CDE Detailed Report
Disease: Cerebral Palsy
Subdomain Name: General Health History
CRF: Surgical and Hospitalization History
Displaying 1 - 24 of 24
Subdomain Name: General Health History
CRF: Surgical and Hospitalization History
Displaying 1 - 24 of 24
| 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| C04804 | Hospital discharge date and time | HospitDischgDateTime | Date (and time, if applicable and known) the participant/subject was discharged from the hospital | Date (and time, if applicable and known) the participant/subject was discharged from the hospital | Discharge Date (MM/YYYY) or Age (approximate) | Date or Date & Time |
Record the discharge date for each hospitalization episode. 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.). If date unknown, use approximate age. |
No references available | Adult;Pediatric | Supplemental | 3.00 | 2013-07-25 08:54:08.2 | Surgical and Hospitalization History | General Health History | Participant History and Family History |
Free-Form Entry |
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| C12680 | Hospitalization non-surgical elective indicator | HosptlizatnNonSurgElectvInd | Indicator of whether the enumerated non-surgical hospitalization was elective | Indicator of whether the enumerated non-surgical hospitalization was elective | Elective? | Yes;No;Unknown | Yes;No;Unknown | Alphanumeric |
Record if hospitalization was elective (versus emergent) |
No references available | Adult;Pediatric | Supplemental | 3.00 | 2013-07-25 08:54:08.2 | Surgical and Hospitalization History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
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| C52422 | Surgical history procedure neurological surgery type | SurgHistProcedurNeruoSurgTyp | Type of neurological surgery procedure | Type of neurological surgery procedure | If Yes, type of neurological surgery | Selective dorsal rhizotomy (SDR);Baclofen pump placement | Selective dorsal rhizotomy (SDR);Baclofen pump placement | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2017-01-18 13:22:13.0 | Surgical and Hospitalization History | General Health History | Participant History and Family History |
Multiple Pre-Defined Values Selected |
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| C05106 | Surgical therapeutic procedure start date and time | SurgTherapuProcStartDateTime | Date (and time, if applicable and known) on which the surgical or therapeutic procedure started | Date (and time, if applicable and known) on which the surgical or therapeutic procedure started | Date(s) - list all (MM/YYYY) or Age (approximate) | 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 | 3.20 | 2022-08-18 17:27:56.0 | Surgical and Hospitalization History | General Health History | Participant History and Family History |
Free-Form Entry |
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| C12681 | Hospitalization non-surgical ventilation indicator | HospitlNonSurgVentilatnInd | Indicator of whether the participant/subject was ventilated while in the hospital for the specified non-surgical reason | Indicator of whether the participant/subject was ventilated while in the hospital for the specified non-surgical reason | Ventilated? | Yes;No;Unknown | Yes;No;Unknown | Alphanumeric |
Choose one for each hospitalization episode |
No references available | Adult;Pediatric | Supplemental | 3.00 | 2013-07-25 08:54:08.2 | Surgical and Hospitalization History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
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| C52433 | Surgical history procedure bony orthopedic surgery type | SurgHistProcedBonyOrthoSurgTyp | Type of bony orthopedic surgery | Type of bony orthopedic surgery | If Yes, type of bony orthopedic procedure | Hip surgery;Knee surgery;Ankle/foot surgery;Shoulder surgery;Elbow surgery;Wrist surgery | Hip surgery;Knee surgery;Ankle/foot surgery;Shoulder surgery;Elbow surgery;Wrist surgery | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2017-01-18 14:33:33.0 | Surgical and Hospitalization History | General Health History | Participant History and Family History |
Multiple Pre-Defined Values Selected |
