | Whether the single brain CT scan was positive for this stroke event | Was it positive for this event | Yes;No;Result not available | Yes;No;Result not available | Alphanumeric |
The related forms contains the template stroke adjudication form from the Reasons for Geographic And Racial Differences in Stroke (REGARDS) study. The form provides a systematic way to collect data on stroke presence and subtype for an epidemiological study. (Examples of CDEs included: Presenting Symptoms; Stroke according to WHO definition; and Ischemic stroke subtype) |
Howard VJ, Cushman M, Pulley L, Gomez CR, Go RC, Prineas RJ, Graham A, Moy CS, Howard G. The REasons for Geographic and Racial Differences in Stroke study: objectives and design. Neuroepidemiology. 2005; 25:135-143. | Adult | Supplemental | 3.00 | 2013-06-21 00:00:00.0 | Stroke Adjudication Form | Clinical Event End Points | Outcomes and End Points |
Single Pre-Defined Value Selected |
||||||||
| C13475 | Stroke Adjudication Worksheet - stroke TIA sub type | StrokeAdjudWksStrkTIASubTyp | The type of stroke or transient ischemic attack (TIA) subtype | The type of stroke or transient ischemic attack (TIA) subtyp | Stroke or TIA subtype | Ischemic;Hemorrhagic | includes ischemic events with hemorrhagic transformation; | Alphanumeric |
Choose only one |
Howard VJ, Cushman M, Pulley L, Gomez CR, Go RC, Prineas RJ, Graham A, Moy CS, Howard G. The REasons for Geographic and Racial Differences in Stroke study: objectives and design. Neuroepidemiology. 2005; 25:135-143. | Adult | Supplemental | 3.00 | 2013-06-21 00:00:00.0 | Stroke Adjudication Form | Clinical Event End Points | Outcomes and End Points |
Single Pre-Defined Value Selected |
||||||||
| C14054 | Stroke Adjudication Worksheet - neuroimaging multiple CT stroke finding indicator | StrokAdjudWkNimgMultCTStrkFInd | Whether the multiple brain CTs separated in time was positive for this stroke event | Whether the multiple brain CTs separated in time was positive for this stroke event | Were they positive for this event | Yes;No;Result not available | Yes;No;Result not available | Alphanumeric |
The related forms contains the template stroke adjudication form from the Reasons for Geographic And Racial Differences in Stroke (REGARDS) study. The form provides a systematic way to collect data on stroke presence and subtype for an epidemiological study. (Examples of CDEs included: Presenting Symptoms; Stroke according to WHO definition; and Ischemic stroke subtype) |
Howard VJ, Cushman M, Pulley L, Gomez CR, Go RC, Prineas RJ, Graham A, Moy CS, Howard G. The REasons for Geographic and Racial Differences in Stroke study: objectives and design. Neuroepidemiology. 2005; 25:135-143. | Adult | Supplemental | 3.00 | 2013-06-21 00:00:00.0 | Stroke Adjudication Form | Clinical Event End Points | Outcomes and End Points |
Single Pre-Defined Value Selected |
||||||||
| C13465 | Stroke Adjudication Worksheet date | StrokeAdjudWksheetDate | Date of hospital admission or outpatient visit when the stroke event was evaluated | Date of hospital admission or outpatient visit when the stroke event was evaluated | Enter the date of admission or outpatient visit | 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.). |
Howard VJ, Cushman M, Pulley L, Gomez CR, Go RC, Prineas RJ, Graham A, Moy CS, Howard G. The REasons for Geographic and Racial Differences in Stroke study: objectives and design. Neuroepidemiology. 2005; 25:135-143. | Adult | Supplemental | 3.00 | 2013-06-21 00:00:00.0 | Stroke Adjudication Form | Clinical Event End Points | Outcomes and End Points |
Free-Form Entry |
||||||||||
| C13476 | Stroke Adjudication Worksheet - stroke TIA symptoms type | StrokeAdjudWksStkTIASymTyp | The type of symptoms/conditions that were present and relevant for ischemic stroke subtype | The type of symptoms/conditions that were present and relevant for ischemic stroke subtyp | Select all the following that were present and relevant | Cardioembolic source;Small vessel disease;Large vessel disease;Other identified cause of ischemic stroke | includes atrial fibrillation/flutter, dilated cardiomyopathy, acute MI, prosthetic heart valve, intracardiac thrombus, akinesis of ventricular wall, rheumatic MS, ischemic cardiomyopathy (EF < 28%), sick sinus syndrome, etc.;Clinical presentation is typically lacunar, e.g., pure motor hemiparesis of face, or of