data dictionary codebook 08-04-2020 10:03 · % data dictionary codebook 08-04-2020 10:03 # variable...

08/04/2020, 10)04CAPACITY | REDCap

of 103https://redcap.heart-institute.nl/redcap_v9.7.0/Design/data_dictionary_codebook.php?pid=116

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" Project Home # Project Setup $ Online Designer Data Dictionary % Codebook

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% Data Dictionary Codebook 08-04-2020 10:03

# Variable / Field NameField LabelField Note

Field Attributes (Field Type, Validation, Choices,Calculations, etc.)

Instrument: ISARIC/CAPACITY - Participant Identification Number Pin (REQUIRED) (participant_identification_number_pin_required)

1 subjid Participant Identification Number (PIN):999-9999 (SiteNo-PIN)

text

2 studyid Please contact your local study coordinator for the STUDY ID. descriptive

3 participant_identification_number_pin_required_complete

Section Header: Form Status

Complete?

dropdown

0 Incomplete

1 Unverified

2 Complete

Instrument: ISARIC/CAPACITY - Inclusion Criteria (REQUIRED) (inclusion_criteria_required)

4 dsstdat Date of Enrollmentdd-mm-yyyy; definition: date of data entry

text (date_dmy), Required

5 sitename_nhr Site name dropdown

31 Admiraal de Ruyter Ziekenhuis

22 Albert Schweitzer Ziekenhuis

32 Alrijne ziekenhuis

11 Amphia Ziekenhuis

3 Amsterdam UMC, locatie AMC

4 Amsterdam UMC, locatie VU

33 Antonius Ziekenhuis, Sneek

34 Bernhoven Ziekenhuis

35 BovenIJ Ziekenhuis

36 Bravis Ziekenhuis

20 Canisius-Wilhelmina Ziekenhuis

250 Cardiologie Centra Nederland

12 Catharina Ziekenhuis

900 CHU CLU Namur - Site Godinne

37 De Tjongerschans Ziekenhuis

38 Deventer Ziekenhuis

39 Diakonessenhuis Utrecht

40a Dijklander Ziekenhuis, locatie Hoorn

40b Dijklander Ziekenhuis, locatie Purmerend

27 Elisabeth-TweeSteden Ziekenhuis

41 Elkerliek Ziekenhuis

9 Erasmus MC

42 Flevoziekenhuis

43 Franciscus Gasthuis en Vlietland

44 Gelderse Vallei Ziekenhuis

45 Gelre Ziekenhuizen, locatie Apeldoorn

CAPACITY

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46 Gelre Ziekenhuizen, locatie Zutphen

47 Groene Hart Ziekenhuis

25 Haaglanden Medisch Centrum

17 Haga Ziekenhuis/Hartcentrum Den Haag-Delft

48 IJsselland Ziekenhuis

49 Ikazia Ziekenhuis

2a Isala Ziekenhuis (Meppel)

2b Isala Ziekenhuis (Zwolle)

21 Jeroen Bosch Ziekenhuis

50 Langeland Ziekenhuis

51 Laurentius Ziekenhuis

6 Leids Universitair Medisch Centrum

15 Maasstad Ziekenhuis

13 Maastricht UMC+

52 Maasziekenhuis Pantein

53 Martini Ziekenhuis

54 Máxima Medisch Centrum

74 MC Slotervaart

73 MC Zuiderzee

24 Meander Medisch Centrum

16 Medisch Centrum Leeuwarden

18 Medisch Spectrum Twente

55 Nij Smellinghe

14 Noordwest Ziekenhuisgroep

56 Ommelander Ziekenhuis Groningen

5 Onze Lieve Vrouwe Gasthuis

10 Radboudumc

57 Reinier de Graaf Gasthuis

19 Rijnstate Ziekenhuis

58 Rivas Zorggroep

59 Rivierenland Ziekenhuis

60 Rode Kruis Ziekenhuis

61 Ropcke Zweers Ziekenhuis

62 Slingeland Ziekenhuis

63a Spaarne Gasthuis, locatie Haarlem

63b Spaarne Gasthuis, locatie Hoofddorp

1000 Spijkenisse MC

64 St. Anna Ziekenhuis

8 St. Antonius Ziekenhuis Nieuwegein

65 St. Jans Gasthuis

66 St. Jansdal Ziekenhuis

67 Streekziekenhuis Koningin Beatrix

30 Tergooi

23 Treant Zorggroep

1 UMC Groningen

7 UMC Utrecht

201 UZ Antwerpen



68 Van Weel-Bethesda Ziekenhuis

28 VieCuri Medisch Centrum

69 Wilhelmina Ziekenhuis, Assen

70 Zaans Medisch Centrum

71 Ziekenhuis Amstelland

72 Zorg Groep Twente

26 ZorgSaam Zorggroep Zeeuws-Vlaanderen

29 Zuyderland MC

6 country Country dropdown, Required

1 Afghanistan

2 Albania

3 Algeria

4 Andorra

5 Angola

6 Antigua & Deps

7 Argentina

8 Armenia

9 Australia

10 Austria

11 Azerbaijan

12 Bahamas

13 Bahrain

14 Bangladesh

15 Barbados

16 Belarus

17 Belgium

18 Belize

19 Benin

20 Bhutan

21 Bolivia

22 Bosnia Herzegovina

23 Botswana

24 Brazil

25 Brunei

26 Bulgaria

27 Burkina

28 Burundi

29 Cambodia

30 Cameroon

31 Canada

32 Cape Verde

33 Central African Rep

34 Chad

35 Chile

36 China

37 Colombia

38 Comoros

39 Congo



40 Congo {Democratic Rep}

41 Costa Rica

42 Croatia

43 Cuba

44 Cyprus

45 Czech Republic

46 Denmark

47 Djibouti

48 Dominica

49 Dominican Republic

50 East Timor

51 Ecuador

52 Egypt

53 El Salvador

54 Equatorial Guinea

55 Eritrea

56 Estonia

57 Ethiopia

58 Fiji

59 Finland

60 France

61 Gabon

62 Gambia

63 Georgia

64 Germany

65 Ghana

66 Greece

67 Grenada

68 Guatemala

69 Guinea

70 Guinea-Bissau

71 Guyana

72 Haiti

73 Honduras

74 Hungary

75 Iceland

76 India

77 Indonesia

78 Iran

79 Iraq

80 Ireland {Republic}

81 Israel

82 Italy

83 Ivory Coast

84 Jamaica

85 Japan

86 Jordan

87 Kazakhstan



88 Kenya

89 Kiribati

90 Korea North

91 Korea South

92 Kosovo

93 Kuwait

94 Kyrgyzstan

95 Laos

96 Latvia

97 Lebanon

98 Lesotho

99 Liberia

100 Libya

101 Liechtenstein

102 Lithuania

103 Luxembourg

104 Macedonia

105 Madagascar

106 Malawi

107 Malaysia

108 Maldives

109 Mali

110 Malta

111 Marshall Islands

112 Mauritania

113 Mauritius

114 Mexico

115 Micronesia

116 Moldova

117 Monaco

118 Mongolia

119 Montenegro

120 Morocco

121 Mozambique

122 Myanmar, {Burma}

123 Namibia

124 Nauru

125 Nepal

126 Netherlands

127 New Zealand

128 Nicaragua

129 Niger

130 Nigeria

131 Norway

132 Oman

133 Pakistan

134 Palau

135 Panama



136 Papua New Guinea

137 Paraguay

138 Peru

139 Philippines

140 Poland

141 Portugal

142 Qatar

143 Romania

144 Russian Federation

145 Rwanda

146 St Kitts & Nevis

147 St Lucia

148 Saint Vincent & the Grenadines

149 Samoa

150 San Marino

151 Sao Tome & Principe

152 Saudi Arabia

153 Senegal

154 Serbia

155 Seychelles

156 Sierra Leone

157 Singapore

158 Slovakia

159 Slovenia

160 Solomon Islands

161 Somalia

162 South Africa

163 South Sudan

164 Spain

165 Sri Lanka

166 Sudan

167 Suriname

168 Swaziland

169 Sweden

170 Switzerland

171 Syria

172 Taiwan

173 Tajikistan

174 Tanzania

175 Thailand

176 Togo

177 Tonga

178 Trinidad & Tobago

179 Tunisia

180 Turkey

181 Turkmenistan

182 Tuvalu

183 Uganda



184 Ukraine

185 United Arab Emirates

186 United Kingdom

187 United States

188 Uruguay

189 Uzbekistan

190 Vanuatu

191 Vatican City

192 Venezuela

193 Vietnam

194 Yemen

195 Zambia

196 Zimbabwe

197 Other

7 othcountry

Show the field ONLY if:[country] = 197

Other country text

8 corona_ieorres Section Header: INCLUSION CRITERIA

1. Suspected or proven acute novel Coronavirus (COVID-19)infection as main cause for admission:Including if an admission that was initially for a different reason was prolongeddue to COVID

yesno, Required

1 Yes

0 No

Custom alignment: RH

9 symptoms_epi_physical

Show the field ONLY if:[corona_ieorres] = '1'

Section Header: EPIDEMIOLOGICAL FACTORS - In the 14 days before onset ofillness had any of the following:

2. Close contact* with a confirmed or probable case of nCoVinfection, while that patient was symptomatic

radio (Matrix), Required

1 YES

2 NO

3 Unknown

Field Annotation: Including confirmed/probable casespresenting (with symptoms) simultaneously

10 symptoms_epi_healthfac


3. Presence in a healthcare facility where nCoV infections havebeen managed


1 YES

2 NO

3 Unknown

11 symptoms_epi_lab


4. Presence in a laboratory handling suspected or confirmednCoV samples


1 YES

2 NO

3 Unknown

12 contact


* Close contact' is defined as:- Health care associated exposure, including providing directcare for novel coronavirus patients, e.g. health care worker,working with health care workers infected with novelcoronavirus, visiting patients or staying in the same closeenvironment of a novel coronavirus patient, or direct exposureto body fluids or specimens including aerosols.- Working together in close proximity or sharing the sameclassroom environment with a novel coronavirus patient.- Traveling together with novel coronavirus patient in any kindof conveyance.- Living in the same household as a novel coronavirus patient.

descriptive

13 inclusion_criteria_required_complete


Complete?

dropdown

0 Incomplete

1 Unverified

2 Complete



! CollapseInstrument: ISARIC/CAPACITY - Demographics (REQUIRED) (demographics_required)

14 sex Section Header: 1. DEMOGRAPHICS

1.1 Sex at Birth:

radio, Required, Identifier

1 Male

2 Female

-1 Not specified

15 age_estimateyears 1.2 Age/Estimated ageIf patient is a child less than one year age, include age in months

text (number, Max: 100), Required, Identifier

16 age_estimateyearsu Age/Estimated age Unit dropdown, Required

1 Months

2 Years

17 ethnic 1.3 Ethnic group (check all that apply) checkbox

1 ethnic___1 Arab

2 ethnic___2 Black

3 ethnic___3 East Asian

4 ethnic___4 South Asian

5 ethnic___5 West Asian

6 ethnic___6 Latin American

7 ethnic___7 White

8 ethnic___8 Aboriginal/First Nations

9 ethnic___9 Other

10 ethnic___10 N/A

18 other_ethnic

Show the field ONLY if:[ethnic(9)] = '1'

If Other: Specify text

19 healthwork_erterm 1.4 Employed as a healthcare worker? dropdown, Required

1 YES

2 NO

3 N/A

20 labwork_erterm 1.4 Employed in a microbiology laboratory? dropdown, Required

1 YES

2 NO

3 N/A

21 pregyn_rptestcd

Show the field ONLY if:[sex] = '2' and [age_estimateyears] > 12 and [age_estimateyears] < 55 and [age_estimateyearsu] = '2'

1.5 Pregnant ? radio, Required

1 Yes

0 No

998 Unknown

999 N/A

22 egestage_rptestcd

Show the field ONLY if:[pregyn_rptestcd] = '1'

If YES: Gestational weeks assessment:weeks

text (number_2dp, Min: 1, Max: 41)

23 postpart_rptestcd

Show the field ONLY if:[sex] = '2' and [age_estimateyears] >12 <55 and [age_estimateyearsu] = '2' and [pregyn_rptestcd] = '0' or [pregyn_rptestcd] = '998' or [pregyn_rptestcd] = '998'

1.6 Post Partum yesno, Required

1 Yes

0 No

24 pregout_rptestcd

Show the field ONLY if:[postpart_rptestcd] = '1'

1.6.1 Pregnancy Outcome radio, Required

1 Live birth

2 Still birth



25 dlvrdtc_rptestcd

Show the field ONLY if:[postpart_rptestcd] = '1'

1.6.2 Delivery date text (date_dmy), Required

26 aplb_lbperf

Show the field ONLY if:[postpart_rptestcd] = '1' and [pregout_rptestcd] = '1'

1.6.3 Baby tested for mother's ARI infectionIf baby positive for COVID-19, complete a separate CRF for the baby

radio, Required

1 Yes

2 No

3 N/A

27 aplb_lborres

Show the field ONLY if:[aplb_lbperf] = '1'

If YES radio, Required

1 Positive

2 Negative

3 N/A

28 aplb_lbmethod

Show the field ONLY if:[aplb_lbperf] = '1'

1.6.4 Method radio, Required

1 PCR

2 Other

29 aplb_lbmethodoth

Show the field ONLY if:[aplb_lbmethod] = '2'

If OTHER method; Specify text, Required

30 apdm_age

Show the field ONLY if:[age_estimateyearsu] = '1'

1.7 INFANT - Less than 1 year old? yesno, Required

1 Yes

0 No

31 apvs_weight

Show the field ONLY if:[apdm_age] = '1'

1.7.1 Birth weight text (number_2dp, Max: 50), Required

32 apvs_weightu


Birth weight unit dropdown, Required

1 kg

2 lbs

33 apsc_gestout


1.7.2 Gestational outcome radio, Required

1 Term birth ( >= 37wk GA)

2 Preterm birth (< 37wk GA)

3 N/A

34 apsc_brfedind


1.7.3 Breastfed radio, Required

1 Yes

2 No

3 N/A

35 apsc_brfedindy

Show the field ONLY if:[apsc_brfedind] = '1'

If YES radio, Required

1 Currently breastfed

2 Breastfeeding discontinued

3 N/A

Field Annotation: weeks

36 apsc_brdisdat

Show the field ONLY if:[apsc_brfedindy] = '2'

Discontinued breastfeeding atweeks

text (number, Min: 0, Max: 300)

37 apsc_dvageind


1.7.4 Appropriate development for age? dropdown, Required

1 Yes

2 No

3 N/A

38 apsc_vcageind

Show the field ONLY if:

1.7.5 Vaccinations appropriate for age/country? dropdown, Required

1 Yes



! Collapse

[apdm_age] = '1' 2 No

3 Unknown

4 N/A

39 demographics_required_complete


Complete?

dropdown

0 Incomplete

1 Unverified

2 Complete

Instrument: CAPACITY - Cardiac baseline assessment (REQUIRED) (capacity_cardiac_baseline_assessment_required)

40 admission_sympt_date Section Header: Admission

Date of symptoms appearancedd-mm-yyyy; any symptom suspect for COVID

text (date_dmy)

41 admission_any_date Date of first admission to any facilitydd-mm-yyyy; trace back to very first admission related to COVID in anyhospital/facility

text (date_dmy)

42 admission_date Date of (first) admission at this facilitydd-mm-yyyy; may be the same as date first admission to any facility

text (date_dmy)