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| C05108 | Surgical or therapeutic procedure type | SurgTherapProcedurTyp | Type of surgical or therapeutic procedure received by the participant/subject | Type of surgical or therapeutic procedure received by the participant/subject | Past Surgical History | Appendicectomy;Cholecystectomy;Colostomy;Ileostomy;Feeding tube placement;Fundoplication;Scoliosis surgery;Tendon release;Tympanostomy tubes;Tracheostomy;Airway surgery;Other surgery, specify;Unknown;Diagnostic;Anterior temporal lobectomy (ATL);Anterior temporal lobectomy plus (ATL+);Amygdalohippocampectomy;Lesionectomy;Lesionectomy plus (Lesionectomy +);Extratemporal resection (Topectomy);Multi-lobar resection;Hemispherectomy;Vagus nerve stimulation (VNS) surgery;Corpus callosotomy;Multiple subpial transection;Radiosurgery;Therapeutic brain stimulation;Other, specify;Appendicostomy;Appendectomy;Neurological surgery;Bony orthopedic surgery | Appendicectomy;Cholecystectomy;Colostomy;Ileostomy;Feeding tube placement;Fundoplication;Scoliosis surgery;Tendon release;Tympanostomy tubes;Tracheostomy;Airway surgery;Other surgery, specify;Unknown;Diagnostic surgery;Anterior temporal lobectomy (ATL);Anterior temporal lobectomy plus (ATL+);Amygdalohippocampectomy;Lesionectomy;Lesionectomy plus (Lesionectomy +);Extratemporal resection (Topectomy);Multi-lobar resection;Hemispherectomy;Vagus nerve stimulation (VNS) surgery;Corpus callosotomy;Multiple subpial transection;Radiosurgery;Therapeutic brain stimulation;Other, specify;Appendicostomy (antegrade colonic anema);Appendectomy;Neurological surgery;Bony orthopedic surgery | Alphanumeric |
Additional lines and other surgeries should be added as appropriate |
International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM): http://www.cdc.gov/nchs/icd/icd9cm.htm | Adult;Pediatric | Supplemental | 3.00 | 2013-07-25 08:54:08.2 | Surgical and Hospitalization History | General Health History | Participant History and Family History |
Multiple Pre-Defined Values Selected |
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| C17402 | Site name | SiteName | The name of the site for the study | The name of the site for the study | Site Name | Alphanumeric | Adult;Pediatric | Core | 3.00 | 2013-06-21 00:00:00.0 | Surgical and Hospitalization History | General Health History | Participant History and Family History | 255 |
Free-Form Entry |
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| C05408 | Hospital admission date and time | HospitlAdmissDateTime | Date (and time, if applicable and known) the participant/subject was admitted to the hospital | Date (and time, if applicable and known) the participant/subject was admitted to the hospital | Admission Date (MM/YYYY) or Age (approximate) | Date or Date & Time |
Record the admission date for each hospitalization episode. 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.). If date unknown, use approximate age. |
No references available | Adult;Pediatric | Supplemental | 3.00 | 2013-07-25 08:54:08.2 | Surgical and Hospitalization History | General Health History | Participant History and Family History |
Free-Form Entry |
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| C17971 | Hospitalization non surgical number | HosptlizatnNonSurgNum | Number used to identify the non-surgical hospitalization being described | Number used to identify the non-surgical hospitalization being described | Hospitalization Number | Numeric Values | No references available | Adult;Pediatric | Supplemental | 3.00 | 2013-07-25 08:54:08.2 | Surgical and Hospitalization History | General Health History | Participant History and Family History |
Free-Form Entry |
1 | 99 | |||||||||
| C06025 | Surgical or therapeutic procedure performed indicator | SurgTherProcedurPerfInd | Indicator whether the participant/subject has undergone the selected surgical procedure | Indicator whether the participant/subject has undergone the selected surgical procedure | Yes/No | Yes;No;Unknown | Yes;No;Unknown | Alphanumeric |
For each type of surgical procedure indicate if it was ever performed |
No references available | Adult;Pediatric | Supplemental | 3.00 | 2013-07-25 08:54:08.2 | Surgical and Hospitalization History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
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| C18765 | Surgical or therapeutic procedure other text | SurgTherapProcedurOTH | The free-text field related to 'Surgical or therapeutic procedure type' specifying other text. Type of surgical or therapeutic procedure received by the participant/subject | The free-text field related to 'Surgical or therapeutic procedure type' specifying other text. Type of surgical or therapeutic procedure received by the participant/subject | Other, specify | Alphanumeric |
Additional lines and other surgeries should be added as appropriate |
International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM): http://www.cdc.gov/nchs/icd/icd9cm.htm | Adult;Pediatric | Supplemental | 1.00 | 2014-05-27 13:34:46.0 | Surgical and Hospitalization History | General Health History | Participant History and Family History | 4000 |
Free-Form Entry |
