CDE Detailed Report
Disease: Spinal Cord Injury
Subdomain Name: History of Disease/Injury Event
CRF: Pre-Hospital Assessment Form
Displaying 1 - 41 of 41
Subdomain Name: History of Disease/Injury Event
CRF: Pre-Hospital Assessment Form
Displaying 1 - 41 of 41
| 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| C14201 | Emergency Medical Services (EMS) dispatch date and time | EMSDispatchDateTime | This refers to the date when Emergency Medical Services (EMS) transport (either by ground or air) leaves the station to pick up the patient for transport | This refers to the date when Emergency Medical Services (EMS) transport (either by ground or air) leaves the station to pick up the patient for transpor | Date and Time of EMS dispatch | 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 | 2013-06-21 00:00:00.0 | Pre-Hospital Assessment Form | History of Disease/Injury Event | Disease/Injury Related Events |
Free-Form Entry |
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| C19333 | Arrival intubation indicator | ArrivalIntubationInd | Indicator for intubation on arrival | Indicator for intubation on arrival | Was patient intubated on arrival | No;Yes;Unknown | No;Yes;Unknown | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2014-06-09 17:15:10.0 | Pre-Hospital Assessment Form | History of Disease/Injury Event | Disease/Injury Related Events |
Single Pre-Defined Value Selected |
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| C05418 | Hospital transport type | HospTrnsprtTyp | Type of transportation from injury scene to hospital | Type of transportation from injury scene to hospital | Type of transport to hospital: | Ground ambulance with physician;Ground ambulance no physician;Private transportation/taxi/other from home/scene;By foot;Other, specify;Helicopter | Ground ambulance with physician;Ground ambulance no physician;Private transportation/taxi/other from home/scene;By foot;Other, specify;Helicopter | Alphanumeric | Pediatric | Supplemental | 3.00 | 2013-07-20 10:21:25.65 | Pre-Hospital Assessment Form | History of Disease/Injury Event | Disease/Injury Related Events |
Single Pre-Defined Value Selected |
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| C21628 | Pediatric Glasgow coma scale date and time | PedGCSDateAndTime | Date (and time, if known) of Pediatric Glasgow Coma Scale assessment | Date (and time, if known) of Pediatric Glasgow Coma Scale assessment | Date and Time of PGCS | 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.). |
Pediatric | Supplemental | 1.00 | 2014-06-12 17:17:29.0 | Pre-Hospital Assessment Form | History of Disease/Injury Event | Disease/Injury Related Events |
Free-Form Entry |
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| C14202 | Emergency Medical Services (EMS) dispatch priority type | EMSDispatchPriorityTyp | For EMS systems where there is prioritizing of calls, this item would capture what level of prioritization was assigned to the transport at dispatch | For EMS systems where there is prioritizing of calls, this item would capture what level of prioritization was assigned to the transport at dispatc | EMS dispatch priority | High acuity;Moderate acuity;Other;Unknown | the highest level assigned to life-threatening illnesses;the next highest level indicating urgent but not life-threatening illnesses;Other;Unknown | Alphanumeric |
Choose one. |
https://ncim.nci.nih.gov/ncimbrowser/pages/concept_details.jsf?dictionary=NCI%20MetaThesaurus&code=C1553717&type=properties | Adult;Pediatric | Supplemental | 3.00 | 2013-06-21 00:00:00.0 | Pre-Hospital Assessment Form | History of Disease/Injury Event | Disease/Injury Related Events |
Single Pre-Defined Value Selected |
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| C19334 | Patient paralytics utilization indicator | PatientParalyticsUtilizatnInd | Indicator for the utilization of paralytics by patient | Indicator for the utilization of paralytics by patient | Was patient on paralytics | No;Yes;Unknown | No;Yes;Unknown | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2014-06-09 17:19:46.0 | Pre-Hospital Assessment Form | History of Disease/Injury Event | Disease/Injury Related Events |
Single Pre-Defined Value Selected |
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| C05433 | Protective devices use indicator | PrtctvDevcUseInd | Indicator of protective devices used by participant/subject (e.g., helmet, car seat, seat belt, etc.) | Indicator of protective devices used by participant/subject (e.g., helmet, car seat, seat belt, etc.) | Was a protective device used in the vehicle? | Yes;No;Unknown | Yes;No;Unknown | Alphanumeric |