43 admis_complaints Complaints at admission checkbox

1 admis_complaints___1 Fever (Temperature>38°C or >100.4°F)

2 admis_complaints___2 Cough

3 admis_complaints___3 Sore throat

4 admis_complaints___4 Dyspnea

5 admis_complaints___5 Orthopnea

6 admis_complaints___6 Chest pain

7 admis_complaints___7 Peripheral edema

8 admis_complaints___8 Palpitations

9 admis_complaints___9 (Near) syncope

10 admis_complaints___10 Fatigue

11 admis_complaints___11 Gastrointestinalsymptoms

12 admis_complaints___12 Anosmia

99 admis_complaints___99 Other

-1 admis_complaints____1 Unknown

44 admis_compl_other

Show the field ONLY if:[admis_complaints(99)] = '1'

Specify complaints at admission text

45 susp_pe Was there also a suspicion of a pulmonary embolism atpresentation?

radio

1 Yes

2 No

-1 Unknown

46 admission_transfer Transfer from other facility? radio

1 Yes

0 No

-1 Unknown

47 admission_transf_facility

Show the field ONLY if:[admission_transfer] = '1'

Name of facility from which patient was transferred dropdown























9 Erasmus MC

42 Flevoziekenhuis

















13 Maastricht UMC+




74 MC Slotervaart

73 MC Zuiderzee




55 Nij Smellinghe




10 Radboudumc





58 Rivas Zorggroep







900 Spijkenisse MC






30 Tergooi

23 Treant Zorggroep

1 UMC Groningen

7 UMC Utrecht

201 UZ Antwerpen








29 Zuyderland MC

-1 Other

48 capacity_covid_test Section Header: COVID-19 infection status

Suspected or proven acute COVID-19 infection

radio

1 Proven

2 Suspected

-1 Unknown

49 capacity_covid_date

Show the field ONLY if:[capacity_covid_test] = '1'

Date of proven COVID-19 infectiondd-mm-yyyy

text (date_dmy)

50 cvrisk_def Section Header: Cardiovascular risk factors prior to COVID-19 diagnosis

Definitions of cardiovascular risk factors Hypertension: Indicateif the patient has a current diagnosis of hypertension definedby any 1 of the following: History of hypertension diagnosedand treatment with medication, diet and/or exercise; Currentlyon pharmacological therapy for the treatment of hypertension. Diabetes Mellitus: History of diabetes diagnosed and/ortreated by a physician, as documented in the EPD. The currentWHO diagnostic criteria for diabetes are used: fasting plasmaglucose ≥ 7.0mmol/l (126mg/dl) or 2–h plasma glucose ≥11.1mmol/l (200mg/dl.2 Type 1 diabetes is characterized bydeficiency of insulin due to destruction of pancreatic beta-cells,progressing to absolute insulin deficiency. Type 2 diabetes ischaracterized by a combination of insulin resistance andbetacell failure, in association with obesity (typically with anabdominal distribution) and sedentary lifestyle—major riskfactors forT2DM. Dyslipidemia: Indicate if the patient has ahistory of dyslipidemia diagnosed and/or treated by aphysician. Cut-off values are defined as: Total cholesterol

descriptive



greater than 200 mg/dl (5.18 mmol/l) Low-density lipoprotein(LDL) greater than or equal to 130 mg/dl (3.37 mmol/l) High-density lipoprotein (HDL) less than 40 mg/dl (1.04 mmol/l) inmen and less than 50 mg/dl (1.30 mmol/l) in women Currentlyon antilipidemic treatment Positive family history: Indicatewhether the family history in first degree familymembers (parents, siblings, children) was positive forcardiovascular disease (coronary artery disease,cardiomyopathy, stroke, etc.) before the age of 65. Chronickidney disease: Indicate if the patient has a history of chronickidney disease diagnosed and/or treated by a physician. Cut-off values are defined as: eGFR < 60 ml/min/1.73 m2 or urinealbumin-creatinin ratio ≥ 3 mg/mmol Chronic obstructivepulmonary disease (COPD): Indicate if the patient has a historyof chronic kidney disease diagnosed and/or treated by aphysician. Cut-off values are defined as: FEV1 / FVC < 5thpercentile of reference population (z-score < -1.64)

51 cvrisk_ht Hypertension radio

0 No

1 Yes

-1 Unknown

52 cvrisk_dm Diabetes Mellitus radio

0 No

1 Yes, type 1

2 Yes, type 2

-1 Unknown

53 cvrisk_lipid Dyslipidemia radio

0 No

1 Yes, treated

2 Yes, untreated

-1 Unknown

54 cvrisk_smoking Smoking radio

0 Never

1 Former smoker

2 Current smoker

-1 Unknown

55 cvrisk_smoking_py

Show the field ONLY if:[cvrisk_smoking] = '1' or [cvrisk_smoking] = '2'

Smoking: Pack yearsCalculation: (number of cigarettes smokedper day / 20) × years as a smokerpack years

text

56 cvrisk_famhist Family history positive for cardiovascular disease radio

0 No

1 Yes

-1 Unknown

57 cvrisk_inflammatory Known auto-immune or inflammatory disease radio

0 No

1 Yes

58 cvrisk_inflam_type

Show the field ONLY if:[cvrisk_inflammatory] = '1'

Type of auto-immune / inflammatory disease(s) checkbox

1 cvrisk_inflam_type___1 (Rheumatoid) arthritis

2 cvrisk_inflam_type___2 Gout

3 cvrisk_inflam_type___3 Ankylosingspondylitis(Bechterew disease)

4 cvrisk_inflam_type___4 Psoriasis

5 cvrisk_inflam_type___5 Crohn's disease



6 cvrisk_inflam_type___6 Celiac disease

7 cvrisk_inflam_type___7 Systemic Lupuserythematosus

8 cvrisk_inflam_type___8 Sjögren syndrome

9 cvrisk_inflam_type___9 Vasculitis

99 cvrisk_inflam_type___99 Other

59 cvrisk_inflam_type_spec

Show the field ONLY if:[cvrisk_inflam_type(99)] = '1'

Type of auto-immune / inflammatory disease: Specify text

60 cvrisk_ckd Known chronic kidney disease radio

0 No

1 Yes

61 cvrisk_ckd_sev

Show the field ONLY if:[cvrisk_ckd] = '1'

Severity chronic kidney disease (at last evaluation)eGFR = estimated glomerular filtration speed (ml/min/1.73 m2), ACR = urinealbumin creatinineratio (mg/mmol)

radio

1 Mild (eGFR < 60 or ACR ≥ 3)

2 Moderate (eGFR 30-44 and ACR < 3, or eGFR 45-59 and ACR 3-30, or eGFR ≥ 60 and ACR > 30)

3 Severe (eGFR < 29, or eGFR 30-44 and ACR 3-30mg/mmol, or eGFR 45-59 and ACR >30mg/mmol)

-1 Unknown

62 cvrisk_copd Known chronic obstructive pulmonary disease (COPD) radio

0 No

1 Yes

63 cvrisk_copd_sev

Show the field ONLY if:[cvrisk_copd] = '1'

Severity chronic obstructive pulmonary disease (COPD, at lastevaluation)FEV1 % of predicted after bronchodilatation

radio

1 GOLD I (mild, FEV1 ≥ 80%)

2 GOLD II (moderate, FEV1 50-79%)

3 GOLD III (severe, FEV1 30-49%)

4 GOLD IV (very severe, FEV1 < 30%)

-1 Unknown

64 cvrisk_height_unit Section Header: Height & Weight

Height

radio

1 Meters

2 Inches

-1 Unknown


65 carhist_height_m

Show the field ONLY if:[cvrisk_height_unit] = '1'

Height (meters)meters

text (number_2dp, Min: 0.40, Max: 2.40)

66 cvrisk_height_inch

Show the field ONLY if:[cvrisk_height_unit] = '2'

Height (inches)inches

text

67 cvrisk_weight_unit Weight radio

1 Kilogram

2 Pounds

-1 Unknown


68 carhist_weight_kg

Show the field ONLY if:[cvrisk_weight_unit] = '1'

Weight (kilogram)kilogram


69 cvrisk_weight_pound Weight (pounds) text



Show the field ONLY if:[cvrisk_weight_unit] = '2'

pounds

70 carhist_bmi

Show the field ONLY if:[carhist_height_m] > 0 and [carhist_weight_kg] > 0

Body Mass Index (kg/m2) kg/m2

calcCalculation:round([carhist_weight_kg]/([carhist_height_m]*[carhist_height_m]),1)

71 cvrisk_bmi_inchpound

Show the field ONLY if:[cvrisk_height_inch] > 0 and [cvrisk_height_inch] > 0

Body Mass Index (pounds/inches2)pounds/inches2

calcCalculation: 703*([cvrisk_weight_pound]/([cvrisk_height_inch]*[cvrisk_height_inch]))

72 med_nsaid Section Header: Prior use of NSAIDs

Non-steroid anti-inflammatory drugs (NSAIDs)

checkbox

0 med_nsaid___0 None

1 med_nsaid___1 Ibuprofen

2 med_nsaid___2 Naproxen

3 med_nsaid___3 Diclofenac

-1 med_nsaid____1 Unknown

73 med_nsaid_use_chronic

Show the field ONLY if:[med_nsaid(1)] = '1' or [med_nsaid(2)] = '1' or [med_nsaid(3)] = '1'

NSAIDs: Use >1 month? radio

1 Yes

0 No

-1 Unknown

74 med_nsaid_usage

Show the field ONLY if:[med_nsaid(1)] = '1' or [med_nsaid(2)] = '1' or [med_nsaid(3)] = '1'

NSAIDs: Indication radio

1 Chronic use

2 Started due to recent onset of flu symptoms

3 Other

-1 Unknown

75 med_nsaid_use_indication

Show the field ONLY if:[med_nsaid_usage] = '3'

NSAID: Specify indication text

76 carmed_examples Section Header: Use of cardiovascular medication prior to COVID-19 diagnosis

Cardiovascular medication classification system (withexamples) Betablocker e.g. atenolol, bisoporolol, carvedilolAntiarrhythmic drugs e.g. Class 1 (quinidine, procainamide,flecainide), Class III (amiodarone, sotalol), Class IV (diltiazem,verapamil Diuretics e.g. furosemide, bumetanide,hydrochlorothiazide calcium channel blockers(dihypdropyridine) e.g. amlodipine, nifedipine, barnidipine ACEinhibitor e.g. captopril, enalapril, perindopril Angiontensin IIreceptor blocker e.g.candesartan, losartan, valsartanAldosterone antagonist e.g. spironolactone, eplerenonePhosphodieseterase inhibitor e.g. sildenafil, tadalafil Anti-platelet agents e.g. acetylsalicyd acid, clopidogrel, ticagrelorCoumarin e.g. acenocoumarol, fenprocoumon Direct oralanticoagulants e.g. apixaban, dabigatran, rivaroxaban Lipidlowering agents e.g. atorvastatin, rosuvastatin, ezetimib Oralantidiabetic agents e.g. gliclazide, metformin

descriptive

77 carmed Cardiovascular medications checkbox, Required

0 carmed___0 None

1 carmed___1 Betablocker

3 carmed___3 Antiarrhytmic drugs

4 carmed___4 Digoxine

5 carmed___5 Diuretics

6 carmed___6 Calcium channel blocker(dihydropyridine)

7 carmed___7 ACE inhibitor

8 carmed___8 Angiotensin II receptor blocker



15 carmed___15 Aldosterone antagonist

16 carmed___16 Sacubitril/valsartan (Entresto)

17 carmed___17 Phosphodiesterase inhibitors

9 carmed___9 Anti-platelet agents

10 carmed___10 Coumarin

11 carmed___11 Direct oral anticoagulants(DOAC)

12 carmed___12 Lipid lowering agents

13 carmed___13 Insulin

14 carmed___14 Oral antidiabetic agents

99 carmed___99 Other cardiovascular medication

78 carmed_bb

Show the field ONLY if:[carmed(1)] = '1'

Betablockers checkbox

1 carmed_bb___1 Atenolol

2 carmed_bb___2 Bisoprolol (Emcor)

3 carmed_bb___3 Carvedilol

4 carmed_bb___4 Labetalol

5 carmed_bb___5 Metoprolol (Selokeen)

6 carmed_bb___6 Nebivolol (Nebilet)

7 carmed_bb___7 Propranolol

99 carmed_bb___99 Other

79 carmed_bb_spec

Show the field ONLY if:[carmed_bb(99)] = '1'

Specify betablocker text

80 carmed_antiarrh


Antiarrhytmic drugs checkbox

1 carmed_antiarrh___1 Class I

3 carmed_antiarrh___3 Class III

4 carmed_antiarrh___4 Class IV

99 carmed_antiarrh___99 Other

81 carmed_arrhyth_class1

Show the field ONLY if:[carmed_antiarrh(1)] = '1'

Class I antiarrhytmic drugs checkbox

1 carmed_arrhyth_class1___1 1a - Quinidine

2 carmed_arrhyth_class1___2 1a - Disopyramide

3 carmed_arrhyth_class1___3 1a - Procainamide

4 carmed_arrhyth_class1___4 1b - Lidocaine

5 carmed_arrhyth_class1___5 1b - Phenytoin

6 carmed_arrhyth_class1___6 1b - Mexiletine

7 carmed_arrhyth_class1___7 1b - Tocainide

8 carmed_arrhyth_class1___8 1c - Flecainide

9 carmed_arrhyth_class1___9 1c - Propafenone



Class III antiarrhytmic drugs checkbox

1 carmed_arrhyth_class3___1 Amiodarone

2 carmed_arrhyth_class3___2 Sotalol

3 carmed_arrhyth_class3___3 Ibutilide

4 carmed_arrhyth_class3___4 Dofetilide



Class IV antiarrhytmic drugs: Calcium channel blockers radio

1 Diltiazem (Tildiem)

2 Verapamil (Isoptin)

84 carmed_antiarrh_spec


Specify antiarrhythmic drug(s) text



[carmed_antiarrh(99)] = '1'

85 carmed_diuretic


Diuretics checkbox

1 carmed_diuretic___1 Bumetanide (Burinex)

2 carmed_diuretic___2 Chloortalidon

3 carmed_diuretic___3 Furosemide (Lasix)

4 carmed_diuretic___4 Hydrochlorothiazide

99 carmed_diuretic___99 Other

86 carmed_diuretic_spec

Show the field ONLY if:[carmed_diuretic(99)] = '1'

Specify diuretic text

87 carmed_cablock


Calcium channel blocker (dihydropyridine) radio

1 Amlodipin (Norvasc)

2 Barnidipin (Cyress, Vasexten)

3 Nifedipin (Adalat)

99 Other

88 carmed_cablock_spec

Show the field ONLY if:[carmed_cablock] = '99'

Specify dihydropyridine calciumblocker text

89 carmed_acei


ACE inhibitor radio

1 Captopril

2 Enalapril (Renitec)

3 Lisinopril (Zestril)

4 Perindopril (Coversyl)

99 Other

90 carmed_acei_spec

Show the field ONLY if:[carmed_acei] = '99'

Specify ACE inhibitor text

91 carmed_ace_dosage


ACE inhibitor: Total dosage per day (mg/day)mg/day

text

92 carmed_acei_chronic


ACE inhibitor: Use >1 month? radio

1 Yes

0 No

-1 Unknown

93 carmed_arb


Angiotensin II receptor blocker radio

1 Candesartan (Atacand)

2 Irbesartan (Aprovel)

3 Losartan (Cozaar, Losanox)

4 Valsartan (Diovan, Vagrecor)

99 Other

94 carmed_arb_spec

Show the field ONLY if:[carmed_arb] = '99'