the arm and leg. Alternatively, clinical presentation is other than the classically described lacunar stroke, but brain image report demonstrates deep infarct < 1.5 cm that could explain the clinical syndrome.;> 50% stenosis or occlusion consistent with atherosclerosis of an artery appropriate to the site of the infarct, or with evidence for distal emboli that explain infarct, or tandem lesion strokes.;includes vessel dissection, hypercoagulable state, illicit drug use, temporal arteritis, cancer, venous thrombosis, aortic arch atheroma, patent foramen ovalle, angiography or percutaneous intervention, surgery (within 24 hours of event), etc. | Alphanumeric |
Choose all that apply. |
Howard VJ, Cushman M, Pulley L, Gomez CR, Go RC, Prineas RJ, Graham A, Moy CS, Howard G. The REasons for Geographic and Racial Differences in Stroke study: objectives and design. Neuroepidemiology. 2005; 25:135-143. | Adult | Supplemental | 3.00 | 2013-06-21 00:00:00.0 | Stroke Adjudication Form | Clinical Event End Points | Outcomes and End Points |
Multiple Pre-Defined Values Selected |
||||||||
| C14055 | Stroke Adjudication Worksheet - neuroimaging MRI stroke finding indicator | StrokeAdjudWkNroimagMRIStFInd | Whether the MRI was positive for this stroke event | Whether the MRI was positive for this stroke event | Was it positive for this event | Yes;No;Result not available | Yes;No;Result not available | Alphanumeric |
The related forms contains the template stroke adjudication form from the Reasons for Geographic And Racial Differences in Stroke (REGARDS) study. The form provides a systematic way to collect data on stroke presence and subtype for an epidemiological study. (Examples of CDEs included: Presenting Symptoms; Stroke according to WHO definition; and Ischemic stroke subtype) |
Howard VJ, Cushman M, Pulley L, Gomez CR, Go RC, Prineas RJ, Graham A, Moy CS, Howard G. The REasons for Geographic and Racial Differences in Stroke study: objectives and design. Neuroepidemiology. 2005; 25:135-143. | Adult | Supplemental | 3.00 | 2013-06-21 00:00:00.0 | Stroke Adjudication Form | Clinical Event End Points | Outcomes and End Points |
Single Pre-Defined Value Selected |
||||||||
| C13466 | Stroke Adjudication Worksheet - type | StrokeAdjudWksTyp | Whether the participant/subject presented with neurologic symptoms | Whether the participant/subject presented with neurologic symptoms | Presenting Symptoms | Neurologic symptoms not present;Neurologic symptoms present | Neurologic symptoms not present;Neurologic symptoms present | Alphanumeric |
Choose only one. If 'Neurologic symptoms not present' is answered, skip to question 4. If "Neurologic symptoms present" is answered, go to question 2.1. |
Howard VJ, Cushman M, Pulley L, Gomez CR, Go RC, Prineas RJ, Graham A, Moy CS, Howard G. The REasons for Geographic and Racial Differences in Stroke study: objectives and design. Neuroepidemiology. 2005; 25:135-143. | Adult | Supplemental | 3.00 | 2013-06-21 00:00:00.0 | Stroke Adjudication Form | Clinical Event End Points | Outcomes and End Points |
Single Pre-Defined Value Selected |
||||||||
| C13477 | Stroke Adjudication Worksheet - stroke TIA cardioembolic source symptoms type | StrokAdjudWkStTIACardSrcSypTyp | The type of symptoms/conditions that were present and relevant for cardioembolic source | The type of symptoms/conditions that were present and relevant for cardioembolic sourc | Which of the following were present and relevant | Atrial fibrillation/flutter;Acute MI (< 2 weeks);Intracardiac thrombus;Rheumatic MS;Sick sinus syndrome;Dilated cardiomyopathy;Prosthetic heart valve;Akinesis of ventricular wall;Ischemic cardiomyopathy (EF<28%);Other, specify | Atrial fibrillation/flutter;Acute MI (< 2 weeks);Intracardiac thrombus;Rheumatic MS;Sick sinus syndrome;Dilated cardiomyopathy;Prosthetic heart valve;Akinesis of ventricular wall;Ischemic cardiomyopathy (EF<28%);Other, specify | Alphanumeric |
Choose all that apply. Only answer if 'Cardioembolic source' was answered for ischemic stroke subtype. |
Howard VJ, Cushman M, Pulley L, Gomez CR, Go RC, Prineas RJ, Graham A, Moy CS, Howard G. The REasons for Geographic and Racial Differences in Stroke study: objectives and design. Neuroepidemiology. 2005; 25:135-143. | Adult | Supplemental | 3.00 | 2013-06-21 00:00:00.0 | Stroke Adjudication Form | Clinical Event End Points | Outcomes and End Points |