Choose one. |
Pediatric | Supplemental | 3.00 | 2013-07-20 10:21:25.65 | Pre-Hospital Assessment Form | History of Disease/Injury Event | Disease/Injury Related Events |
Single Pre-Defined Value Selected |
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| C14204 | Emergency Medical Services (EMS) vehicle type | EMSVehicleTyp | This refers to the Emergency Medical Services (EMS) vehicle that is used to transport the patient to the hospital. Choose one response | This refers to the Emergency Medical Services (EMS) vehicle that is used to transport the patient to the hospital. Choose one respons | Type of EMS vehicle | Ground;Air;Other;Unknown | Ground;Air;Other;Unknown | Alphanumeric |
Choose one. |
See Pre-Hospital EMS Course form | Adult;Pediatric | Supplemental | 3.00 | 2013-06-21 00:00:00.0 | Pre-Hospital Assessment Form | History of Disease/Injury Event | Disease/Injury Related Events |
Single Pre-Defined Value Selected |
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| C19364 | Glasgow coma scale date and time | GCSDateAndTime | Date (and time, if known) of Glasgow Coma Scale assessment | Date (and time, if known) of Glasgow Coma Scale assessment | Date and Time of GCS | 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.). |
Teasdale G, Jennett B. Assessment of coma and impaired consciousness. A practical scale. Lancet. 1974 Jul 13;2(7872):81-4. | Adult | Supplemental | 1.00 | 2014-06-12 17:17:29.0 | Pre-Hospital Assessment Form | History of Disease/Injury Event | Disease/Injury Related Events |
Free-Form Entry |
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| C05434 | Vehicular protective device type | VehclrPrtctvDevTyp | Type of protective devices used by the participant/subject | Type of protective devices used by the participant/subject | What type of protective device was used? | Helmet;Child safety restraint;Seat belt;Airbag;Other, specify | Helmet;Child safety restraint;Seat belt;Airbag;Other, specify | Alphanumeric |
Choose one. |
Pediatric | Supplemental | 3.00 | 2013-07-20 10:21:25.65 | Pre-Hospital Assessment Form | History of Disease/Injury Event | Disease/Injury Related Events |
Multiple Pre-Defined Values Selected |
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| C14205 | Emergency Medical Services (EMS) scene arrival date and time | EMSSceneArrvlDateTime | This refers to the date/time when the Emergency Medical Services (EMS) vehicle arrives on the scene to transport the patient to the hospital | This refers to the date/time when the Emergency Medical Services (EMS) vehicle arrives on the scene to transport the patient to the hospita | Date and Time of EMS arrival at scene | Date or Date & Time |
This data element refers to the original scene and is not applicable to inter-facility transport or to patients arriving by means other than EMS. Note that EMS includes response by volunteer and professional paramedics, EMTs, fire, police and other municipal service officers responding to 911 calls. 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.). |
See Pre-Hospital EMS Course form | Adult;Pediatric | Supplemental | 3.00 | 2013-06-21 00:00:00.0 | Pre-Hospital Assessment Form | History of Disease/Injury Event | Disease/Injury Related Events |
Free-Form Entry |
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| C01000 | Glasgow Coma Scale (GCS) - eye response scale | GCSEyeRespnsScale | Glasgow Coma Scale (GCS) - Best eye response (E). The GCS is a standardized instrument for assessing the level of consciousness. It evaluates three aspects of responsiveness: eye opening, motor response, verbal response | Glasgow Coma Scale (GCS) - Best eye response (E). The GCS is a standardized instrument for assessing the level of consciousness. It evaluates three aspects of responsiveness: eye opening, motor response, verbal respons | Best eye response Score | 1;2;3;4 | No eye opening;Eye opening to pain;Eye opening to speech/verbal command;Eyes open spontaneously | Numeric Values |
Choose one |
Teasdale G, Jennett B. Assessment of coma and impaired consciousness. A practical scale. Lancet. Jul 1974;2(7872):81-4. Marmarou A, Lu J, Butcher I, et al. Prognostic value of the Glasgow Coma Scale and pupil reactivity in traumatic brain injury assessed pre-hospital and on enrollment: an IMPACT analysis. J Neurotrauma. Feb 2007;24(2):270-80. Stocchetti N, Pagan F, Calappi E, et al. Inaccurate early assessment of neurological severity in head injury. J Neurotrauma. Sep 2004:21(9):1131-40. Balestreri M, Czosnyka M, Chatfield DA, et al. Predictive value of Glasgow Coma Scale after brain trauma: change in trend over the past ten years. J Neurol Neurosurg Psychiatry. Jan 2004;75(1):161-2. | Adult | Supplemental | 3.00 | 2013-07-20 10:21:25.65 | Pre-Hospital Assessment Form | History of Disease/Injury Event | Disease/Injury Related Events |