Specify angiotensin II receptor blocker text

95 carmed_arb_chronic


Angiotensin II receptor blocker: Use >1 month? radio

1 Yes

0 No

-1 Unknown

96 carmed_arb_dosage


Angiotensin II receptor blocker: Total dosage per day (mg/day)mg/day

text



[carmed(8)] = '1'

97 carmed_mra


Aldosterone antagonist radio

1 Spironolacton

2 Eplerenon

98 carmed_pde5

Show the field ONLY if:[carmed(17)]='1'

Phosphodiesterase inhibitors radio

1 Avanafil

2 Sildenafil

3 Tadalafil

4 Vardenaifl

99 carmed_antiplate


Anti-platelet agents checkbox

1 carmed_antiplate___1 Acetylsalicylic acid

2 carmed_antiplate___2 Carbasalate calcium

3 carmed_antiplate___3 Clopidogrel (Plavix,Grepid, Iscover)

4 carmed_antiplate___4 Dipyridamole(Persantin)

5 carmed_antiplate___5 Prasugrel (Efient)

6 carmed_antiplate___6 Ticagrelor (Brilique)

99 carmed_antiplate___99 Other

100 carmed_antiplate_spec

Show the field ONLY if:[carmed_antiplate(99)] = '1'

Specify anti-platelet agent text

101 carmed_coum


Coumarin radio

1 Acenocoumarol

2 Fenprocoumon (Marcoumar)

102 carmed_doac


Direct oral anticoagulants (DOAC) radio

1 Apixaban (Eliquis)

2 Dabigatran (Pradaxa)

3 Edoxaban (Lixiana)

4 Rivaroxaban (Xarelto)

99 Other

103 carmed_doac_spec

Show the field ONLY if:[carmed_doac] = '99'

Specify DOAC text

104 carmed_lipid


Lipid lowering agents checkbox

1 carmed_lipid___1 Atorvastatin (Lipitor)

2 carmed_lipid___2 Ciprofibrate (Modalim)

3 carmed_lipid___3 Evolocumab (Repatha)

4 carmed_lipid___4 Ezetimib (Ezetrol)

5 carmed_lipid___5 Gemfibrozil (Lopid)

6 carmed_lipid___6 Pravastatin (Selektine)

7 carmed_lipid___7 Rosuvastatin (Crestor)

8 carmed_lipid___8 Simvastatin (Zocor)

99 carmed_lipid___99 Other

105 carmed_lipid_spec

Show the field ONLY if:[carmed_lipid(99)] = '1'

Specify lipid lowering agent text

106 carmed_oraldm


Oral antidiabetic agents checkbox

1 carmed_oraldm___1 Gliclazide (Diamicron)

2 carmed_oraldm___2 Glimepiride (Amaryl)



3 carmed_oraldm___3 Metformin (Glucient)

4 carmed_oraldm___4 Sitagliptine (Januvia)

99 carmed_oraldm___99 Other

107 carmed_oraldm_spec

Show the field ONLY if:[carmed_oraldm(99)] = '1'

Specify oral antidiabetic agent text

108 carmed_other


Other cardiovascular medication text

109 carcons Section Header: Reason for consultation cardiology (to be filled in bydepartment of cardiology)

Cardiology consulted during admission

radio

0 No

1 Yes

-1 Unknown

110 carcons_date

Show the field ONLY if:[carcons] = '1'

Date of first cardiac consultationdd-mm-yyyy

text (date_dmy)

111 carcons_reason


Reason for cardiac consultation checkbox

1 carcons_reason___1 Cardiac complaints

2 carcons_reason___2 Abnormal findings

3 carcons_reason___3 Preventive screening

112 carcons_carcompl


Cardiac complaints at 1st consultation checkbox

0 carcons_carcompl___0 None

1 carcons_carcompl___1 Dyspnea

2 carcons_carcompl___2 Orthopnea

3 carcons_carcompl___3 Peripheral edema

4 carcons_carcompl___4 Chest pain

5 carcons_carcompl___5 Palpitations

6 carcons_carcompl___6 (near) syncope

7 carcons_carcompl___7 Fatigue

99 carcons_carcompl___99 Other

-1 carcons_carcompl____1 Unknown

113 carcons_carcompl_other

Show the field ONLY if:[carcons_carcompl(99)] = '1'

Specify cardiac complaints text

114 carcons_abnfindings

Show the field ONLY if:[carcons_reason(2)] = '1'

Reason for consultation: Abnormal findings checkbox

1 carcons_abnfindings___1 Physicalexamination

2 carcons_abnfindings___2 ECG

3 carcons_abnfindings___3 Echocardiography

4 carcons_abnfindings___4 Laboratory analysis

5 carcons_abnfindings___5 CT Thorax

99 carcons_abnfindings___99 Other

115 carcons_carcons_abnfindings_other

Show the field ONLY if:[carcons_abnfindings(99)] = '1'

Specify abnormal finding text

116 carhist_yesno Section Header: Cardiac diagnosis prior to COVID-19 infection (to be filled inby department of cardiology)

Cardiac diagnosis prior to COVID-19 infection?

radio

1 Yes

0 No



117 carhist

Show the field ONLY if:[carhist_yesno] = '1'

Cardiac diagnosis prior to COVID-19 infection checkbox

1 carhist___1 Arrhythmia / conduction disorder

5 carhist___5 Heart failure

3 carhist___3 Coronary artery disease

4 carhist___4 Valvular disease

6 carhist___6 Congenital heart disease

99 carhist___99 Other

118 carhist_arrhytmia

Show the field ONLY if:[carhist(1)] = '1'

Arrhythmia checkbox

1 carhist_arrhytmia___1 Supraventriculartachycardia

2 carhist_arrhytmia___2 Ventriculararrhythmias

3 carhist_arrhytmia___3 Sinus nodedysfunction

4 carhist_arrhytmia___4 Conduction disorders

99 carhist_arrhytmia___99 Other

119 carhist_arrhth_date


Arrhythmia: Date of diagnosisdd-mm-yyyy; Choose the date of the first event;

text (date_dmy)

120 carhist_arrhythmia_svt_def

Show the field ONLY if:[carhist_arrhytmia(1)] = '1'

Definitions of supraventricular tachycardias Atrial fibrillation: Acardiac arrhythmia arising from the atrium with an atrial rate>300 bpm and an irregularly irregular ventricular response inthe presence of conduction. * Paroxysmal: Self-terminating, inmost cases within 48 hours. Some AF paroxysms may continuefor up to 7 days. AF episodes that are cardioverted within 7days should be considered paroxysmal.* Persistent: AF thatlasts longer than 7 days, including episodes that areterminated by cardioversion, either with drugs or by directcurrent cardioversion, after 7 days or more.* Permanent: AFthat is accepted by the patient (and physician). Hence, rhythmcontrol interventions are, by definitions, not pursued inpatients with permanent AF. Atrial flutter: a reentranttachycardia following a counterclockwise (typical) or clockwise(reverse typical) rotation pattern around the tricuspid annulusresulting in a sawtooth pattern of atrial activation on inferiorECG leads. Atrial tachycardia: A usually regular cardiacarrhythmia arising from the atrium with a rate >100 bpm (cyclelength < 600 ms). AV nodal reentry tachycardia: A regular SVTwhich results from reentry within the AV node and/orperinodal atrial tissue AV reentry tachycardia: A reentrantarrhythmia whose circuit involves the atrium, the AV node, theventricles, and one or more accessory AV connections

descriptive

121 carhist_arrhythmia_svt


Supraventricular tachycardia checkbox

1 carhist_arrhythmia_svt___1 Paroxysmal atrialfibrillation

2 carhist_arrhythmia_svt___2 Persistent atrialfibrillation

3 carhist_arrhythmia_svt___3 Permanent atrialfibrillation

4 carhist_arrhythmia_svt___4 Atrial flutter

5 carhist_arrhythmia_svt___5 Atrial tachycardia

6 carhist_arrhythmia_svt___6 AV nodal reentrytachycardia

7 carhist_arrhythmia_svt___7 AV reentrytachycardia

-1 carhist_arrhythmia_svt____1 Not otherwisespecified

122 carhist_arrhythmia_vt_def


Definitions of ventricular arrhythmias Non-sustainedventricular tachycardia: =>3 consecutive premature ventricular

descriptive



[carhist_arrhytmia(2)] = '1' complexes with a rate >100/min, lasting < 30 seconds.Sustained ventricular tachycardia: Ventricular tachycardiawhich lasts 30 second or more, or les than 30 seconds whenterminated electrically or pharmacologically Ventricularfibrillation: Rapid, usually more than 300bpm (cycle length:180ms or less), grossly irregular ventricular rhythm withmarked variability in QRS cycle lenght, morphology, andamplitude.

123 carhist_arrhythmia_vt


Ventricular arrhythmia checkbox

1 carhist_arrhythmia_vt___1 Non-sustainedventriculartachycardia

2 carhist_arrhythmia_vt___2 Sustainedventriculartachycardia

3 carhist_arrhythmia_vt___3 Ventricularfibrillation

124 carhist_arrhyth_cond_def


Definitions of conduction disorders First degree AV block: PRinterval >200ms Second degree AV block: i) Mobitz I:progressive PR prolongation and shortening of RR interval untilP-wave is blocked. Pause after blocked P-wave is less thantwice the PP interval. PR following block is shorter than PRimmediately preceding block. ii) Mobitz II: Regualr sinus/atrialrhythm with intermittent non-conducted P-waves. Constand PRinterval in the conducted beat. Third degree AV block:Characterized by independent atrial and ventricular complexeswith atrial rate usually exceeding ventricular rate. Left bundlebranch block: QRS duration of 120ms or longer with: Delayedonset of intrinsicoid deflection in 1, V5 and V6 >60 ms. Broadand notched or slurred R waves in I, aVL, V5, and V6. rS or QScomplexes in right precordial leads. ST-segment and T-waves inopposite polarity to the major QRS deflection. Right bundlebranch block: QRS duration of 120ms or longer and: rsR' or rSR'complexes in V1 and V2. Delayed onset of intrinsicoiddeflection in V1 and V2 >50 ms. Broad, slurred S-wave in 1, V5and V6. Secondary ST-T-wave changes. Nonspecificintraventricular conduction delay: QRS duration of 110ms ormore with morphology different from LBBB or RBBB. Pre-exitation: An ECG pattern characterized by a short PR interval, awidened QRS complex, and a delta wave. A pre-exitationpattern on the ECG is evidence of the presence of ananomalous AV connection, which results in ventricularactivation prior to what would have occurred through thenormal His-Purkinje system. The PR interval is typically >120ms. Long QT syndrome: QTc =>480ms in repeated 12-leadECGs in the absence of secondary causes for QT prolongation.

descriptive

125 carhist_conduct


Conduction disorder checkbox

1 carhist_conduct___1 First degree AV block

2 carhist_conduct___2 Second degree AV block

3 carhist_conduct___3 Third degree AV block

4 carhist_conduct___4 Left bundle branch block

5 carhist_conduct___5 Right bundle branchblock

6 carhist_conduct___6 Nonspecificintraventricularconduction delay

7 carhist_conduct___7 Pre-excitation

8 carhist_conduct___8 Long QT syndrome

-1 carhist_conduct____1 Not otherwise specified

126 carhist_arrhythmia_other


Specify arrhythmia text



127 carhist_hf_date


Heart failure: date of diagnosisdd-mm-yyyy; Choose the date of the first event;

text (date_dmy)

128 carhist_hf_nyha


Heart failure: NYHA classificationHighest documented NYHA classification in the past year. If not available, select'Unknown'.

dropdown

1 NYHA I / IV

2 NYHA II / IV

3 NYHA III / IV

4 NYHA IV / IV

99 Unknown

129 carhist_cmp


Heart failure: etiology checkbox

1 carhist_cmp___1 Dilated cardiomyopathy

2 carhist_cmp___2 Hypertrophic (obstructive)cardiomyopathy

3 carhist_cmp___3 Restrictive cardiomyopathy

4 carhist_cmp___4 Non-compactioncardiomyopathy

5 carhist_cmp___5 Arrhythmogeniccardiomyopathy

6 carhist_cmp___6 Impaired cardiac functiondue to ischemic heartdisease

7 carhist_cmp___7 Hypertensivecardiomyopathy

8 carhist_cmp___8 Valvular heart disease

9 carhist_cmp___9 Myocarditis

10 carhist_cmp___10 Toxic cardiomyopathy

99 carhist_cmp___99 Other

-1 carhist_cmp____1 Unknown

130 carhist_cmp_spec

Show the field ONLY if:[carhist_cmp(99)] = '1'

Specify etiology text

131 carhist_cad_date


Coronary artery disease: date of diagnosisdd-mm-yyyy; Choose the date of the first event;

text (date_dmy)

132 carhist_cad_diagn


Coronary artery disease: Diagnosis checkbox

1 carhist_cad_diagn___1 Angina pectoris (stable)

2 carhist_cad_diagn___2 Angina pectoris(unstable)

3 carhist_cad_diagn___3 NSTEMI

4 carhist_cad_diagn___4 STEMI

133 carhist_cad_treat


Coronary artery disease: treatment checkbox

1 carhist_cad_treat___1 Pharmacological

2 carhist_cad_treat___2 Percutaneous coronaryintervention (PCI)

3 carhist_cad_treat___3 Coronary artery bypassgrafting (CABG)

134 carhist_valve_def


Valvular heart diseaseSelect the specific valve if the stenosis orregurgitation is classified as ≥ moderate. Mild valvular diseaseshould not be recorded. Classification according to:Baumgartner H, Hung J, Bermejo J, Chambers JB, Evangelista A,Griffin BP, Lung B, Otto CM, Pellikka PA, Quiñones M.Echocardiographic assessment of valve stenosis: EAE/ASErecommendations for clinical practice. J Am SocEchocardiogr 2009;22:1–23. Lancellotti P, Tribouilloy C,Hagendorff A, Moura L, Popescu BA, Agricola E, Monin J-L,

descriptive



Pierard LA, Badano L, Zamorano JL, Sicari R, Vahanian A,Roelandt JRTC. European association of echocardiographyrecommendations for the assessment of valvular regurgitation.Part 1: Aortic and pulmonary regurgitation (native valvedisease). Eur J Echocardiogr 2010;11:223–244. Lancellotti P,Moura L, Pierard LA, Agricola E, Popescu BA, Tribouilloy C,Hagendorff A, Monin JL, Badano L, Zamorano JL, Sicari R,Vahanian A, Roelandt JRTC. European association ofechocardiography recommendations for the assessment ofvalvular regurgitation. Part 2: Mitral and tricuspid regurgitation(native valve disease). Eur J Echocardiogr 2010;11:307–332. Zoghbi WA, Enriquez-Sarano M, Foster E, Grayburn PA, KraftCD, Levine RA, Nihoyannopoulos P, Otto CM, Quinones MA,Rakowski H, Stewart WJ, Waggoner A, Weissman NJ.Recommendations for Evaluation of the Severity ofNative Valvular Regurgitation with Two-dimensional andDoppler Echocardiography. J Am SocEchocardiogr 2003;16:777-802. Select the specific valve if the stenosis or regurgitation is classified as≥moderate. Mild valvular disease should not be recorded.