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| C08018 | Surgery age value | SurgAgeVal | Age of the participant/subject at the time of the selected surgical procedure | Age of the participant/subject at the time of the selected surgical procedure | Date(s) - list all (MM/YYYY) or Age (approximate) | Numeric Values |
This value can be captured in years or months. |
No references available | Adult;Pediatric | Supplemental | 3.00 | 2013-07-24 11:38:01.2 | Surgical and Hospitalization History | General Health History | Participant History and Family History |
Free-Form Entry |
0 | 99 | ||||||||
| C18805 | Hospitalization other text | HospitOTH | The free-text field related to 'Hospitalization reason' specifying other text. Reason why the participant/subject was hospitalized, excluding all surgeries | The free-text field related to 'Hospitalization reason' specifying other text. Reason why the participant/subject was hospitalized, excluding all surgeries | Other, specify | Alphanumeric |
Record the letter corresponding to the reason applicable in the "Reasons" list. For "Other, specify", also record the other reason the subject/participant was admitted to the hospital. |
No references available | Adult;Pediatric | Supplemental | 3.00 | 2013-07-25 08:54:08.2 | Surgical and Hospitalization History | General Health History | Participant History and Family History | 4000 |
Free-Form Entry |
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| C10609 | Hospitalization reason | HospitRsn | Reason why the participant/subject was hospitalized, excluding all surgeries | Reason why the participant/subject was hospitalized, excluding all surgeries | Reason | Pneumonia or Respiratory;Failure to Thrive;Dehydration;Other, specify;Trauma;Infection other than pneumonia;Fracture;Seizures;Cardiomyopathy/Arrhythmia | Pneumonia or Respiratory;Failure to Thrive;Dehydration;Other, specify;Trauma;Infection other than pneumonia;Fracture;Seizures;Cardiomyopathy/Arrhythmia | Alphanumeric |
Record the letter corresponding to the reason applicable in the "Reasons" list. For "Other, specify", also record the other reason the subject/participant was admitted to the hospital. |
No references available | Adult;Pediatric | Supplemental | 3.00 | 2013-07-25 08:54:08.2 | Surgical and Hospitalization History | General Health History | Participant History and Family History |
Multiple Pre-Defined Values Selected |
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| C18868 | Surgical history procedure scoliosis other text | SurgHistProcedurScoliosisOTH | The free-text field related to 'Surgical history procedure scoliosis type' specifying other text. Type of surgical procedure the participant/ subject has undergone for the treatment of scoliosis | The free-text field related to 'Surgical history procedure scoliosis type' specifying other text. Type of surgical procedure the participant/ subject has undergone for the treatment of scoliosis | Other, specify | Alphanumeric |
Choose all that apply. Only answer if 'Scoliosis surgery' is answered Yes. |
No references available | Adult;Pediatric | Supplemental | 3.00 | 2013-07-25 08:54:08.2 | Surgical and Hospitalization History | General Health History | Participant History and Family History | 4000 |
Free-Form Entry |
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| C12674 | Surgical history procedure scoliosis type | SurgHistProcedurScoliosisTyp | Type of surgical procedure the participant/ subject has undergone for the treatment of scoliosis | Type of surgical procedure the participant/ subject has undergone for the treatment of scoliosis | If Yes, type of scoliosis surgery | Non-extendable rod;Extendable rod;Vertical Expandable Prosthetic Titanium Rib;Fusion;Other, specify | Non-extendable rod;Extendable rod;Vertical Expandable Prosthetic Titanium Rib (VEPTR);Fusion;Other, specify | Alphanumeric |
Choose all that apply. Only answer if 'Scoliosis surgery' is answered Yes. |
No references available | Adult;Pediatric | Supplemental | 3.00 | 2013-07-25 08:54:08.2 | Surgical and Hospitalization History | General Health History | Participant History and Family History |
Multiple Pre-Defined Values Selected |
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| C18869 | Surgical history procedure tendon release other text | SurgHistProcedurTendnReleasOTH | The free-text field related to 'Surgical history procedure tendon release type' specifying other text. Type of surgical procedure the participant/ subject has undergone for tendon release | The free-text field related to 'Surgical history procedure tendon release type' specifying other text. Type of surgical procedure the participant/ subject has undergone for tendon release | Other, specify | Alphanumeric |