Single Pre-Defined Value Selected |
C124724 | |||||||
| C19365 | Abbreviated injury scale six body region category | AISSixBodyRegionCat | The six body regions assessed with the 6 point intermediate ordinal severity scale | The six body regions assessed with the 6 point intermediate ordinal severity scale | 6 body regions | Abdomen;Chest;External;Extremity;Face;Head & Neck | Abdomen;Chest;External;Extremity;Face;Head & Neck | Alphanumeric | Copes WS, Sacco WJ, Champion HR, Bain LW, "Progress in Characterising Anatomic Injury", In Proceedings of the 33rd Annual Meeting of the Association for the Advancement of Automotive Medicine, Baltimore, MD, USA, 1993; 205-218. | Adult;Pediatric | Supplemental | 1.00 | 2014-06-12 17:23:40.0 | Pre-Hospital Assessment Form | History of Disease/Injury Event | Disease/Injury Related Events |
Single Pre-Defined Value Selected |
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| C05450 | Abbreviated Injury Scale body region score | AISBodyRegionScore | Score for the body region measured by Abbreviated Injury Scale | Score for the body region measured by Abbreviated Injury Scale | Abbreviated Injury Score | 1;2;3;4;5;6;9 | Minor: no treatment needed;Moderate: requires only outpatient treatment;Serious: requires non-ICU hospital admission;Severe: requires ICU observation and/or basic treatment;Critical: requires intubation, mechanical ventilation or vasopressors for blood pressure support;Maximal: not survivable;Not possible to assign (in NINDS this is 'unknown') | Numeric Values |
No instructions available |
Copes WS, Sacco WJ, Champion HR, Bain LW, "Progress in Characterising Anatomic Injury", In Proceedings of the 33rd Annual Meeting of the Association for the Advancement of Automotive Medicine, Baltimore, MD, USA, 1993; 205-218. | Adult;Pediatric | Supplemental | 3.00 | 2013-07-20 10:21:25.65 | Pre-Hospital Assessment Form | History of Disease/Injury Event | Disease/Injury Related Events |
Single Pre-Defined Value Selected |
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| C14206 | Emergency Medical Services (EMS) scene departure date and time | EMSSceneDepartureDateTime | Date and time the EMS vehicle departs with the patient from the scene to take the patient to the hospital | Date and time the EMS vehicle departs with the patient from the scene to take the patient to the hospita | Date and Time of EMS departure from scene | 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.). |
See Pre-Hospital EMS Course form | Adult;Pediatric | Supplemental | 3.00 | 2013-06-21 00:00:00.0 | Pre-Hospital Assessment Form | History of Disease/Injury Event | Disease/Injury Related Events |
Free-Form Entry |
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| C01001 | Glasgow Coma Scale (GCS) - motor response scale | GCSMotorRespnsScale | Glasgow Coma Scale (GCS) - Best motor response (M). The GCS is a standardized instrument for assessing the level of consciousness. It evaluates three aspects of responsiveness: eye opening, motor response, verbal response | Glasgow Coma Scale (GCS) - Best motor response (M). The GCS is a standardized instrument for assessing the level of consciousness. It evaluates three aspects of responsiveness: eye opening, motor response, verbal respons | Best motor response Score (Choose one) | 1;2;3;4;5;6;Untestable;Unknown | No motor response;Abnormal extension/Extensor response;Abnormal flexion;Flexion withdrawal/withdraws from pain;Localizes pain;Obeys command;Untestable;Unknown | Numeric Values |
No instructions available |
Marcin J and Pollack M. (2002). Triage scoring systems, severity of illness measures, and mortality prediction models in pediatric trauma. Crit Care Med. 30:S457-S467. | Adult | Supplemental | 3.00 | 2013-07-20 10:21:25.65 | Pre-Hospital Assessment Form | History of Disease/Injury Event | Disease/Injury Related Events |
Single Pre-Defined Value Selected |
C124725 | |||||||