135 carhist_valve


Valvular heart disease, specifySelect the specific valve if the stenosis or regurgitation is classified as≥moderate. Mild valvular disease should not be recorded.

checkbox

1 carhist_valve___1 Aortic valve stenosis

2 carhist_valve___2 Aortic valve regurgitation

3 carhist_valve___3 Mitral valve stenosis

4 carhist_valve___4 Mitral valve regurgitation

5 carhist_valve___5 Pulmonary valve stenosis

6 carhist_valve___6 Pulmonary valveregurgitation

7 carhist_valve___7 Tricuspid valve stenosis

8 carhist_valve___8 Tricuspid valve regurgitation

136 carhist_as_date

Show the field ONLY if:[carhist_valve(1)] = '1'

Aortic valve stenosis: Date of diagnosisdd-mm-yyyy; Choose the date of the first event;

text (date_dmy)

137 carhist_ar_date


Aortic valve regurgitation: Date of diagnosisdd-mm-yyyy; Choose the date of the first event;

text (date_dmy)

138 carhist_ms_date


Mitral valve stenosis: Date of diagnosisdd-mm-yyyy; Choose the date of the first event;

text (date_dmy)

139 carhist_mr_date


Mitral valve regurgitation: Date of diagnosisdd-mm-yyyy; Choose the date of the first event;

text (date_dmy)

140 carhist_ps_date


Pulmonary valve stenosis: Date of diagnosisdd-mm-yyyy; Choose the date of the first event;

text (date_dmy)

141 carhist_pr_date


Pulmonary valve regurgitation: Date of diagnosisdd-mm-yyyy; Choose the date of the first event;

text (date_dmy)

142 carhist_ts_date


Tricuspid valve stenosis: Date of diagnosisdd-mm-yyyy; Choose the date of the first event;

text (date_dmy)

143 carhist_tr_date


Tricuspid valve regurgitation: Date of diagnosisdd-mm-yyyy; Choose the date of the first event;

text (date_dmy)

144 carhist_valve_treat


Valvular heart disease: treatment radio

1 No intervention performed

2 Intervention performed



! Collapse

! Collapse

3 Intervention planned

145 carhist_other


Specify cardiac diagnosis notes

146 carhist_other_2


Specify the date of cardiac diagnosisdd-mm-yyyy; Choose the date of the first event;

text (date_dmy)

147 capacity_cardiac_baseline_assessment_required_complete


Complete?

dropdown

0 Incomplete

1 Unverified

2 Complete

Instrument: ISARIC - Pre-admission medication (within 14 days of admission) (OPTIONAL) (isaric_preadmission_medication)

148 isaric_medication_inhste Inhaled steroids radio

1 Yes

0 No

-1 Unknown

149 isaric_medication_oraste Oral steroids radio

1 Yes

0 No

-1 Unknown

150 isaric_medication_antiv Antivirals radio

1 Yes

0 No

-1 Unknown

151 isaric_medication_antib Inhaled steroids radio

1 Yes

0 No

-1 Unknown

152 isaric_preadmission_medication_complete


Complete?

dropdown

0 Incomplete

1 Unverified

2 Complete

Instrument: ISARIC - Comorbidities (OPTIONAL) (isaric_comorbidities_optional)

153 chroniccard_mhyn Section Header: 4b. CO-MORBIDITIES & Risk Factors Charlson index will becalculated for each patient at analysis

4b.1. Chronic cardiac disease, including congenital heartdisease (not hypertension)


1 YES

2 NO

3 N/A

154 chronicpul_mhyn 4b.2. Chronic pulmonary disease radio (Matrix), Required

1 YES

2 NO

3 N/A

155 asthma_mhyn 4b. 3. Asthma (physician diagnosed) radio (Matrix), Required

1 YES

2 NO

3 N/A

156 renal_mhyn 4b.4. Chronic kidney disease radio (Matrix), Required

1 YES



2 NO

3 N/A

157 modliver_mhyn 4b.5. Moderate or severe liver disease radio (Matrix), Required

1 YES

2 NO

3 N/A

158 mildliv_mhyn 4b.6. Mild Liver disease radio (Matrix), Required

1 YES

2 NO

3 N/A

159 chronicneu_mhyn 4b.7. Chronic neurological disorder radio (Matrix), Required

1 YES

2 NO

3 N/A

160 malignantneo_mhyn 4b.8. Malignant neoplasm radio (Matrix), Required

1 YES

2 NO

3 N/A

161 chronhaemo_mhyn 4b.9. Chronic hematologic disease radio (Matrix), Required

1 YES

2 NO

3 N/A

162 aidshiv_mhyn 4b.10. AIDS/HIV radio (Matrix), Required

1 YES

2 NO

3 N/A

163 obesity_mhyn 4b.11. Obesity (as defined by clinical staff) radio (Matrix), Required

1 YES

2 NO

3 N/A

164 diabetiscomp_mhyn 4b.12. Diabetes with complications radio (Matrix), Required

1 YES

2 NO

3 N/A

165 diabetes_mhyn 4b.13. Diabetes without complications radio (Matrix), Required

1 YES

2 NO

3 N/A

166 rheumatology_mhyr 4b.14. Rheumatologic disorder radio (Matrix), Required

1 YES

2 NO

3 N/A

167 dementia_mhyn 4b.15. Dementia radio (Matrix), Required

1 YES

2 NO

3 N/A

168 malnutrition_mhyn 4b.16. Malnutrition radio (Matrix), Required



! Collapse

1 YES

2 NO

3 N/A

169 other_mhyn 4b.17. Other relevant risk factors radio (Matrix), Required

1 YES

2 NO

3 N/A

170 smoking_mhyn 4b.18. Smoking radio, Required

1 Yes

2 Never Smoker

3 Former Smoker

4 Unknown


171 otherrisktext

Show the field ONLY if:[other_mhyn] = '1'

Other relevant risk factor; Specify text

172 isaric_comorbidities_optional_complete


Complete?

dropdown

0 Incomplete

1 Unverified

2 Complete

Instrument: ISARIC - Onset And Admission (OPTIONAL) (isaric_onset_and_admission_optional)

173 cestdat Section Header: 2. ONSET and ADMISSION

2.1 Onset date of first/earliest symptomdd-mm-yyyy


174 hostdat 2.2 Admission date at this facilitydd-mm-yyyy


175 hosttim 2.3 Admission time at this facility(24-hr format)

text (time), Required

176 hooccur 2.4 Transfer from other facility? radio

1 Yes-facility is a study site

2 Yes-facility is not a study site

3 No

4 N/A

177 siteid_transfer

Show the field ONLY if:[hooccur] = '1' or [hooccur] = '2'

2.5.1 If YES: Name of transfer facility: dropdown























9 Erasmus MC

42 Flevoziekenhuis

















13 Maastricht UMC+




74 MC Slotervaart

73 MC Zuiderzee




55 Nij Smellinghe




10 Radboudumc



58 Rivas Zorggroep







900 Spijkenisse MC




! Collapse





30 Tergooi

23 Treant Zorggroep

1 UMC Groningen

7 UMC Utrecht

201 UZ Antwerpen








29 Zuyderland MC

-1 Other

178 subjidcat_transfer

Show the field ONLY if:[hooccur] = '1'

2.5.3 If YES - Study Site: Participant ID # at transfer facility radio

1 Same as above

2 Different

3 N/A

179 hostdat_transfer

Show the field ONLY if:[hooccur] = '1' or [hooccur] = '2'

2.5.2 If YES: Admission date at transfer facilitydd-mm-yyyy

text (date_dmy)

180 subjid_transfer

Show the field ONLY if:[subjidcat_transfer] = '2'

If DIFFERENT; Participant number in CAPACITY in transferfacility

text

181 isaric_study_id If your centre is also participating in ISARIC through anotherdata collection environment (i.e. REDCap, CASTOR etc.) and theISARIC data collection forms are filled in another system,please indicate which study ID the patient has been assigned inISARIC:

text

182 admit_icu_trans Was the patient admitted to the ICU at the transfer facility? yesno

1 Yes

0 No

183 date_icu_transf Which date was the patient admitted to the ICU at the transferfacility?dd-mm-yyyy

text (date_dmy)

184 isaric_onset_and_admission_optional_complete


Complete?

dropdown

0 Incomplete

1 Unverified

2 Complete

Instrument: ISARIC - Admission Signs And Symptoms (OPTIONAL) (isaric_admission_signs_and_symptoms_optional)

185 temp_vsyn Section Header: Admission Signs and Symptoms (first available data atpresentation/admission - within 24 hours)

Temperature on admission available?

yesno, Required

1 Yes

0 No




186 temp_vsorres

Show the field ONLY if:[temp_vsyn] = '1'

Temperature text (number), Required

187 temp_vsorresu

Show the field ONLY if:[temp_vsyn] = '1'

Temperature Units radio, Required

1 °C

2 °F


188 hr_vsyn Heart rate on admission available? yesno, Required

1 Yes

0 No


189 hr_vsorres

Show the field ONLY if:[hr_vsyn] = '1'

Heart Ratebeats per minute

text (number), Required

190 rr_vsyn Respiratory rate on admission available? yesno, Required

1 Yes

0 No


191 rr_vsorres

Show the field ONLY if:[rr_vsyn] = '1'

Respiratory Ratebreaths per minute

text (number), RequiredCustom alignment: RH

192 sysbp_vsyn Systolic blood pressure on admission available? yesno, Required

1 Yes

0 No


193 sysbp_vsorres

Show the field ONLY if:[sysbp_vsyn] = '1'

Systolic blood pressuremmHg


194 diabp_vsyn Diastolic blood pressure on admission available? yesno, Required

1 Yes

0 No


195 admission_diabp_vsorres

Show the field ONLY if:[diabp_vsyn] = '1'

Diastolic blood pressuremmHg


196 dehydration_vsorres Severe dehydration: radio, Required

1 Yes

2 No

3 Unknown


197 stercap_vsyn Sternal capillary refill time on admission available? yesno, Required

1 Yes

0 No


198 stercap_vsorres

Show the field ONLY if:[stercap_vsyn] = '1'

Sternal capillary refill time >2 seconds ? radio, Required

1 Yes

2 No



3 Unknown


199 oxy_vsyn Oxygen saturation on admission available: yesno, Required

1 Yes

0 No


200 oxy_vsorresu

Show the field ONLY if:[oxy_vsyn] = '1'

Oxygen saturation on: radio, Required

1 Room air

2 Oxygen therapy

3 N/A


201 oxy_vsorres

Show the field ONLY if:[oxy_vsyn] = '1'

Oxygen saturation%

text, RequiredCustom alignment: RH

202 fever_ceoccur_v2 Section Header: 4. Admission Signs and Symptoms (observed/reported atadmission and associated with this episode of acute illness)

4a.1. History of fever


1 YES

2 NO

3 Unknown

203 cough_ceoccur_v2 4a.2. Cough radio (Matrix), Required

1 YES

2 NO

3 Unknown

204 coughsput_ceoccur_v2 4a.2.1 Cough: with sputum production radio (Matrix), Required

1 YES

2 NO

3 Unknown

205 coughhb_ceoccur_v2 4a.2.2 Cough: bloody sputum / haemoptysis radio (Matrix), Required

1 YES

2 NO

3 Unknown

206 sorethroat_ceoccur_v2 4a.3. Sore throat radio (Matrix), Required

1 YES

2 NO

3 Unknown

207 runnynose_ceoccur_v2 4a.4. Runny nose (Rhinorrhoea) radio (Matrix), Required

1 YES

2 NO

3 Unknown

208 earpain_ceoccur_v2 4a.5. Ear pain radio (Matrix), Required

1 YES

2 NO

3 Unknown

209 wheeze_ceoccur_v2 4a.6. Wheezing radio (Matrix), Required

1 YES

2 NO

3 Unknown

210 chestpain_ceoccur_v2 4a.7. Chest pain radio (Matrix), Required



1 YES

2 NO

3 Unknown

211 myalgia_ceoccur_v2 4a.8. Muscle aches (Myalgia) radio (Matrix), Required

1 YES

2 NO

3 Unknown

212 jointpain_ceoccur_v2 4a.9. Joint pain (Arthralgia) radio (Matrix), Required

1 YES

2 NO

3 Unknown

213 fatigue_ceoccur_v2 4a.10. Fatigue / Malaise radio (Matrix), Required

1 YES

2 NO

3 Unknown

214 shortbreath_ceoccur_v2 4a.11. Shortness of breath (Dyspnea) radio (Matrix), Required

1 YES

2 NO

3 Unknown

215 lowerchest_ceoccur_v2 4a.12. Lower chest wall indrawing radio (Matrix), Required

1 YES

2 NO

3 Unknown

216 headache_ceoccur_v2 4a.13. Headache radio (Matrix), Required

1 YES

2 NO

3 Unknown

217 inabwalk_ceoccur_v2 Inability to walk radio (Matrix), Required

1 YES

2 NO

3 Unknown

218 confusion_ceoccur_v2 4a.14. Altered consciousness / confusion radio (Matrix), Required

1 YES

2 NO

3 Unknown

219 seizures_cecoccur_v2 4a.15. Seizures radio (Matrix), Required

1 YES

2 NO

3 Unknown

220 abdopain_ceoccur_v2 4a.16. Abdominal pain radio (Matrix), Required

1 YES

2 NO

3 Unknown

221 vomit_ceoccur_v2 4a.17. Vomiting / Nausea radio (Matrix), Required

1 YES

2 NO

3 Unknown



! Collapse

222 diarrhoea_ceoccur_v2 4a.18. Diarrhoea radio (Matrix), Required

1 YES

2 NO

3 Unknown

223 conjunct_ceoccur_v2 4a.19. Conjunctivitis radio (Matrix), Required

1 YES

2 NO

3 Unknown

224 rash_ceoccur_v2 4a.19. Skin rash radio (Matrix), Required

1 YES

2 NO

3 Unknown

225 skinulcers_ceoccur_v2 4a.20. Skin ulcers radio (Matrix), Required

1 YES

2 NO

3 Unknown

226 lymp_ceoccur_v2 4a.21. Lymphadenopathy radio (Matrix), Required

1 YES

2 NO

3 Unknown

227 losssmell_ceoccur_v2 Loss of smell radio (Matrix), Required

1 YES

2 NO

3 Unknown

228 losstaste_ceoccur_v2 Loss of taste radio (Matrix), Required

1 YES

2 NO

3 Unknown

229 bleed_ceoccur_v2 4a.22. Bleeding (Haemorrhage) radio (Matrix), Required

1 YES

2 NO

3 Unknown

230 bleed_ceterm_v2 4a.23. If Bleeding (others) radio (Matrix), Required

1 YES

2 NO

3 Unknown

231 bleed_cetermy_v2

Show the field ONLY if:[bleed_ceoccur_v2] = '1'

If Yes, specify site(s) textCustom alignment: RH

232 isaric_admission_signs_and_symptoms_optional_complete


Complete?

dropdown

0 Incomplete

1 Unverified

2 Complete

Instrument: ISARIC - Infectious Respiratory Disease Diagnosis (OPTIONAL) (isaric_infectious_respiratory_disease_diagnosis_op)

233 mbperf 5.1 Was pathogen testing done during this illness episode?5.2 is available as a repeating instrument in the next section

radio, Required

1 YES

2 NO



3 N/A

234 influ_mbyn

Show the field ONLY if:[mbperf] = '1'

Section Header: Does the patient have:

5.3 Influenza:

radio, Required

2 YES - Confirmed

1 YES - Probable

0 NO

235 influ_mbcat

Show the field ONLY if:[influ_mbyn] = '2' or [influ_mbyn] = '1'

5.3.1 If Yes radio, Required

1 A/H3N2

2 A/H1N1pdm09

3 A/H7N9

4 A/H5N1

5 A - not typed

6 B

888 Other

236 influother_mborres

Show the field ONLY if:[influ_mbcat] = '888'

Other influenza, specify: text, Required

237 corna_mbcat


5.3 Coronavirus: radio, Required

2 YES - Confirmed

1 YES - Probable

0 NO

238 corna_mbcaty

Show the field ONLY if:[corna_mbcat] = '2' or [corna_mbcat] = '1'

5.3.1 If Yes: radio, Required

1 Novel-CoV

2 MERS-CoV

888 Other CoV

239 coronaother_mborres

Show the field ONLY if:[corna_mbcaty] = '888'

IF Other coronavirus; Specify: text, Required

240 rsv_mbcat


5.4 RSV radio, Required

2 YES - Confirmed

1 YES - Probable

0 NO

241 adeno_mbcat


5.5 Adenovirus radio, Required

2 YES - Confirmed

1 YES - Probable

0 NO

242 bact_mborres


5.6 Bacteria radio, Required

1 YES-Confirmed

2 NO

243 bact_mborres_2


5.6 Bacteria radio, Required

1 YES-Confirmed

2 NO

244 other_mbyn


5.7 Other Infectious Respiratory Diagnosis: radio, Required

2 YES - Confirmed

1 YES - Probable

0 NO

245 other_mborres

Show the field ONLY if:[other_mbyn] = '2' or [other_

If YES: Other infectious respiratory diagnosis, specify: text, Required



! Collapse

mbyn] = '1'

246 otherpath_mbyn


5.7 Other pathogen of Public Health interest detected: radio, Required

2 YES - Confirmed

1 YES - Probable

0 N/A

247 otherpath_mborres

Show the field ONLY if:[otherpath_mbyn] = '2' or [otherpath_mbyn] = '1'

If YES: specify HIV radio, Required

1 Positive

2 Negative

3 N/A

248 clinicalpneu_mborres


5.8 Clinical pneumonia: dropdown, Required

1 YES

0 NO

2 Unknown

249 infectuk_mborres


5.9 IF NONE OF THE ABOVE: Suspected Non-infective: dropdown

1 Yes

2 N/A

250 isaric_infectious_respiratory_disease_diagnosis_op_complete


Complete?

dropdown

0 Incomplete

1 Unverified

2 Complete

Instrument: ISARIC - Infectious Respiratory Disease Pathogen Testing (OPTIONAL)(isaric_infectious_respiratory_disease_pathogen_tes)

251 path_test_perf Section Header: 5.2 PATHOGEN TESTING: Details of pathogen testing andsample type done during admission

Pathogen testing done during admission

yesno

1 Yes

0 No

252 bio_spec_types

Show the field ONLY if:[path_test_perf] = '1'

Bio specimen type(s) checkbox

1 bio_spec_types___1 Nasal / NP swab

2 bio_spec_types___2 Throat swab

3 bio_spec_types___3 Combined nasal / NPswab

4 bio_spec_types___4 Sputum

5 bio_spec_types___5 Bronchoalveolar lavage(BAL)

6 bio_spec_types___6 Pleural fluid

7 bio_spec_types___7 Endotracheal aspirate(ETA)

8 bio_spec_types___8 Blood

9 bio_spec_types___9 Urine

10 bio_spec_types___10 Other

253 nasal_number

Show the field ONLY if:[bio_spec_types(1)] = '1'

Section Header: Nasal / NP swab (The results of maximal 5 swabs can bereported)

Number of nasal swabs

dropdown

1 1

2 2

3 3

4 4

5 5

6 >5

254 nasal_date_1

Show the field ONLY if:[nasal_number] >= '1'

Test 1: Collection date nasal / NP swabdd-mm-yyyy

text (date_dmy)



255 lab_test_method_nasal_1

Show the field ONLY if:[nasal_number] >= '1'

Test 1: Laboratory test method nasal / NP swab checkbox

1 lab_test_method_nasal_1___1 PCR

2 lab_test_method_nasal_1___2 Other

256 pcr_nasal_1

Show the field ONLY if:[lab_test_method_nasal_1(1)] = '1'

Test 1: PCR checkbox

1 pcr_nasal_1___1 SARS-CoV-2

2 pcr_nasal_1___2 Adenovirus

3 pcr_nasal_1___3 Parainfluenzavirus

4 pcr_nasal_1___4 Rhinovirus/Enterovirus

5 pcr_nasal_1___5 RS-virus

6 pcr_nasal_1___6 Influenzavirus

7 pcr_nasal_1___7 Coronavirus (not SARS-CoV-2)

8 pcr_nasal_1___8 Human Metapneumovirus

9 pcr_nasal_1___9 Chlamydia pneumoniae

10 pcr_nasal_1___10 Chlamydophila psittaci

11 pcr_nasal_1___11 Coxiella burneti

12 pcr_nasal_1___12 Legionella pneumophila

13 pcr_nasal_1___13 Mycoplasma pneumoniae

14 pcr_nasal_1___14 Other, specify

257 pcr_nasal_other_1

Show the field ONLY if:[pcr_nasal_1(14)] = '1'

Test 1: If other please specify pathogen text

258 nasal_other_1


Test 1: If other, please specify laboratory test method nasal /NP swab + outcome

text

259 date_nasal_2

Show the field ONLY if:[nasal_number] > '1'

Test 2: Collection date nasal / NP swab 2dd-mm-yyyy

text (date_dmy)






261 nasal_other_2



text

262 pcr_nasal_2






















264 date_nasal_3



text (date_dmy)






266 nasal_other_3



text

267 pcr_nasal_3




















269 date_nasal_4



text (date_dmy)


Show the field ONLY if:[nasal_number] >'3'




271 nasal_other_4



text

272 pcr_nasal_4






















274 date_nasal_5



text (date_dmy)






276 nasal_other_5



text

277 pcr_nasal_5




















279 throat_number


Section Header: Throat swab (the results of maximal 5 tests can be reported)

Number of throat swabs

dropdown

1 1

2 2

3 3

4 4

5 5

6 >5

280 throat_date_1


Test 1: Collection date throat swabdd-mm-yyyy

text (date_dmy)



[throat_number] >= '1'

281 throat_method_1

Show the field ONLY if:[throat_number] >= '1'

Test 1: Laboratory test method throat swab checkbox

1 throat_method_1___1 PCR

2 throat_method_1___2 Other

282 throat_method_other_1

Show the field ONLY if:[throat_method_1(2)] = '1'

Test 1: If other, please specify laboratory test method throatswab + outcome

text

283 throat_pcr_1



1 throat_pcr_1___1 SARS-CoV-2

2 throat_pcr_1___2 Adenovirus

3 throat_pcr_1___3 Parainfluenzavirus

4 throat_pcr_1___4 Rhinovirus/Enterovirus

5 throat_pcr_1___5 RS-virus

6 throat_pcr_1___6 Influenzavirus

7 throat_pcr_1___7 Coronavirus (not SARS-CoV-2)

8 throat_pcr_1___8 Human Metapneumovirus

9 throat_pcr_1___9 Chlamydia pneumoniae

10 throat_pcr_1___10 Chlamydophila psittaci

11 throat_pcr_1___11 Coxiella burneti

12 throat_pcr_1___12 Legionella pneumophila

13 throat_pcr_1___13 Mycoplasma pneumoniae

14 throat_pcr_1___14 Other, specify

284 throat_pcr_other_1

Show the field ONLY if:[throat_pcr_1(14)] = '1'


285 throat_date_2



text (date_dmy)

286 throat_method_2








text




289 throat_pcr_2



















290 throat_date_3



text (date_dmy)

291 throat_method_3








text

293 throat_pcr_3




















295 throat_date_4



text (date_dmy)

296 throat_method_4








text

298 throat_pcr_4






















300 throat_date_5



text (date_dmy)

301 throat_method_5








text

303 throat_pcr_5




















305 comnpnasal_number


Section Header: Combined nasal / NP swab

Number of combined nasal / NP swabs

dropdown

1 1

2 2

3 3

4 4

5 5

6 >5

306 comnpnasal_date_1

Show the field ONLY if:[comnpnasal_number] >= '1'

Test 1: Collection date combined nasal / NP swabdd-mm-yyyy

text (date_dmy)

307 comnpnasal_method_1 Test 1: Laboratory test method nasal / NP swab checkbox

1 comnpnasal_method_1___1 PCR




2 comnpnasal_method_1___2 Other

308 comnpnasal_method_other_1

Show the field ONLY if:[comnpnasal_method_1(2)]='1'

Test 1: If other, please specify laboratory test methodcombined nasal / NP swab + outcome

text

309 comnpnasal_pcr_1

Show the field ONLY if:[comnpnasal_method_1(1)] = '1'


1 comnpnasal_pcr_1___1 SARS-CoV-2

2 comnpnasal_pcr_1___2 Adenovirus

3 comnpnasal_pcr_1___3 Parainfluenzavirus

4 comnpnasal_pcr_1___4 Rhinovirus/Enterovirus

5 comnpnasal_pcr_1___5 RS-virus

6 comnpnasal_pcr_1___6 Influenzavirus

7 comnpnasal_pcr_1___7 Coronavirus (notSARS-CoV-2)

8 comnpnasal_pcr_1___8 HumanMetapneumovirus

9 comnpnasal_pcr_1___9 Chlamydiapneumoniae

10 comnpnasal_pcr_1___10 Chlamydophila psittaci

11 comnpnasal_pcr_1___11 Coxiella burneti

12 comnpnasal_pcr_1___12 Legionellapneumophila

13 comnpnasal_pcr_1___13 Mycoplasmapneumoniae

14 comnpnasal_pcr_1___14 Other, specify

310 comnpnasal_pcr_other_1

Show the field ONLY if:[comnpnasal_pcr_1(14)] = '1'





text (date_dmy)

312 comnpnasal_method_2








text


























text (date_dmy)









text
























text (date_dmy)









text


























text (date_dmy)









text























331 sputum_number


Section Header: Sputum

Number of sputum tests

dropdown

1 1

2 2

3 3

4 4

5 5

6 >5

332 sputum_date_1

Show the field ONLY if:[sputum_number] >= '1'

Test 1: Collection date sputumdd-mm-yyyy

text (date_dmy)

333 sputum_method_1


Test 1: Laboratory test method sputum checkbox

1 sputum_method_1___1 PCR

2 sputum_method_1___2 Culture

3 sputum_method_1___3 Other

334 sputum_pcr_1

Show the field ONLY if:[sputum_method_1(1)]='1'


1 sputum_pcr_1___1 SARS-CoV-2

2 sputum_pcr_1___2 Adenovirus

3 sputum_pcr_1___3 Parainfluenzavirus

4 sputum_pcr_1___4 Rhinovirus/Enterovirus

5 sputum_pcr_1___5 RS-virus

6 sputum_pcr_1___6 Influenzavirus

7 sputum_pcr_1___7 Coronavirus (not SARS-CoV-2)

8 sputum_pcr_1___8 HumanMetapneumovirus

9 sputum_pcr_1___9 Chlamydia pneumoniae

10 sputum_pcr_1___10 Chlamydophila psittaci

11 sputum_pcr_1___11 Coxiella burneti

12 sputum_pcr_1___12 Legionella pneumophila

13 sputum_pcr_1___13 Mycoplasma pneumoniae

14 sputum_pcr_1___14 Other, specify

335 sputum_pcr_other_1

Show the field ONLY if:[sputum_pcr_1(14)]='1'


336 sputum_culture_1


Test 1: Culture checkbox

1 sputum_culture_1___1 Acinetobacter spp

2 sputum_culture_1___2 Burkholderiapseudomallei

3 sputum_culture_1___3 Escherichia coli

4 sputum_culture_1___4 Haemophilusinfluenzae

5 sputum_culture_1___5 Klebsiella spp

6 sputum_culture_1___6 Moraxella catarrhalis

7 sputum_culture_1___7 Pseudomonasaeruginosa

8 sputum_culture_1___8 Staphylococcusaureus



9 sputum_culture_1___9 Streptococcuspneumoniae

10 sputum_culture_1___10 Streptococcuspyogenes

11 sputum_culture_1___11 Streptococcusagalactiae

12 sputum_culture_1___12 Coagulase negativestaphylococci

13 sputum_culture_1___13 Corynebacterium,bacillus, micrococcus,enterococcus,propionibacterium

14 sputum_culture_1___14 Other, specify

337 sputum_culture_other_1

Show the field ONLY if:[sputum_culture_1(14)]='1'

Test 1: If other please specify pathogen in culture text

338 sputum_method_other_1


Test 1: If other, please specify laboratory test method ofsputum + outcome

text

339 sputum_date_2



text (date_dmy)

340 sputum_method_2






341 sputum_pcr_2


























4 sputum_culture_2___4 Haemophilus



influenzae

















text

346 sputum_date_3



text (date_dmy)

347 sputum_method_3






348 sputum_pcr_3






















[sputum_pcr_3(14)]='1'
























text

353 sputum_date_4



text (date_dmy)

354 sputum_method_4






355 sputum_pcr_4













































text

360 sputum_date_5



text (date_dmy)

361 sputum_method_5






362 sputum_pcr_5













































text

367 bal_number


Section Header: Bronchoalveolar lavage (BAL)

Number of bronchoalveolar lavages

dropdown

1 1

2 2

3 3

4 >3

368 bal_date_1

Show the field ONLY if:[bal_number] >= '1'

Test 1: Collection date bronchoalveolar lavage (BAL)dd-mm-yyyy

text (date_dmy)



369 bal_method_1


Test 1: Laboratory test method bronchoalveolar lavage (BAL) checkbox

1 bal_method_1___1 PCR

2 bal_method_1___2 Culture

3 bal_method_1___3 Other

370 pcr_bal_1

Show the field ONLY if:[bal_method_1(1)]='1'


1 pcr_bal_1___1 SARS-CoV-2

2 pcr_bal_1___2 Adenovirus

3 pcr_bal_1___3 Parainfluenzavirus

4 pcr_bal_1___4 Rhinovirus/Enterovirus

5 pcr_bal_1___5 RS-virus

6 pcr_bal_1___6 Influenzavirus

7 pcr_bal_1___7 Coronavirus (not SARS-CoV-2)

8 pcr_bal_1___8 Human Metapneumovirus

9 pcr_bal_1___9 Chlamydia pneumoniae

10 pcr_bal_1___10 Chlamydophila psittaci

11 pcr_bal_1___11 Coxiella burneti

12 pcr_bal_1___12 Legionella pneumophila

13 pcr_bal_1___13 Mycoplasma pneumoniae

14 pcr_bal_1___14 Other, specify

371 bal_pcr_other_1

Show the field ONLY if:[pcr_bal_1(14)]='1'


372 bal_culture_1



1 bal_culture_1___1 Acinetobacter spp

2 bal_culture_1___2 Burkholderia pseudomallei

3 bal_culture_1___3 Escherichia coli

4 bal_culture_1___4 Haemophilus influenzae

5 bal_culture_1___5 Klebsiella spp

6 bal_culture_1___6 Moraxella catarrhalis

7 bal_culture_1___7 Pseudomonas aeruginosa

8 bal_culture_1___8 Staphylococcus aureus

9 bal_culture_1___9 Streptococcuspneumoniae

10 bal_culture_1___10 Streptococcus pyogenes

11 bal_culture_1___11 Streptococcus agalactiae

12 bal_culture_1___12 Coagulase negativestaphylococci

13 bal_culture_1___13 Corynebacterium, bacillus,micrococcus,enterococcus,propionibacterium