Choose all that apply. Only answer if 'Tendon release surgery' is answered Yes. |
No references available | Adult;Pediatric | Supplemental | 3.00 | 2013-07-25 08:54:08.2 | Surgical and Hospitalization History | General Health History | Participant History and Family History | 4000 |
Free-Form Entry |
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| C12675 | Surgical history procedure tendon release type | SurgHistProcedurTendnReleasTyp | Type of surgical procedure the participant/ subject has undergone for tendon release | Type of surgical procedure the participant/ subject has undergone for tendon release | If Yes, type of tendon release | Achilles tendon;Hip release;Tensor fascia lata release;Knee release;Elbow release;Other, specify | Achilles tendon;Hip release;Tensor fascia lata release;Knee release;Elbow release;Other, specify | Alphanumeric |
Choose all that apply. Only answer if 'Tendon release surgery' is answered Yes. |
No references available | Adult;Pediatric | Supplemental | 3.00 | 2013-07-25 08:54:08.2 | Surgical and Hospitalization History | General Health History | Participant History and Family History |
Multiple Pre-Defined Values Selected |
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| C19247 | Subject ID | SubIDNam | Subject identification ID | Subject identification ID | Subject ID | Alphanumeric | Adult;Pediatric | Core | 1.00 | 2014-06-05 13:10:49.0 | Surgical and Hospitalization History | General Health History | Participant History and Family History | 255 |
Free-Form Entry |
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| C12677 | Surgical history procedure tympanostomy same ear count | SrgHistProcdrTympnostSameEarCt | Count of times that the participant/subject has undergone tympanostomy tube insertion in the same ear | Count of times that the participant/subject has undergone tympanostomy tube insertion in the same ear | If Yes, how many times in the same ear? | Numeric Values |
Only answer if 'Tympanostomy tubes' was answered Yes. |
No references available | Adult;Pediatric | Supplemental | 3.00 | 2013-07-25 08:54:08.2 | Surgical and Hospitalization History | General Health History | Participant History and Family History |
Free-Form Entry |
1 | 42 | ||||||||
| C21668 | ICD-10-CM code | SurgTherapuProcICD10CMCode | Code from the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) for the selected surgical procedure | Code from the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) for the selected surgical procedure | Reason | Other, specify | Other specify | Alphanumeric |
If the data will be shared, code each surgical procedure using ICD-10-CM |
International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM): http://www.cdc.gov/nchs/icd/icd10cm.htm#icd2016 | Adult;Pediatric | Supplemental | 1.00 | 2013-08-28 16:08:00.453 | Surgical and Hospitalization History | General Health History | Participant History and Family History |
Multiple Pre-Defined Values Selected |
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| C12678 | Hospitalization non surgical total lifetime count | HosptlNonSurgTtlLifetimCt | Count of the total number of times that the participant/subject has been hospitalized for a non-surgical reason | Count of the total number of times that the participant/subject has been hospitalized for a non-surgical reason | Total number of hospitalizations in lifetime | Numeric Values |
No additional instructions |
No references available | Adult;Pediatric | Supplemental | 3.00 | 2013-07-25 08:54:08.2 | Surgical and Hospitalization History | General Health History | Participant History and Family History |
Free-Form Entry |
0 | 99 | ||||||||
| C21669 | Surgical therapeutic procedure ICD-10-CM other text | SurgTherapuProcICD10CMOthTxt | The free-text field related to 'Surgical or therapeutic procedure ICD-10-CM code' specifying other text. Code from the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) for the selected surgical procedure | The free-text field related to 'Surgical or therapeutic procedure ICD-10-CM code' specifying other text. Code from the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) for the selected surgical procedure | Other, specify | Alphanumeric |
If the data will be shared, code each surgical procedure using ICD-10-CM |
International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM): http://www.cdc.gov/nchs/icd/icd10cm.htm#icd2016 | Adult;Pediatric | Supplemental | 1.00 | 2014-05-27 13:34:46.0 | Surgical and Hospitalization History | General Health History | Participant History and Family History | 4000 |
Free-Form Entry |