| C19367 | Abbreviated injury scale nine body region category | AISNineBodyRegionCat | The nine body regions assessed with the 6 point advanced ordinal severity scale | The nine body regions assessed with the 6 point advanced ordinal severity scale | 9 body regions | Abdomen;Chest/Thorax;External and Other;Face;Head;Lower Extremity;Neck;Spine;Upper Extremity | Abdomen;Chest/Thorax;External and Other;Face;Head;Lower Extremity;Neck;Spine;Upper Extremity | Alphanumeric | Copes WS, Sacco WJ, Champion HR, Bain LW, "Progress in Characterising Anatomic Injury", In Proceedings of the 33rd Annual Meeting of the Association for the Advancement of Automotive Medicine, Baltimore, MD, USA, 1993; 205-218. | Adult;Pediatric | Supplemental | 1.00 | 2014-06-13 10:03:51.0 | Pre-Hospital Assessment Form | History of Disease/Injury Event | Disease/Injury Related Events |
Single Pre-Defined Value Selected |
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| C05451 | Injury Severity Score | InjSeverScore | Score measured by injury severity score (ISS) | Score measured by injury severity score (ISS) | Injury severity score (ISS) | Numeric Values |
Between 0-75. The element may be included if relevant to the study. For additional details like permissible values, see the data dictionary associated with this CRF. |
Baker SP, O'Neill B, Haddon W Jr, et al. The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma. Mar 1974;14(3):187-196. Medicine AftAoA. The Abbreviated Injury Scale, 1990 Revision. Association for the Advancement of Automotive Medicine. 15-24. 1990. Des Plaines, IL. http://www.sfar.org/scores2/triss2.html - ISS calculator Pediatric: Gennarelli TA, Wodzin A. AIS 2005: A contemporary injury scale. Injury 2006 37:1083-1091. | Adult;Pediatric | Supplemental | 3.00 | 2013-07-20 10:21:25.65 | Pre-Hospital Assessment Form | History of Disease/Injury Event | Disease/Injury Related Events |
Free-Form Entry |
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| C14208 | Pre-hospital neurological impairment scale indicator | PrehospNeuroImpairScaleInd | Whether a pre-hospital neurologic impairment scale screen was documented by EMS personnel. Pre-hospital neurologic impairment scales are defined as published validated scales or those required by state EMS agencies (e.g., GCS for suspected hemorrhagic stroke or any stroke with impaired consciousness, Los Angeles Motor Scale, etc.) | Whether a pre-hospital neurologic impairment scale screen was documented by EMS personnel. Pre-hospital neurologic impairment scales are defined as published validated scales or those required by state EMS agencies (e.g., GCS for suspected hemorrhagic stroke or any stroke with impaired consciousness, Los Angeles Motor Scale, etc. | Was a pre-hospital neurologic impairment screen documented by EMS personnel | Yes;No;Unknown | Yes;No;Unknown | Alphanumeric |
Choose one |
See Pre-Hospital EMS Course form | Adult;Pediatric | Supplemental | 3.00 | 2013-06-21 00:00:00.0 | Pre-Hospital Assessment Form | History of Disease/Injury Event | Disease/Injury Related Events |
Single Pre-Defined Value Selected |
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| C01002 | Glasgow Coma Scale (GCS) - verbal response scale | GCSVerbalRspnsScale | Score that describes the participant's verbal response according to the Glasgow Coma Scale (GCS) | Score that describes the participant's verbal response according to the Glasgow Coma Scale (GCS) | Best verbal response score | 1;2;3;4;5 | No verbal response/sounds;Incomprehensible sound;Inappropriate words;Confused;Oriented | Numeric Values |
Choose one |
Teasdale G, Jennett B. Assessment of coma and impaired consciousness. A practical scale. Lancet. Jul 1974;2(7872):81-4. Marmarou A, Lu J, Butcher I, et al. Prognostic value of the Glasgow Coma Scale and pupil reactivity in traumatic brain injury assessed pre-hospital and on enrollment: an IMPACT analysis. J Neurotrauma. Feb 2007;24(2):270-80. Stocchetti N, Pagan F, Calappi E, et al. Inaccurate early assessment of neurological severity in head injury. J Neurotrauma. Sep 2004:21(9):1131-40. Balestreri M, Czosnyka M, Chatfield DA, et al. Predictive value of Glasgow Coma Scale after brain trauma: change in trend over the past ten years. J Neurol Neurosurg Psychiatry. Jan 2004;75(1):161-2. | Adult | Supplemental | 3.00 | 2013-07-20 10:21:25.65 | Pre-Hospital Assessment Form | History of Disease/Injury Event | Disease/Injury Related Events |
Single Pre-Defined Value Selected |
C124726 | |||||||
| C21622 | Hypotensive episode pediatric indicator | HypotnsnEpiPedInd | Indicator of pediatric hypotensive episode. In children, it is defined as systolic blood pressure < 5th percentile for age | Indicator of hypotensive episode. In children, it is defined as systolic blood pressure < 5th percentile for age | Did the participant/subject experience hypotensive episode for longer than 5 minutes? | Yes;No;Unknown;Suspected | Yes;No;Unknown;Suspected | Alphanumeric |
In children, it is defined as: |