Multiple Pre-Defined Values Selected |
||||||||
| C18884 | Stroke Adjudication Worksheet - stroke TIA cardioembolic source symptoms other text | StrokeAdjdWkStTIACardSrcSypOTH | The free-text field related to 'Stroke Adjudication Worksheet - stroke TIA cardioembolic source symptoms type' specifying other text. The type of symptoms/conditions that were present and relevant for cardioembolic source | The free-text field related to 'Stroke Adjudication Worksheet - stroke TIA cardioembolic source symptoms type' specifying other text. The type of symptoms/conditions that were present and relevant for cardioembolic sourc | Other, specify | Alphanumeric |
Choose all that apply. Only answer if 'Cardioembolic source' was answered for ischemic stroke subtype. |
Howard VJ, Cushman M, Pulley L, Gomez CR, Go RC, Prineas RJ, Graham A, Moy CS, Howard G. The REasons for Geographic and Racial Differences in Stroke study: objectives and design. Neuroepidemiology. 2005; 25:135-143. | Adult | Supplemental | 3.00 | 2013-06-21 00:00:00.0 | Stroke Adjudication Form | Clinical Event End Points | Outcomes and End Points | 4000 |
Free-Form Entry |
|||||||||
| C13467 | Stroke Adjudication Worksheet - anatomic site | StrokeAdjudWksAntmicSite | Type of neurologic symptom(s) presented in participant/subject | Type of neurologic symptom(s) presented in participant/subject | Type of symptoms | Focal symptom;Non focal symptom | Focal symptom;Non focal symptom | Alphanumeric |
Choose only one |
Howard VJ, Cushman M, Pulley L, Gomez CR, Go RC, Prineas RJ, Graham A, Moy CS, Howard G. The REasons for Geographic and Racial Differences in Stroke study: objectives and design. Neuroepidemiology. 2005; 25:135-143. | Adult | Supplemental | 3.00 | 2013-06-21 00:00:00.0 | Stroke Adjudication Form | Clinical Event End Points | Outcomes and End Points |
Single Pre-Defined Value Selected |
||||||||
| C13478 | Stroke Adjudication Worksheet - stroke TIA other symptoms type | StrokeAdjudWkStrkTIAOthSymTyp | The type of other identified cause(s) of ischemic stroke | The type of other identified cause(s) of ischemic strok | Please specify other cause(s) | Vessel dissection;Illicit drug Use;Cancer;Aortic arch atheroma;Angiography or percutaneous intervention;Surgery;Hypercoagulable state;Temporal arteritis;Venous thrombosis;Patent foramen ovalle;Other, specify | Vessel dissection;Illicit drug Use;Cancer;Aortic arch atheroma;Angiography or percutaneous intervention;Surgery;Hypercoagulable state;Temporal arteritis;Venous thrombosis;Patent foramen ovalle;Other, specify | Alphanumeric |
Choose all that apply. Only answer if 'Other identified cause of ischemic stroke' was answered for ischemic stroke subtype. |
Howard VJ, Cushman M, Pulley L, Gomez CR, Go RC, Prineas RJ, Graham A, Moy CS, Howard G. The REasons for Geographic and Racial Differences in Stroke study: objectives and design. Neuroepidemiology. 2005; 25:135-143. | Adult | Supplemental | 3.00 | 2013-06-21 00:00:00.0 | Stroke Adjudication Form | Clinical Event End Points | Outcomes and End Points |
Multiple Pre-Defined Values Selected |
||||||||
| C18885 | Stroke Adjudication Worksheet - stroke TIA other symptoms other text | StrokeAdjudWkStrkTIAOthSymOTH | The free-text field related to 'Stroke Adjudication Worksheet - stroke TIA other symptoms type' specifying other text. The type of other identified cause(s) of ischemic stroke | The free-text field related to 'Stroke Adjudication Worksheet - stroke TIA other symptoms type' specifying other text. The type of other identified cause(s) of ischemic strok | Other, specify | Alphanumeric |
Choose all that apply. Only answer if 'Other identified cause of ischemic stroke' was answered for ischemic stroke subtype. |
Howard VJ, Cushman M, Pulley L, Gomez CR, Go RC, Prineas RJ, Graham A, Moy CS, Howard G. The REasons for Geographic and Racial Differences in Stroke study: objectives and design. Neuroepidemiology. 2005; 25:135-143. | Adult | Supplemental | 3.00 | 2013-06-21 00:00:00.0 | Stroke Adjudication Form | Clinical Event End Points | Outcomes and End Points | 4000 |
Free-Form Entry |
|||||||||
