CDE Detailed Report

Disease: Spinal Cord Injury
Sub-Domain: History of Disease/Injury Event
CRF: Pre-Hospital Assessment Form

Displaying 1 - 41 of 41
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
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

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 hospital. 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

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 response. 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

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

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 hospital. 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

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 response. 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

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

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. 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

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:
Systolic BP Systolic BP Systolic BP Systolic BP

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

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

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
BLS: Basic Life Support; ALS: Advanced Life Support

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

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. 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 vehicle. 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

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

C14964 Sedation used indicator SedationUsedInd Whether the participant/subject was administered any sedation Whether the participant/subject was administered any sedation Was patient sedated Yes;No;Unknown Yes;No;Unknown Alphanumeric

No instructions available

Adult;Pediatric Supplemental 3.00 2013-07-14 19:48:50.273 Pre-Hospital Assessment Form History of Disease/Injury Event Disease/Injury Related Events

Single Pre-Defined Value Selected

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. The participant's total Pediatric Glasgow Coma Scale (PGCS) score of 3 tests, eye, motor, and verbal responses. A score of less than 9 would indicate that that participant is in a severe coma; a score of greater than 9 is a mild or no coma at all. 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

C21624 Vehicular protective device seat belt type VehclrPrtctvDevSeatBltTyp Type of seat belt used in the vehicle. Type of seat belt used in the vehicle. 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

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

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 available. Or data. 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

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 18. 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

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 injury. 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

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-S&Oslash;rensen 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

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

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 18. 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

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-out. 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

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 documentation. 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

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

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 18. 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

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 pad. 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

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 transport. 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

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

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

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

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 dispatch. 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.
Acuity is defined as the level of resource intensiveness of patient care.

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

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

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

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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

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 response. Type of EMS vehicle Ground;Air;Other;Unknown Ground;Air;Other;Unknown Alphanumeric

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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

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

CSV