Haque IU, Zaritsky AL. Analysis of the evidence for the lower limit of systolic and mean arterial pressure in children. Pediatr Crit Care Med. 2007 Mar;8(2):138-44. PubMed PMID: 17273118.<br /><br />Zubrow AB, Hulman S, Kushner H, Falkner B. Determinants of blood pressure in infants admitted to neonatal intensive care units: a prospective multicenter study. Philadelphia Neonatal Blood Pressure Study Group. J Perinatol. 1995<br />Nov-Dec;15(6):470-9. PubMed PMID: 8648456. | Pediatric | Supplemental | 3.00 | 2013-07-20 10:21:25.65 | Pre-Hospital Assessment Form | History of Disease/Injury Event | Disease/Injury Related Events |
Single Pre-Defined Value Selected |
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| C05453 | Hypotensive episode indicator | HypotnsnEpiInd | Indicator of hypotensive episode. In adults, hypotensive episode is defined as systolic blood pressure < 90 mmHg. In children, it is defined as systolic blood pressure < 5th percentile for age | Indicator of hypotensive episode. In adults, hypotensive episode is defined as systolic blood pressure < 90 mmHg. In children, it is defined as systolic blood pressure < 5th percentile for age | Did patient/participant experience hypotensive episode (systolic BP < 90 mm Hg for longer than 5 minutes) (choose one) | Yes;No;Unknown;Suspected | Yes;No;Unknown;Suspected | Alphanumeric |
No instructions available |
Adult | Supplemental | 3.00 | 2013-07-20 10:21:25.65 | Pre-Hospital Assessment Form | History of Disease/Injury Event | Disease/Injury Related Events |
Single Pre-Defined Value Selected |
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| C14223 | Emergency Medical Services (EMS) service highest level type | EMSServiceHighestLevelTyp | Highest level of emergency medical service (EMS) provided | Highest level of emergency medical service (EMS) provided | Highest level of EMS service | ALS;BLS;Flight nurse;MD;Paramedic;Unknown | Advanced life support or equivalent;Basic life support or equivalent;;MD;Paramedic or equivalent;Unknown | Alphanumeric |
Choose one |
See Pre-Hospital EMS Course form | Adult;Pediatric | Supplemental | 3.00 | 2013-06-21 00:00:00.0 | Pre-Hospital Assessment Form | History of Disease/Injury Event | Disease/Injury Related Events |
Single Pre-Defined Value Selected |
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| C01016 | Glasgow Coma Scale (GCS) - total score | GCSTotalScore | Glasgow Coma Scale (GCS) - Total Score. The GCS is a standardized instrument for assessing the level of consciousness. It evaluates three aspects of responsiveness: eye opening, motor response, verbal response. The total score is the sum of the scores for the three response types. (3-15) | Glasgow Coma Scale (GCS) - Total Score. The GCS is a standardized instrument for assessing the level of consciousness. It evaluates three aspects of responsiveness: eye opening, motor response, verbal response. The total score is the sum of the scores for the three response types. (3-15 | Total Score (3–15; calculated field) | 3;4;5;6;7;8;9;10;11;12;13;14;15;Untestable;Unknown | 3;4;5;6;7;8;9;10;11;12;13;14;15;Untestable;Unknown | Numeric Values |
http://www.glasgowcomascale.org/faq/ ----*Dealing with missing information: There are various different strategies for dealing with information that is missing because of factors interfering with assessment such as those described above. 1.Assess, communicate and make decisions using the remaining components. Although guidelines are often expressed in terms of a total GCS 'score,' the trend in whichever of the components (eye, motor or verbal) can be assessed is still valuable. 2.Do not use number '1' to record missing component; use 'NT' (Not testable). 3.Do not report a total score when a component is Not Testable because the score will be low and this could be confusing to medical colleagues. This may also imply that the patient is more unwell than they actually are. 4.It is possible using statistical methods to estimate a missing component from the findings in the other components. This is probably more relevant to research than clinical practice. |
Marcin J and Pollack M. (2002). Triage scoring systems, severity of illness measures, and mortality prediction models in pediatric trauma. Crit Care Med. 30:S457-S467. | Adult | Supplemental | 3.00 | 2013-07-20 10:21:25.65 | Pre-Hospital Assessment Form | History of Disease/Injury Event | Disease/Injury Related Events |
Single Pre-Defined Value Selected |
C124727 | |||||||