| C13468 | Stroke Adjudication Worksheet - symptom duration | StrokeAdjudWksSymDur | How long the symptom(s) experienced around the time of the stroke event lasted | How long the symptom(s) experienced around the time of the stroke event lasted | Duration of symptoms | Confirmed to be greater than or equal to 24 hours;Confirmed to be less than 24 hours;Duration of symptoms could not be confirmed | Confirmed to be greater than or equal to 24 hours;Confirmed to be less than 24 hours;Duration of symptoms could not be confirmed | Alphanumeric |
Choose only one |
Howard VJ, Cushman M, Pulley L, Gomez CR, Go RC, Prineas RJ, Graham A, Moy CS, Howard G. The REasons for Geographic and Racial Differences in Stroke study: objectives and design. Neuroepidemiology. 2005; 25:135-143. | Adult | Supplemental | 3.00 | 2013-06-21 00:00:00.0 | Stroke Adjudication Form | Clinical Event End Points | Outcomes and End Points |
Single Pre-Defined Value Selected |
||||||||
| C13479 | Stroke Adjudication Worksheet - ischemic stroke type | StrokeAdjudWksIschStrokTyp | The type of ischemic stroke subtype most likely to have contributed to this stroke | The type of ischemic stroke subtype most likely to have contributed to this strok | Ischemic stroke subtype | Cardioembolic source;Small vessel disease;Large vessel disease;Other;Unknown | Cardioembolic source;Small vessel disease;Large vessel disease;Other;Unknown | Alphanumeric |
Select the single most likely |
Howard VJ, Cushman M, Pulley L, Gomez CR, Go RC, Prineas RJ, Graham A, Moy CS, Howard G. The REasons for Geographic and Racial Differences in Stroke study: objectives and design. Neuroepidemiology. 2005; 25:135-143. | Adult | Supplemental | 3.00 | 2013-06-21 00:00:00.0 | Stroke Adjudication Form | Clinical Event End Points | Outcomes and End Points |
Single Pre-Defined Value Selected |
||||||||
| C18886 | Stroke Adjudication Worksheet - ischemic infarction hemorrhagic transformation anatomic other text | StrokeAdjudWkIsInfrHmTfAntOTH | The free-text field related to 'Stroke Adjudication Worksheet - ischemic infarction hemorrhagic transformation anatomic site' specifying other text. The anatomic location(s) of the hemorrhagic transformation during ischemic infarction | The free-text field related to 'Stroke Adjudication Worksheet - ischemic infarction hemorrhagic transformation anatomic site' specifying other text. The anatomic location(s) of the hemorrhagic transformation during ischemic infarctio | Other, specify | Alphanumeric |
Choose all that apply. Only answer if 'Hemorrhagic' was answered for Stroke/TIA subtype. |
Howard VJ, Cushman M, Pulley L, Gomez CR, Go RC, Prineas RJ, Graham A, Moy CS, Howard G. The REasons for Geographic and Racial Differences in Stroke study: objectives and design. Neuroepidemiology. 2005; 25:135-143. | Adult | Supplemental | 3.00 | 2013-06-21 00:00:00.0 | Stroke Adjudication Form | Clinical Event End Points | Outcomes and End Points | 4000 |
Free-Form Entry |
|||||||||
| C13469 | Stroke Adjudication Worksheet - neuroimaging indicator | StrokeAdjudWksNeuroimagInd | The indicator for whether neuro-imaging done for this stroke event | The indicator for whether neuro-imaging done for this stroke even | Was neuro-imaging done for this event | Yes;No;Unknown | Yes;No;Unknown | Alphanumeric |
If "Yes" is answered, go to question 4.1 |
Howard VJ, Cushman M, Pulley L, Gomez CR, Go RC, Prineas RJ, Graham A, Moy CS, Howard G. The REasons for Geographic and Racial Differences in Stroke study: objectives and design. Neuroepidemiology. 2005; 25:135143. | Adult | Supplemental | 3.00 | 2013-06-21 00:00:00.0 | Stroke Adjudication Form | Clinical Event End Points | Outcomes and End Points |
Single Pre-Defined Value Selected |
||||||||
| C13480 | Stroke Adjudication Worksheet - ischemic infarction hemorrhagic transformation indicator | StrokeAdjudWkIsInfrcHemTrnfInd | The indicator of ischemic infarction with hemorrhagic transformation being present | The indicator of ischemic infarction with hemorrhagic transformation being presen | Ischemic infarction with hemorrhagic transformation present | Yes;No;Unknown | Yes;No;Unknown | Alphanumeric |
If 'Yes' is answered, end worksheet and sign bottom of form. If 'No' is answered, skip to question 9. |
Howard VJ, Cushman M, Pulley L, Gomez CR, Go RC, Prineas RJ, Graham A, Moy CS, Howard G. The REasons for Geographic and Racial Differences in Stroke study: objectives and design. Neuroepidemiology. 2005; 25:135-143. | Adult | Supplemental | 3.00 | 2013-06-21 00:00:00.0 | Stroke Adjudication Form | Clinical Event End Points | Outcomes and End Points |
Single Pre-Defined Value Selected |