14 bal_culture_1___14 Other, specify

373 bal_culture_other_1

Show the field ONLY if:[bal_culture_1(14)]='1'


374 bal_method_other_1


Test 1: If other, please specify laboratory test method of BAL +outcome

text

375 bal_date_2



text (date_dmy)



376 bal_method_2






377 pcr_bal_2

















378 bal_pcr_other_2



379 bal_culture_2























text

382 bal_date_3



text (date_dmy)



383 bal_method_3






384 pcr_bal_3

















385 bal_pcr_other_3



386 bal_culture_3























text

389 pleural_number


Section Header: Pleural fluid

Number of pleural fluid tests

dropdown

1 1



[bio_spec_types(6)] = '1' 2 2

3 >2

390 pleural_date_1

Show the field ONLY if:[pleural_number] >='1'

Test 1: Collection date pleural fluiddd-mm-yyyy

text (date_dmy)

391 pleural_method_1


Test 1: Laboratory test method pleural fluid checkbox

1 pleural_method_1___1 PCR

2 pleural_method_1___2 Culture

3 pleural_method_1___3 Other

392 pleural_pcr_1

Show the field ONLY if:[pleural_method_1(1)]='1'


1 pleural_pcr_1___1 SARS-CoV-2

2 pleural_pcr_1___2 Adenovirus

3 pleural_pcr_1___3 Parainfluenzavirus

4 pleural_pcr_1___4 Rhinovirus/Enterovirus

5 pleural_pcr_1___5 RS-virus

6 pleural_pcr_1___6 Influenzavirus

7 pleural_pcr_1___7 Coronavirus (not SARS-CoV-2)

8 pleural_pcr_1___8 Human Metapneumovirus

9 pleural_pcr_1___9 Chlamydia pneumoniae

10 pleural_pcr_1___10 Chlamydophila psittaci

11 pleural_pcr_1___11 Coxiella burneti

12 pleural_pcr_1___12 Legionella pneumophila

13 pleural_pcr_1___13 Mycoplasma pneumoniae

14 pleural_pcr_1___14 Other, specify

393 pleural_pcr_other_1

Show the field ONLY if:[pleural_pcr_1(14)]='1'


394 pleural_culture_1



1 pleural_culture_1___1 Acinetobacter spp

2 pleural_culture_1___2 Burkholderiapseudomallei

3 pleural_culture_1___3 Escherichia coli

4 pleural_culture_1___4 Haemophilusinfluenzae

5 pleural_culture_1___5 Klebsiella spp

6 pleural_culture_1___6 Moraxella catarrhalis

7 pleural_culture_1___7 Pseudomonasaeruginosa

8 pleural_culture_1___8 Staphylococcus aureus

9 pleural_culture_1___9 Streptococcuspneumoniae

10 pleural_culture_1___10 Streptococcuspyogenes

11 pleural_culture_1___11 Streptococcusagalactiae

12 pleural_culture_1___12 Coagulase negativestaphylococci

13 pleural_culture_1___13 Corynebacterium,bacillus, micrococcus,enterococcus,propionibacterium



14 pleural_culture_1___14 Other, specify

395 pleural_culture_other_1

Show the field ONLY if:[pleural_culture_1(14)]='1'

Test 1: If other please specify pathogen in pleural fluid text

396 pleural_method_other_1


Test 1: If other, please specify laboratory test method of pleuralfluid + outcome

text

397 pleural_date_2


Test 2: Collection date pleural fluiddd-mm-yyyy

text (date_dmy)

398 pleural_method_2


Test 2: Laboratory test method pleural fluid checkbox

1 pleural_method_2___1 PCR

2 pleural_method_2___2 Culture

3 pleural_method_2___3 Other

399 pleural_pcr_2



1 pleural_pcr_2___1 SARS-CoV-2

2 pleural_pcr_2___2 Adenovirus

3 pleural_pcr_2___3 Parainfluenzavirus

4 pleural_pcr_2___4 Rhinovirus/Enterovirus

5 pleural_pcr_2___5 RS-virus

6 pleural_pcr_2___6 Influenzavirus

7 pleural_pcr_2___7 Coronavirus (not SARS-CoV-2)

8 pleural_pcr_2___8 Human Metapneumovirus

9 pleural_pcr_2___9 Chlamydia pneumoniae

10 pleural_pcr_2___10 Chlamydophila psittaci

11 pleural_pcr_2___11 Coxiella burneti

12 pleural_pcr_2___12 Legionella pneumophila

13 pleural_pcr_2___13 Mycoplasma pneumoniae

14 pleural_pcr_2___14 Other, specify

400 pleural_pcr_other_2

Show the field ONLY if:[pleural_pcr_2(14)]='1'


401 pleural_culture_2



1 pleural_culture_2___1 Acinetobacter spp

2 pleural_culture_2___2 Burkholderiapseudomallei

3 pleural_culture_2___3 Escherichia coli

4 pleural_culture_2___4 Haemophilusinfluenzae

5 pleural_culture_2___5 Klebsiella spp

6 pleural_culture_2___6 Moraxella catarrhalis

7 pleural_culture_2___7 Pseudomonasaeruginosa

8 pleural_culture_2___8 Staphylococcus aureus

9 pleural_culture_2___9 Streptococcuspneumoniae

10 pleural_culture_2___10 Streptococcuspyogenes

11 pleural_culture_2___11 Streptococcusagalactiae

12 pleural_culture_2___12 Coagulase negative



staphylococci

13 pleural_culture_2___13 Corynebacterium,bacillus, micrococcus,enterococcus,propionibacterium

14 pleural_culture_2___14 Other, specify

402 pleural_culture_other_2

Show the field ONLY if:[pleural_culture_2(14)]='1'

Test 2: If other please specify pathogen in pleural fluid text

403 pleural_method_other_2



text

404 trach_number


Section Header: Endotracheal aspirate

Number of endotracheal aspirate analyses

dropdown

1 1

2 2

3 >2

405 trach_date_1

Show the field ONLY if:[trach_number] >= '1'

Test 1: Collection date endotracheal aspirate (ETA)dd-mm-yyyy

text (date_dmy)

406 trach_method_1


Test 1: Laboratory test method endotracheal aspirate (ETA) checkbox

1 trach_method_1___1 PCR

2 trach_method_1___2 Culture

3 trach_method_1___3 Other

407 trach_pcr_1

Show the field ONLY if:[trach_method_1(1)]='1'


1 trach_pcr_1___1 SARS-CoV-2

2 trach_pcr_1___2 Adenovirus

3 trach_pcr_1___3 Parainfluenzavirus

4 trach_pcr_1___4 Rhinovirus/Enterovirus

5 trach_pcr_1___5 RS-virus

6 trach_pcr_1___6 Influenzavirus

7 trach_pcr_1___7 Coronavirus (not SARS-CoV-2)

8 trach_pcr_1___8 Human Metapneumovirus

9 trach_pcr_1___9 Chlamydia pneumoniae

10 trach_pcr_1___10 Chlamydophila psittaci

11 trach_pcr_1___11 Coxiella burneti

12 trach_pcr_1___12 Legionella pneumophila

13 trach_pcr_1___13 Mycoplasma pneumoniae

14 trach_pcr_1___14 Other, specify

408 trach_pcr_other_1

Show the field ONLY if:[trach_pcr_1(14)]='1'


409 trach_culture_1



1 trach_culture_1___1 Acinetobacter spp

2 trach_culture_1___2 Burkholderiapseudomallei

3 trach_culture_1___3 Escherichia coli

4 trach_culture_1___4 Haemophilus influenzae

5 trach_culture_1___5 Klebsiella spp

6 trach_culture_1___6 Moraxella catarrhalis



7 trach_culture_1___7 Pseudomonasaeruginosa

8 trach_culture_1___8 Staphylococcus aureus

9 trach_culture_1___9 Streptococcuspneumoniae

10 trach_culture_1___10 Streptococcus pyogenes

11 trach_culture_1___11 Streptococcus agalactiae

12 trach_culture_1___12 Coagulase negativestaphylococci

13 trach_culture_1___13 Corynebacterium,bacillus, micrococcus,enterococcus,propionibacterium

14 trach_culture_1___14 Other, specify

410 trach_culture_other_1

Show the field ONLY if:[trach_culture_1(14)]='1'

Test 1: If other please specify pathogen in endotrachealaspirate

text

411 trach_method_other_1



text

412 trach_date_2


Test 2: Collection date endotracheal aspirate (ETA)dd-mm-yyyy

text (date_dmy)

413 trach_method_2


Test 2: Laboratory test method endotracheal aspirate (ETA) checkbox

1 trach_method_2___1 PCR

2 trach_method_2___2 Culture

3 trach_method_2___3 Other

414 trach_pcr_2



1 trach_pcr_2___1 SARS-CoV-2

2 trach_pcr_2___2 Adenovirus

3 trach_pcr_2___3 Parainfluenzavirus

4 trach_pcr_2___4 Rhinovirus/Enterovirus

5 trach_pcr_2___5 RS-virus

6 trach_pcr_2___6 Influenzavirus

7 trach_pcr_2___7 Coronavirus (not SARS-CoV-2)

8 trach_pcr_2___8 Human Metapneumovirus

9 trach_pcr_2___9 Chlamydia pneumoniae

10 trach_pcr_2___10 Chlamydophila psittaci

11 trach_pcr_2___11 Coxiella burneti

12 trach_pcr_2___12 Legionella pneumophila

13 trach_pcr_2___13 Mycoplasma pneumoniae

14 trach_pcr_2___14 Other, specify

415 trach_pcr_other_2

Show the field ONLY if:[trach_pcr_2(14)]='1'


416 trach_culture_2



1 trach_culture_2___1 Acinetobacter spp

2 trach_culture_2___2 Burkholderiapseudomallei

3 trach_culture_2___3 Escherichia coli

4 trach_culture_2___4 Haemophilus influenzae



5 trach_culture_2___5 Klebsiella spp

6 trach_culture_2___6 Moraxella catarrhalis

7 trach_culture_2___7 Pseudomonasaeruginosa

8 trach_culture_2___8 Staphylococcus aureus

9 trach_culture_2___9 Streptococcuspneumoniae

10 trach_culture_2___10 Streptococcus pyogenes

11 trach_culture_2___11 Streptococcus agalactiae

12 trach_culture_2___12 Coagulase negativestaphylococci

13 trach_culture_2___13 Corynebacterium,bacillus, micrococcus,enterococcus,propionibacterium

14 trach_culture_2___14 Other, specify

417 trach_culture_other_2

Show the field ONLY if:[trach_culture_2(14)]='1'

Test 2: If other please specify pathogen in endotrachealaspirate

text

418 trach_method_other_2



text

419 blood_number


Section Header: Blood

Number of blood analyses

dropdown

1 1

2 2

3 >2

420 blood_date_1

Show the field ONLY if:[blood_number] >= '1'

Test 1: Collection date blooddd-mm-yyyy

text (date_dmy)

421 blood_method_1


Test 1: Laboratory test method blood checkbox

1 blood_method_1___1 PCR

2 blood_method_1___2 Culture

3 blood_method_1___3 Other

422 blood_pcr_1

Show the field ONLY if:[blood_method_1(1)]='1'


1 blood_pcr_1___1 SARS-CoV-2

2 blood_pcr_1___2 Adenovirus

3 blood_pcr_1___3 Parainfluenzavirus

4 blood_pcr_1___4 Rhinovirus/Enterovirus

5 blood_pcr_1___5 RS-virus

6 blood_pcr_1___6 Influenzavirus

7 blood_pcr_1___7 Coronavirus (not SARS-CoV-2)

8 blood_pcr_1___8 Human Metapneumovirus

9 blood_pcr_1___9 Chlamydia pneumoniae

10 blood_pcr_1___10 Chlamydophila psittaci

11 blood_pcr_1___11 Coxiella burneti

12 blood_pcr_1___12 Legionella pneumophila

13 blood_pcr_1___13 Mycoplasma pneumoniae

14 blood_pcr_1___14 Other, specify

423 blood_pcr_other_1





[blood_pcr_1(14)]='1'

424 blood_culture_1



1 blood_culture_1___1 Acinetobacter spp

2 blood_culture_1___2 Burkholderiapseudomallei

3 blood_culture_1___3 Escherichia coli

4 blood_culture_1___4 Haemophilus influenzae

5 blood_culture_1___5 Klebsiella spp

6 blood_culture_1___6 Moraxella catarrhalis

7 blood_culture_1___7 Pseudomonasaeruginosa

8 blood_culture_1___8 Staphylococcus aureus

9 blood_culture_1___9 Streptococcuspneumoniae

10 blood_culture_1___10 Streptococcus pyogenes

11 blood_culture_1___11 Streptococcusagalactiae

12 blood_culture_1___12 Coagulase negativestaphylococci

13 blood_culture_1___13 Corynebacterium,bacillus, micrococcus,enterococcus,propionibacterium

14 blood_culture_1___14 Other, specify

425 blood_culture_other_1

Show the field ONLY if:[blood_culture_1(14)]='1'

Test 1: If other please specify pathogen in blood text

426 blood_method_other_1


Test 1: If other, please specify laboratory test method of blood+ outcome

text

427 blood_date_2


Test 2: Collection date blooddd-mm-yyyy

text (date_dmy)

428 blood_method_2


Test 2: Laboratory test method blood checkbox

1 blood_method_2___1 PCR

2 blood_method_2___2 Culture

3 blood_method_2___3 Other

429 blood_pcr_2



1 blood_pcr_2___1 SARS-CoV-2

2 blood_pcr_2___2 Adenovirus

3 blood_pcr_2___3 Parainfluenzavirus

4 blood_pcr_2___4 Rhinovirus/Enterovirus

5 blood_pcr_2___5 RS-virus

6 blood_pcr_2___6 Influenzavirus

7 blood_pcr_2___7 Coronavirus (not SARS-CoV-2)

8 blood_pcr_2___8 Human Metapneumovirus

9 blood_pcr_2___9 Chlamydia pneumoniae

10 blood_pcr_2___10 Chlamydophila psittaci

11 blood_pcr_2___11 Coxiella burneti

12 blood_pcr_2___12 Legionella pneumophila

13 blood_pcr_2___13 Mycoplasma pneumoniae



14 blood_pcr_2___14 Other, specify

430 blood_pcr_other_2

Show the field ONLY if:[blood_pcr_2(14)]='1'


431 blood_culture_2



1 blood_culture_2___1 Acinetobacter spp

2 blood_culture_2___2 Burkholderiapseudomallei

3 blood_culture_2___3 Escherichia coli

4 blood_culture_2___4 Haemophilus influenzae

5 blood_culture_2___5 Klebsiella spp

6 blood_culture_2___6 Moraxella catarrhalis

7 blood_culture_2___7 Pseudomonasaeruginosa

8 blood_culture_2___8 Staphylococcus aureus

9 blood_culture_2___9 Streptococcuspneumoniae

10 blood_culture_2___10 Streptococcus pyogenes

11 blood_culture_2___11 Streptococcusagalactiae

12 blood_culture_2___12 Coagulase negativestaphylococci

13 blood_culture_2___13 Corynebacterium,bacillus, micrococcus,enterococcus,propionibacterium