| C21623 | Vehicular protective device safety restraint type | VehclrPrtctvDevSftyRestrntTyp | Type of child safety restraint used in the vehicle | Type of child safety restraint used in the vehicl | If child safety restraint used, indicate what type: | Booster seat;Forward-facing car seat;Rear-facing car seat | Booster seat;Forward-facing car seat;Rear-facing car seat | Alphanumeric |
Choose one. |
Pediatric | Supplemental | 3.00 | 2013-07-20 10:21:25.65 | Pre-Hospital Assessment Form | History of Disease/Injury Event | Disease/Injury Related Events |
Multiple Pre-Defined Values Selected |
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| C05457 | Hypoxic episode indicator | HypxEpiInd | Indicator of hypoxic episode. Hypoxic episode is defined as partial pressure of oxygen in the blood (paO2) < 8kPa (60mmHg) or oxygen saturation (SaO2) < 90% | Indicator of hypoxic episode. Hypoxic episode is defined as partial pressure of oxygen in the blood (paO2) < 8kPa (60mmHg) or oxygen saturation (SaO2) < 90% | Did patient/participant experience hypoxic episode [Oxygen saturation SpO2) less than 90% for >5 minutes] (Choose one) | Yes;No;Unknown;Suspected | Yes;No;Unknown;Suspected | Alphanumeric |
No instructions available |
Adult | Supplemental | 3.00 | 2013-07-20 10:21:25.65 | Pre-Hospital Assessment Form | History of Disease/Injury Event | Disease/Injury Related Events |
Single Pre-Defined Value Selected |
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| C14964 | Sedation used indicator | SedationUsedInd | Indicator of whether the participant was administered any sedation | Indicator of whether the participant was administered any sedation | Was patient sedated | Yes;No;Unknown | Yes;No;Unknown | Alphanumeric |
No instructions available |
Adult;Pediatric | Supplemental | 3.10 | 2024-02-29 15:47:29.0 | Pre-Hospital Assessment Form | History of Disease/Injury Event | Disease/Injury Related Events |
Single Pre-Defined Value Selected |
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| C01017 | Pediatric Glasgow Coma Scale (PGCS) - total score | PGCSTotalScore | Score for the participant's total Pediatric Glasgow Coma Scale (PGCS) score of the 3 tests, eye, motor, and verbal responses. A score of less than 9 would indicate that that participant is in a severe coma while a score of greater than 9 is a mild or no coma at all | Score for the participant's total Pediatric Glasgow Coma Scale (PGCS) score of the 3 tests, eye, motor, and verbal responses. A score of less than 9 would indicate that that participant is in a severe coma while a score of greater than 9 is a mild or no coma at al | Total Glasgow score: | 3;4;5;6;7;8;9;10;11;12;13;14;15;Untestable;Unknown | 3;4;5;6;7;8;9;10;11;12;13;14;15;Untestable;Unknown | Alphanumeric |
(3-15; calculated field) |
Pediatric | Supplemental | 3.00 | 2013-07-20 10:21:25.65 | Pre-Hospital Assessment Form | History of Disease/Injury Event | Disease/Injury Related Events |
Single Pre-Defined Value Selected |
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| C21624 | Vehicular protective device seat belt type | VehclrPrtctvDevSeatBltTyp | Type of seat belt used in the vehicle | Type of seat belt used in the vehicl | If seat belt used, indicate what type: | Five-point restraint;Lap belt;Not applicable;Three-point restraint;Unknown | Five-point restraint;Lap belt;Not applicable;Three-point restraint;Unknown | Alphanumeric |
Choose one. |
Pediatric | Supplemental | 3.00 | 2013-07-20 10:21:25.65 | Pre-Hospital Assessment Form | History of Disease/Injury Event | Disease/Injury Related Events |
Multiple Pre-Defined Values Selected |
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| C05459 | Cardiac arrest indicator | CardArrestInd | Indicator of cardiac arrest requiring cardiopulmonary resuscitation (i.e. at least two minutes of chest compressions). Cardiac arrest is a condition in which the heart suddenly and unexpectedly stops beating | Indicator of cardiac arrest requiring cardiopulmonary resuscitation (i.e. at least two minutes of chest compressions). Cardiac arrest is a condition in which the heart suddenly and unexpectedly stops beating | Did the participant/subject experience cardiac arrest? | Yes;No;Suspected;Unknown | Yes;No;Suspected;Unknown | Alphanumeric |
Choose one |
Pediatric | Supplemental | 3.00 | 2013-07-20 10:21:25.65 | Pre-Hospital Assessment Form | History of Disease/Injury Event | Disease/Injury Related Events |
Single Pre-Defined Value Selected |
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| C18153 | Data unknown text | DataUnknwnTxt | The free-text field to Mark an "X" in to record if data are unknown or not available | The free-text field to Mark an "X" in to record if data are unknown or not availabl | Alphanumeric | Adult;Pediatric | Supplemental | 3.00 | 2013-07-17 09:26:36.973 | Pre-Hospital Assessment Form | History of Disease/Injury Event | Disease/Injury Related Events | 20 |