14 blood_culture_2___14 Other, specify

432 blood_culture_other_2

Show the field ONLY if:[blood_culture_2(14)]='1'

Test 2: If other please specify pathogen in blood text

433 blood_method_other_2


Test 2: If other, please specify laboratory test method of blood+ outcome

text

434 urine_number


Section Header: Urine

Number of urine analyses

dropdown

1 1

2 2

3 >2

435 urine_date_1

Show the field ONLY if:[urine_number]>='1'

Test 1: Collection date urinedd-mm-yyyy

text (date_dmy)

436 urine_antigen_test_1


Test 1: Urine antigen test checkbox

1 urine_antigen_test_1___1 Streptococcuspneumoniae

2 urine_antigen_test_1___2 Legionellapneumophila

3 urine_antigen_test_1___3 Other, specify

437 urine_antigen_other_1

Show the field ONLY if:[urine_antigen_test_1(3)]='1'

Test 1: Specify urine antigen test text

438 urine_date_2


Test 2: Collection date urinedd-mm-yyyy

text (date_dmy)

439 urine_antigen_test_2 Test 2: Urine antigen test checkbox



! Collapse


1 urine_antigen_test_2___1 Streptococcuspneumoniae

2 urine_antigen_test_2___2 Legionellapneumophila

3 urine_antigen_test_2___3 Other, specify

440 urine_antigen_other_2

Show the field ONLY if:[urine_antigen_test_2(3)]='1'

Test 2: Specify urine antigen test + outcome text

441 bio_spec_other


Section Header: Other bio specimen

If other please specify biospecimen type + outcome

text

442 isaric_infectious_respiratory_disease_pathogen_tes_complete


Complete?

dropdown

0 Incomplete

1 Unverified

2 Complete

Instrument: ISARIC - Daily Form (OPTIONAL) (isaric_daily_form_optional)

443 daily_dsstdat DATE OF ASSESSMENTmay not be the date of completion


444 daily_hoterm Section Header: 1. DAILY ASSESSMENT FORM, to be filled in at; - Firstadmission to the hospital - On admission to the ICU - Daily while on ICU (if >14days on ICU, do only fill in the first 14 days) - Discharge

1.1 Current admission to ICU/IMC/HDU

radio, Required

1 Yes

2 No

3 N/A

445 daily_fi02_lbyn Section Header: Record the worst value from 00:00-24:00 taken on day ofassessment (if Not Available write 'N/A')):

1.2 FiO2 available?

radio

1 Yes

2 No

446 daily_fio2_lborres

Show the field ONLY if:[daily_fi02_lbyn] = '1'

FiO2% (0.21-1.0)

text (number, Min: 0.2, Max: 1), Required

447 daily_sa02_lbyn 1.3 SaO2 available? radio

1 Yes

2 No

448 daily_sao2_lborres

Show the field ONLY if:[daily_sa02_lbyn] = '1'

SaO2%

text, Required

449 daily_pao2_lbyn 1.4 PaO2 available?at time of FiO2 above

yesno

1 Yes

0 No

450 daily_pao2_lborres

Show the field ONLY if:[daily_pao2_lbyn] = '1'

PaO2:at time of FiO2 specified above

text (number, Min: 0, Max: 500), Required

451 daily_pao2_lborresu


PaO2 unit: dropdown, Required

1 kPa

2 mmHg

452 daily_pao2_lbspec


PaO2 sample type dropdown, Required

1 Arterial

2 Venous

3 Capillary

4 N/A

453 daily_pco2_lbyn 1.5 PCO2 available?from same blood gas record as PaO2

radio

1 Yes



2 No

454 daily_pco2_lborres

Show the field ONLY if:[daily_pco2_lbyn] = '1'

PCO2from same blood gas record as PaO2


455 daily_pco2_lborresu

Show the field ONLY if:[daily_pco2_lbyn] = '1'

PCO2 Unit dropdown, Required

1 kPa

2 mmHg

456 daily_ph_lbyn 1.6 pH available yesno

1 Yes

0 No

457 daily_ph_lborres

Show the field ONLY if:[daily_ph_lbyn] = '1'

pH text (number_2dp), Required

458 daily_hco3_lbyn 1.7 HCO3- available yesno

1 Yes

0 No

459 daily_hco3_lborres

Show the field ONLY if:[daily_hco3_lbyn] = '1'

HCO3-mEq/L

text, Required

460 daily_baseex_lbyn 1.8 Base excess available yesno

1 Yes

0 No

461 daily_baseex_lborres

Show the field ONLY if:[daily_baseex_lbyn] = '1'

Base excessmmol/L

text, Required

462 avpu_vsorres 1.9 AVPU radio

1 Alert

2 Verbal

3 Pain

4 Unresponsive

463 rass_vsyn 1.10 Richmond Agitation-Sedation Scale (RASS) available yesno

1 Yes

0 No

464 rass_vsorres

Show the field ONLY if:[rass_vsyn] = '1'

Richmond Agitation-Sedation Scale (RASS) text, Required

465 sas_vsyn 1.11 Riker Sedation-Agitation Scale (SAS) available? yesno

1 Yes

0 No

466 sas_vsorres

Show the field ONLY if:[sas_vsyn] = '1'

Riker Sedation-Agitation Scale (SAS) text

467 daily_gcs_lbyn 1.12 Glasgow Coma Score available? radio

1 Yes

0 No

468 daily_gcs_vsorres

Show the field ONLY if:[daily_gcs_lbyn] = '1'

Glasgow Coma Score:out of 15


469 systolic_vsyn 1.13 Systolic Blood Pressure available? yesno

1 Yes



0 No

470 systolic_vsorres

Show the field ONLY if:[systolic_vsyn] = '1'

Systolic PressuremmHg

text, Required

471 diastolic_vsyn 1.14 Diastolic Blood Pressure available? yesno

1 Yes

0 No

472 diastolic_vsorres

Show the field ONLY if:[diastolic_vsyn] = '1'

Diastolic PressuremmHg

text, Required

473 daily_meanart_lbyn 1.15 Mean Arterial Pressure available? radio

1 Yes

0 No

474 daily_meanart_vsorres

Show the field ONLY if:[daily_meanart_lbyn] = '1'

Mean Arterial Pressure:mmHg


475 daily_urine_lbyn 1.16 Urine flow rate available? radio

1 Yes

2 Estimated

0 No

476 daily_urine_lborres

Show the field ONLY if:[daily_urine_lbyn] = '1' or [daily_urine_lbyn] = '2'

Urine flow rate:mL/24 hours


477 daily_noninvasive_prtrt Section Header: Is the patient currently receiving, or has received (between00:00 to 24:00 on day of assessment) (apply to all questions in this section):

1.16 Non-invasive ventilation (e.g. BIPAP, CPAP)?

radio (Matrix)

1 YES

2 NO

3 N/A

478 daily_invasive_prtrt 1.17 Invasive ventilation? radio (Matrix)

1 YES

2 NO

3 N/A

479 daily_ecmo_prtrt 1.18 ECLS? radio (Matrix)

1 YES

2 NO

3 N/A

480 daily_nasaloxy_cmtrt 1.19 High-flow nasal canula oxygen therapy? radio (Matrix)

1 YES

2 NO

3 N/A

481 daily_rrt_cmtrt 1.20 Dialysis / Hemofiltration? radio (Matrix)

1 YES

2 NO

3 N/A

482 daily_inotrope_cmyn 1.21 Any vasopressor / inotropic support? radio (Matrix)

1 YES

2 NO

3 N/A

Field Annotation: If No; answer the next 3 questions



'NO'

483 daily_dopless5_cmtrt

Show the field ONLY if:[daily_inotrope_cmyn] = '1'

1.22a Dopamine < 5 µg/min OR Dobutamine OR Milrinone ORLevosimendan:

radio (Matrix)

1 YES

2 NO

3 N/A

484 daily_dop5to15_cmtrt


1.22b Dopamine 5-15 µg/min OR Epinephrine/Norepinephrine< 0.1 ?kg/min OR Vasopressin OR Phenylephrine:

radio (Matrix)

1 YES

2 NO

3 N/A

485 daily_dopgr15_cmtrt


1.22c Dopamine > 15 µg/min OR Epinephrine/Norepinephrine> 0.1 ?kg/min:

radio (Matrix)

1 YES

2 NO

3 N/A

486 daily_neuro_cmtrt 1.23 Neuromuscular blocking agents? radio (Matrix)

1 YES

2 NO

3 N/A

487 daily_nitritc_cmtrt 1.24 Inhaled Nitric Oxide ? radio (Matrix)

1 YES

2 NO

3 N/A

488 daily_trach_prperf 1.25 Tracheostomy inserted? radio (Matrix)

1 YES

2 NO

3 N/A

489 daily_prone_cmtrt 1.26 Prone Positioning radio (Matrix)

1 YES

2 NO

3 N/A

490 daily_prperf 1.28 Other intervention or procedure? radio (Matrix)

1 YES

2 NO

3 N/A

491 daily_noninvasive_o2flow

Show the field ONLY if:[daily_noninvasive_prtrt] = '1'

If YES Non-invasive ventilation, specify O2 flow radio, Required

1 1-5 L/min

2 6-10 L/min

3 11-15 L/min

4 >15 L/min

-1 Unknown

492 daily_noninvasive_o2flow_2

Show the field ONLY if:[daily_ecmo_prtrt] = '1'

If YES extra corporeal life supports (ECLS), specify radio, Required

1 VV

2 AV

3 Central

4 N/A

493 daily_other_prtrt

Show the field ONLY if:[daily_prperf] = '1'

If YES other intervention, Specify, text, Required

494 daily_lbperf Section Header: 2. DAILY LABORATORY RESULTS (on admission, on anyadmission to ICU, then daily) Record the worst value from 00:00-24:00 taken on

yesno



day of assessment (if Not Available write 'N/A')):

2.1 Results available for sample taken on the date in section 1above ?

1 Yes

0 No

495 daily_lbdat

Show the field ONLY if:[daily_lbperf] = '1'

Date of assessment text (date_dmy), Required

496 daily_hb_lbyn


2.2 Haemoglobin available yesno

1 Yes

0 No

497 daily_hb_lborres

Show the field ONLY if:[daily_hb_lbyn] = '1'

Haemoglobin text (number, Min: 0, Max: 200), Required

498 daily_hb_lborresu

Show the field ONLY if:[daily_hb_lbyn] = '1'

Haemoglobin Unit dropdown, Required

1 g/L

2 g/dL

499 daily_wbc_lbyn


2.3 WBC count available yesno

1 Yes

0 No

500 daily_wbc_lborres

Show the field ONLY if:[daily_wbc_lbyn] = '1'

WBC count text (number, Min: 0, Max: 200), Required

501 daily_wbc_lborresu

Show the field ONLY if:[daily_wbc_lbyn] = '1'

WBC Unit dropdown, Required

1 x 10^9 / L

2 x 10^3/µL

502 daily_lymp_lbyn


2.4 Lymphocyte count available yesno

1 Yes

0 No

503 daily_lymp_lborres

Show the field ONLY if:[daily_lymp_lbyn] = '1'

Lymphocyte countcells/µL


504 daily_neutro_lbyn


2.5 Neutrophil count available yesno

1 Yes

0 No

505 daily_neutro_lborres

Show the field ONLY if:[daily_neutro_lbyn] = '1'

Neutrophil countcells/µL


506 daily_haematocrit_lbyn


2.6 Haematocrit available yesno

1 Yes

0 No

507 daily_haematocrit_lborres

Show the field ONLY if:[daily_haematocrit_lbyn] = '1'

Haematocrit%

text, Required

508 daily_plt_lbyn


2.7 Platelets available yesno

1 Yes

0 No

509 daily_plt_lborres

Show the field ONLY if:[daily_plt_lbyn] = '1'

Platelet Count text (number, Min: 0, Max: 2000), Required

510 daily_plt_lborresu


Platelets Unit dropdown, Required

1 x 10^9 / L



[daily_plt_lbyn] = '1' 2 x 10^3/µL

511 daily_aptt_lbyn


2.8 APTT/APTR available yesno

1 Yes

0 No

512 daily_aptt_lborres

Show the field ONLY if:[daily_aptt_lbyn] = '1'

APTT/APTR text (number, Min: 0, Max: 200), Required

513 daily_pt_inr_lbyn


2.9 PT or INR available dropdown

1 PT done

2 INR done

3 PT or INR not done

514 daily_pt_lborres

Show the field ONLY if:[daily_pt_inr_lbyn] = '1'

PTseconds


515 daily_inr_lborres

Show the field ONLY if:[daily_pt_inr_lbyn] = '2'

INR text (number, Min: 0, Max: 100), Required

516 daily_alt_lbyn


2.10 ALT / SGPT available yesno

1 Yes

0 No

517 daily_alt_lborres

Show the field ONLY if:[daily_alt_lbyn] = '1'

ALT / SGPTU/L


518 daily_bil_lbyn


2.11 Total Bilirubin available yesno

1 Yes

0 No

519 daily_bil_lborres

Show the field ONLY if:[daily_bil_lbyn] = '1'

Total Bilirubin text (number, Min: 0, Max: 700), Required

520 daily_bil_lborresu

Show the field ONLY if:[daily_bil_lbyn] = '1'

Total Bilirubin Unit dropdown, Required

1 µmol/L

2 mg/dL

521 daily_ast_lbyn


2.12 AST/SGOT available yesno

1 Yes

0 No

522 daily_ast_lborres

Show the field ONLY if:[daily_ast_lbyn] = '1'

AST/SGOTU/L


523 daily_glucose_lbyn


2.13 Glucose available yesno

1 Yes

0 No

524 daily_glucose_lborres

Show the field ONLY if:[daily_glucose_lbyn] = '1'

Glucose text (number, Min: 0, Max: 1000), Required

525 daily_glucose_lborresu

Show the field ONLY if:[daily_glucose_lbyn] = '1'

Glucose Unit dropdown, Required

1 mmol/L

2 mg/dL

526 daily_bun_lbyn


2.14 Blood Urea Nitrogen (urea) available yesno

1 Yes



0 No

527 daily_bun_lborres

Show the field ONLY if:[daily_bun_lbyn] = '1'

Blood Urea Nitrogen (urea) text (number, Min: 0, Max: 300), Required

528 daily_bun_lborresu

Show the field ONLY if:[daily_bun_lbyn] = '1'

Blood Urea Nitrogen (urea) dropdown, Required

1 mmol/L

2 mg/dL

529 daily_lactate_lbyn


2.15 Lactate available yesno

1 Yes

0 No

530 daily_lactate_lborres

Show the field ONLY if:[daily_lactate_lbyn] = '1'

Lactate text (number, Min: 0, Max: 200), Required

531 daily_lactate_lborresu

Show the field ONLY if:[daily_lactate_lbyn] = '1'

Lactate Unit dropdown, Required

1 mmol/L

2 mg/dL

532 daily_creat_lbyn


2.16 Creatinine available yesno

1 Yes

0 No

533 daily_creat_lborres

Show the field ONLY if:[daily_creat_lbyn] = '1'

Creatinine text (number, Min: 0, Max: 5000), Required

534 daily_creat_lborresu

Show the field ONLY if:[daily_creat_lbyn] = '1'

Creatinine Unit dropdown, Required

1 µmol/L

2 mg/dL

535 daily_sodium_lbyn


2.17 Sodium available yesno

1 Yes

0 No

536 daily_sodium_lborres

Show the field ONLY if:[daily_sodium_lbyn] = '1'