Free-Form Entry |
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| C01020 | Pediatric Glasgow Coma Scale (PGCS) - eye response score | PGCSEyeRespnsScore | Score for the participant's eye response according to the Pediatric Glasgow Coma Scale (PGCS) if the participant is under the age of 18 | Score for the participant's eye response according to the Pediatric Glasgow Coma Scale (PGCS) if the participant is under the age of 1 | Best eye response score | 1;2;3;4;Untestable;Unknown | No eye opening;Eye opening to pain;Eye opening to speech;Eyes open spontaneously;Untestable;Unknown | Alphanumeric |
Best eye response (choose one) |
Pediatric | Supplemental | 3.00 | 2013-07-20 10:21:25.65 | Pre-Hospital Assessment Form | History of Disease/Injury Event | Disease/Injury Related Events |
Single Pre-Defined Value Selected |
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| C21625 | Vehicular protective device position type | VehclrPrtctvDevPosnTyp | Where the participant/subject was positioned in the vehicle at the time of the incident causing injury | Where the participant/subject was positioned in the vehicle at the time of the incident causing injur | What was the position in the vehicle: | Back seat;Front seat;Other | Back seat;Front seat;Other | Alphanumeric |
Choose one. |
Pediatric | Supplemental | 3.00 | 2013-07-20 10:21:25.65 | Pre-Hospital Assessment Form | History of Disease/Injury Event | Disease/Injury Related Events |
Multiple Pre-Defined Values Selected |
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| C06003 | Injury associate spinal cord injury indicator | InjAssocSCIInd | Whether any of the following pre-specified major injuries occurred at the same time as the spinal cord injury: moderate to severe traumatic brain injury (Glasgow Coma Scale 12 or below at discharge), non-vertebral fractures requiring surgery, severe facial injuries affecting sense organs, major chest injury requiring chest-tube or mechanical ventilation, traumatic amputations of an arm or leg (or injuries severe enough to require surgical amputation), severe hemorrhaging, or damage to any internal organ requiring surgery | Whether any of a variety of pre-specified major injuries occurred at the same time as the spinal cord injury | Associated injury | 0;1;9 | 0=No;1=Yes;9=Unknown | Numeric values |
Do not include other associated injuries not listed above, negative findings from exploratory surgery, and do not include injuries that pre-date the spinal cord injury. |
Biering-SØrensen F, DeVivo MJ, Charlifue S, Chen Y, New PW, Noonan V, Post MWM, Vogel L. International Spinal Cord Injury Core Data Set (version 2.0)-including standardization of reporting. Spinal Cord. 2017;55(8):759-764. | Adult;Pediatric | Supplemental | 3.00 | 2013-07-17 09:26:36.973 | Pre-Hospital Assessment Form | History of Disease/Injury Event | Disease/Injury Related Events |
Single Pre-Defined Value Selected |
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| C18686 | Hospital transport other text | HospTrnsprtOTH | The free-text field related to 'Hospital transport type' specifying other text. Type of transportation from injury scene to hospital | The free-text field related to 'Hospital transport type' specifying other text. Type of transportation from injury scene to hospital | Other, specify | Alphanumeric | Pediatric | Supplemental | 1.00 | 2014-05-27 13:34:46.0 | Pre-Hospital Assessment Form | History of Disease/Injury Event | Disease/Injury Related Events | 4000 |
Free-Form Entry |
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| C01021 | Pediatric Glasgow Coma Scale (PGCS) - motor response score | PGCSMotorRespnsScore | Score for the participant's motor response according to the Pediatric Glasgow Coma Scale (PGCS) if the participant is under the age of 18 | Score for the participant's motor response according to the Pediatric Glasgow Coma Scale (PGCS) if the participant is under the age of 1 | Best motor response score | 1;2;3;4;5;6;Untestable;Unknown | No motor response;Extension to pain;Flexion to pain;Withdrawal from pain;Localizing pain;Obeys commands;Untestable;Unknown | Alphanumeric |
Choose one. |
Pediatric | Supplemental | 3.00 | 2013-07-20 10:21:25.65 | Pre-Hospital Assessment Form | History of Disease/Injury Event | Disease/Injury Related Events |
Single Pre-Defined Value Selected |
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| C21626 | Hospital transport board cut-out indicator | HospTransprtBrdCtOutInd | Indicates whether the hospital transport board was modified with a cut-out | Indicates whether the hospital transport board was modified with a cut-ou | For children 0-5 years, was backboard modified for transport? | No;Yes;Unknown | No;Yes;Unknown | Alphanumeric |
Cut-out to recess occiput: |
Herzenberg JE, Hensinger RN, Dedrick DK, Phillips WA. Emergency transport and positioning of young children who have an injury of the cervical spine. The standard backboard may be hazardous. J Bone Joint Surg Am. 1989 Jan;71(1):15-22. PubMed PMID: 2912996. | Pediatric | Supplemental | 3.00 | 2013-07-20 10:21:25.65 | Pre-Hospital Assessment Form | History of Disease/Injury Event | Disease/Injury Related Events |
Multiple Pre-Defined Values Selected |
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| C14200 | Emergency Medical Services (EMS) call received date and time | EMSCallRecvdDateTime | Date and time first call was received by the Emergency Medical Services (EMS) dispatcher OR date and time of EMS vehicle dispatch as recorded on the EMS trip sheet or other similar documentation | Date and time first call was received by the Emergency Medical Services (EMS) dispatcher OR date and time of EMS vehicle dispatch as recorded on the EMS trip sheet or other similar documentatio | Date and Time first call received by EMS | Date or Date & Time |
This data element is looking to capture the date and time that EMS was first called to the scene of the stroke (and not meant to capture those patients that are transferred between hospitals via EMS). If a patient is transported by EMS from the scene of the stroke to an outside hospital and is then transferred to EMS to your hospital, enter the time when the first call was received by the EMS. 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.). |
Paul Coverdell National Acute Stroke Registry | Adult;Pediatric | Supplemental | 3.00 | 2013-06-21 00:00:00.0 | Pre-Hospital Assessment Form | History of Disease/Injury Event | Disease/Injury Related Events |
Free-Form Entry |
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| C18772 | Vehicular protective device other text | VehclrPrtctvDevOTH | The free-text field related to 'Vehicular protective device type' specifying other text. Type of protective devices used by the participant/subject | The free-text field related to 'Vehicular protective device type' specifying other text. Type of protective devices used by the participant/subject | Other, specify: | Alphanumeric | Pediatric | Supplemental | 1.00 | 2014-05-27 13:34:46.0 | Pre-Hospital Assessment Form | History of Disease/Injury Event | Disease/Injury Related Events | 4000 |
Free-Form Entry |
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| C01022 | Pediatric Glasgow Coma Scale (PGCS) - verbal response score | PGCSVerbalRespnsScore | Score for the participant's verbal response according to the Pediatric Glasgow Coma Scale (PGCS) if the participant is under the age of 18 | Score for the participant's verbal response according to the Pediatric Glasgow Coma Scale (PGCS) if the participant is under the age of 1 | Best verbal response score | 1;2;3;4;5;Untestable;Unknown | No vocal response;Inconsolable, agitated;Inconsistently consolable, moaning;Cries, but is consolable, inappropriate interactions;Smiles, oriented to sounds, follows objects, interacts;Untestable;Unknown | Alphanumeric |
Choose one |
Pediatric | Supplemental | 3.00 | 2013-07-20 10:21:25.65 | Pre-Hospital Assessment Form | History of Disease/Injury Event | Disease/Injury Related Events |
Single Pre-Defined Value Selected |
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| C21627 | Hospital transport board mattress pad indicator | HospTransprtBrdMatrsPadInd | Indicates whether the hospital transport board was modified with a double matress pad | Indicates whether the hospital transport board was modified with a double matress pa | For children 0-5 years, was backboard modified for transport? | No;Yes;Unknown | No;Yes;Unknown | Alphanumeric |
Double mattress pad to raise chest/trunk: |
Herzenberg JE, Hensinger RN, Dedrick DK, Phillips WA. Emergency transport and positioning of young children who have an injury of the cervical spine. The standard backboard may be hazardous. J Bone Joint Surg Am. 1989 Jan;71(1):15-22. PubMed PMID: 2912996. | Pediatric | Supplemental | 3.00 | 2013-07-20 10:21:25.65 | Pre-Hospital Assessment Form | History of Disease/Injury Event | Disease/Injury Related Events |
Multiple Pre-Defined Values Selected |