Sodiummmol/L

text, Required

537 daily_potassium_lbyn


2.18 Potassium available yesno

1 Yes

0 No

538 daily_potassium_lborres

Show the field ONLY if:[daily_potassium_lbyn] = '1'

Potassiummmol/L

text, Required

539 daily_procal_lbyn


2.19 Procalcitonin available yesno

1 Yes

0 No

540 daily_procal_lborres

Show the field ONLY if:[daily_procal_lbyn] = '1'

Procalcitoninng/mL


541 daily_crp_lbyn


2.20 C-reactive protein (CRP) available yesno

1 Yes

0 No

542 daily_crp_lborres

Show the field ONLY if:[daily_crp_lbyn] = '1'

C-reactive protein (CRP)mg/L




! Collapse

543 daily_ldh_lbyn


2.21 Lactodehydrogenase (LDH) yesno

1 Yes

0 No

544 daily_ldh_lborres

Show the field ONLY if:[daily_ldh_lbyn] = '1'

Lactodehydrogenase (LDH)U/L

text (number, Min: 0), Required

545 daily_esr_lbyn


2.22 Erythrocyte Sedimentation Rate (ESR) available yesno

1 Yes

0 No

546 daily_esr_lborres

Show the field ONLY if:[daily_esr_lbyn] = '1'

Erythrocyte Sedimentation Rate (ESR)mm/hr


547 daily_ddimer_lbyn


2.23 D-dimer available yesno

1 Yes

0 No

548 daily_ddimer_lborres

Show the field ONLY if:[daily_ddimer_lbyn] = '1'

D-dimermg/L


549 daily_ferritin_lbyn


2.24 Ferritin available yesno

1 Yes

0 No

550 daily_crp_lborres_5

Show the field ONLY if:[daily_ferritin_lbyn] = '1'

Ferritinng/mL


551 daily_il6_lbyn


2.25 Interleukin-6 (IL-6) available yesno

1 Yes

0 No

552 daily_il6_lborres

Show the field ONLY if:[daily_il6_lbyn] = '1'

Interleukin-6 (IL-6)mg/L


553 isaric_daily_form_optional_complete


Complete?

dropdown

0 Incomplete

1 Unverified

2 Complete

Instrument: CAPACITY - Cardiac biomarkers (OPTIONAL) (capacity_cardiac_biomarkers_optional)

554 date_biomarker Date of examinationdd-mm-yyyy; only add if cardiac biomarkers were determined

text (date_dmy)

555 bio_trop Section Header: Troponin

Troponin

radio, Required

0 Not available

1 High sensitive Troponin I (hs-cTnI)

2 High sensitive Troponin T (hs-cTnT)

3 Troponin I

4 Troponin T

556 bio_trop_unit

Show the field ONLY if:[bio_trop] = '1' or [bio_trop] = '2' or [bio_trop] = '3' or [bio_trop] = '4'

Troponin: Unit radio

1 ng/L

2 µg/l

557 bio_trop_value


Troponin: value text (number)



! Collapse

[bio_trop] = '1' or [bio_trop] = '2' or [bio_trop] = '3' or [bio_trop] = '4'

558 bio_bnp Section Header: (NT-pro)BNP

(NT-pro)BNP

radio, Required

0 Not available

1 NT-proBNP

2 BNP

559 bio_bnp_unit

Show the field ONLY if:[bio_bnp] = '1' or [bio_bnp] = '2'

(NT-pro)BNP: Units radio

1 pg/mL

2 pmol/L

560 bio_bnp_value

Show the field ONLY if:[bio_bnp] = '1' or [bio_bnp] = '2'

(NT-pro)BNP: value text (number)

561 bio_ckmb Section Header: CK-MB

CK-MB

radio, Required

0 Not available

1 Available

562 bio_ckmb_unit

Show the field ONLY if:[bio_ckmb] = '1'

CK-MB: Units radio

1 U/L

2 µg/L

563 bio_ckmb_value

Show the field ONLY if:[bio_ckmb] = '1'

CK-MB: Value text (number)

564 bio_ck CK radio

0 Not available

1 Available

565 bio_ck_value CK: ValueU/L

text (number)

1 U/L

566 capacity_cardiac_biomarkers_optional_complete


Complete?

dropdown

0 Incomplete

1 Unverified

2 Complete

Instrument: CAPACITY - ECG (OPTIONAL) (capacity_ecg_optional)

567 ecg_file If available, upload the ECG (make sure the file is anonymized). file

568 ecg_date Date of ECGdd-mm-yyyy; only add (i) baseline ecg, (ii) ecg with changes compared tobaseline or (iii) ecg with longest QTc after initiation of (hydro)chloroquinetreatment

text (date_dmy)

569 ecg_normal ECG normal? radio

1 Normal

2 Abnormal

570 ecg_hr

Show the field ONLY if:[ecg_normal] = '2'

Heart ratebpm


571 ecg_rhythm


Rhythm checkbox

1 ecg_rhythm___1 Sinus rhythm

2 ecg_rhythm___2 Atrial fibrillation

3 ecg_rhythm___3 Atrial flutter

4 ecg_rhythm___4 Premature ventricularcontraction

5 ecg_rhythm___5 Premature atrial contraction



6 ecg_rhythm___6 Pacemaker rhythm

99 ecg_rhythm___99 Other

572 ecg_rhythm_spec

Show the field ONLY if:[ecg_rhythm(99)] = '1'

Specify Rhythm text

573 ecg_pq


PQ intervalms


574 ecg_qrs


QRS duration text (number, Min: 40, Max: 260)

575 ecg_axis


Heart axisDegree

text (number)

576 ecg_arrhyth_bbb_def

Show the field ONLY if:[ecg_qrs] >= 120

Definitions of bundle branch block Left bundle branch block:QRS duration of 120ms or longer with: Delayed onset ofintrinsicoid deflection in 1, V5 and V6 >60 ms. Broad andnotched or slurred R waves in I, aVL, V5, and V6. rS or QScomplexes in right precordial leads. ST-segment and T-waves inopposite polarity to the major QRS deflection. Right bundlebranch block: QRS duration of 120ms or longer and: rsR' or rSR'complexes in V1 and V2. Delayed onset of intrinsicoiddeflection in V1 and V2 >50 ms. Broad, slurred S-wave in 1, V5and V6. Secondary ST-T-wave changes. Nonspecificintraventricular conduction delay: QRS duration of 110ms ormore with morphology different from LBBB or RBBB.

descriptive

577 ecg_bbb

Show the field ONLY if:[ecg_qrs] >= 120

Bundle branch block dropdown

1 Left bundle branch block

2 Right bundle branch block

3 Nonspecific intraventricular conduction delay

578 ecg_qt


QT durationms

text (number)

579 ecg_qtc

Show the field ONLY if:[ecg_qt] > 0

Corrected QT time (Bazett formula) calcCalculation: round([ecg_qt]/(sqrt (60 / [ecg_hr])))

580 ecg_abnormal_lvh_def


Definition of pathological Q waves Any Q-wave in leads V2–V3≥ 0.02 s or QS complex in leads V2 and V3 Q-wave ≥ 0.03 s and> 0.1 mV deep or QS complex in leads I, II, aVL, aVF, or V4–V6 inany two leads of a contiguous lead grouping (I, aVL,V6; V4–V6;II, III, and aVF) R-wave ≥ 0.04 s in V1–V2 and R/S ≥ 1 with aconcordant positive T-wave in the absence of a conductiondefect Definition of left ventricular hypertrophy CornellVoltage: RaVL + SV3 >20 mm in women or 28 mm in males.Sokolow-Lyon Voltage: SV1 + RV5 or RV6 >35 mm (does notrequire gender or age adjustment), or R-wave in aVL ≥11mmCornell Product: Cornell voltage times the QRS duration >2,440ms (in women, 6 mm is added to their Cornell voltage).Romhilt-Estes Score: LVH is likely with 4 or more points. LVH ispresent with 5 or more points: Amplitude of R or S wave in limbleads >2.0 mV, or S wave in V1 or V2 >3.0 mV, or R wave inV5 or V6 >3.0 mV: 3 points. ST-segment changes with orwithout digitalis: 1 or 2 points, respectively. LA abnormality: 3points. Left-axis deviation -30° or more: 2 points. QRS duration:>90 ms: 1 point. Intrinsicoid deflection in V5 or V5: 0.05 to0.07s.

descriptive

581 ecg_abnormal


AbnormalitiesCheck LVH if it fulfills any of the criteria listed above

checkbox

0 ecg_abnormal___0 None

1 ecg_abnormal___1 Pathological Qs



! Collapse

2 ecg_abnormal___2 Left ventricular hypertrophy

3 ecg_abnormal___3 ST segments

4 ecg_abnormal___4 T-wave

582 ecg_lvh_crit

Show the field ONLY if:[ecg_abnormal(2)] = '1'

LVH criteria fulfilledDefinitions listed above

checkbox

1 ecg_lvh_crit___1 Cornell

2 ecg_lvh_crit___2 Sokolow-Lyon

3 ecg_lvh_crit___3 Romhilt-Estes

583 ecg_remarks


Other remarks notes

584 capacity_ecg_optional_complete


Complete?

dropdown

0 Incomplete

1 Unverified

2 Complete

Instrument: CAPACITY - Echocardiography (OPTIONAL) (capacity_echocardiography_optional)

585 echo_date Date of examinationdd-mm-yyyy

text (date_dmy)

586 echo_type Type of examination dropdown

1 Transthoracic echocardiography

2 Transoesophageal echocardiography

3 Handheld ultrasound

587 tte_vendor

Show the field ONLY if:[echo_type] = '1' or [echo_type] = '2'

Vendor of echomachine dropdown

1 GE

2 Philips

3 Toshiba

588 echo_height_unit


Section Header: Height & Weight

Height

radio

1 Meters

2 Inches


589 echo_height_meter

Show the field ONLY if:[echo_height_unit] = '1'


text (number, Min: 0.40, Max: 2.50)Custom alignment: RH

590 echo_height_inch

Show the field ONLY if:[echo_height_unit] = '2'

Height (inches)inches

text (number)Custom alignment: RH

591 tte_weight_unit


Weightkilogram

radio

1 Kilogram

2 Pounds

592 echo_weight_kg

Show the field ONLY if:[tte_weight_unit] = '1'

Weight (kilogram)kilogram

text (number)

593 echo_weight_pound

Show the field ONLY if:[tte_weight_unit] = '2'

Weight (pounds)pound

text

594 tte_bsa_kgm

Show the field ONLY if:[echo_height_meter] > 0 and [echo_weight_kg] > 0

Body surface aream2

calcCalculation: round(((([echo_weight_kg])^(0.425)) *(([echo_height_meter]*100)^(0.725)) * 0.007184),2)

595 tte_bsa_inchpoud Body surface area calc



Show the field ONLY if:[echo_height_inch] > 0 and [echo_weight_pound] > 0

m2 Calculation:round(((([echo_weight_pound]*0.45359237)^(0.425))* (([echo_height_inch]*2.54)^(0.725)) * 0.007184),2)

596 tte_analysis

Show the field ONLY if:[echo_type] = '1'

Section Header: Transthoracic echocardiography

Transthoracic echocardiography protocol

checkbox, Required

1 tte_analysis___1 Dimensions

2 tte_analysis___2 Left ventricle: Ejection fraction(REQUIRED)

3 tte_analysis___3 Left ventricle: Strain analysis

4 tte_analysis___4 Left ventricle:Diastolic function

5 tte_analysis___5 Right ventricular function

6 tte_analysis___6 Valve analysis

7 tte_analysis___7 Pericardial effusion

Custom alignment: LV

597 tte_diml_dilate

Show the field ONLY if:[tte_analysis(1)] = '1'

Section Header: Dimensions

Left ventricular dilatationBased on 2D left ventricular end-diastolic diameter (♂ > 58mm; ♀ > 52mm)

radio

0 No

1 Yes

-1 Unknown

598 tte_lvh


Left ventricular hypertrophy (based on 2D images)Male: Septal wall thickness =>12mm or posterior wall thickness >10mm;Female: Septal wall thickness =>11mm or posterior wall thickness >10mm

radio

0 No

1 Yes concentric LVH

2 Yes asymmetrical LVH

-1 Unknown

599 tte_lavi


Left atrial volume indexml/m2; Unknown = NA


600 tte_dim_other


Other abnormal dimensionsNo abnormalities = none; Unknown = NA;

notes

601 tte_lvef


Section Header: Left ventricle: Ejection fraction

Left ventricular ejection fraction:Type of measurement

checkbox

1 tte_lvef___1 3D

2 tte_lvef___2 2D biplane

3 tte_lvef___3 Estimated LVEF

-1 tte_lvef____1 Unknown

602 tte_lvef_3d

Show the field ONLY if:[tte_lvef(1)] = '1'

3D Left ventricular ejection fractionLVEF in %

text (number)

603 tte_lvef_3d_edv


3D Enddiastolic volumemL

text (number)

604 tte_lvef_3d_esv


3D Endsystolic volumemL

text (number)

605 tte_lvef_2d


2D (biplane) Left ventricular ejection fractionLVEF in %

text (number)

606 tte_lvef_2d_edv


2D Enddiastolic volumemL

text (number)

607 tte_lvef_2d_esv


2D Endsystolic volumemL

text (number)



[tte_lvef(2)] = '1'

608 tte_lvef_est


Estimated left ventricular ejection fractionLVEF in %

dropdown

1 Hyperdynamic (>70%)

2 Normal function (>53%)

3 Mild dysfunction (40-53%)

4 Moderate dysfunction (30-39%)

5 Severe dysfunction (< 30%)

609 tte_lvef_location

Show the field ONLY if:[tte_lvef_est] = '3' or [tte_lvef_est] = '4' or [tte_lvef_est] = '5' or ([tte_lvef_3d] < 53 and [tte_lvef_3d] > 0) or ([tte_lvef_2d] <53 and [tte_lvef_2d] > 0)

Localization of myocardial dysfunction radio

1 Global dysfunction

2 Regional dysfunction

610 tte_lvef_wms_figure

Show the field ONLY if:[tte_lvef_location] = '2'

descriptive

611 tte_lvef_wms

Show the field ONLY if:[tte_lvef_location] = '2'

Localization of wall abnormalities checkbox

1 tte_lvef_wms___1 1

















612 tte_2ds_gls


Section Header: Strain analysis

Global longitudinal strain (average)%; Not available = NA

text

613 tte_2ds_plax


3-chamber longitudinal strain (average)%; Not available = NA

text

614 tte_2ds_4ch



text

615 tte_2ds_2ch



text

616 tte_2ds_comments


Strain analysis: Comments on measurements (quality,abnormalities)

notes

617 tte_dia_emax Section Header: Diastolic function text




Mitral inflow: E maximal velocitycm/s; Unknown = NA;

618 tte_dia_amax


Mitral inflow: A maximal velocitycm/s; Unknown = NA;

text

619 tte_dia_earatio


Mitral inflow: E/A Ratio calcCalculation: round([tte_dia_emax] / [tte_dia_amax], 2)

620 tte_dia_dt


Mitral deceleration time (ms)ms; Unknown = NA

text

621 tte_dia_septale


TDI: Septal peak E' velocitycm/s; Unknown = NA;

text

622 tte_dia_laterale


TDI: Lateral peak E' velocitycm/s; Unknown = NA;

text

623 tte_dia_eeacc


E/E' calcCalculation: round([tte_dia_emax]/(([tte_dia_laterale]+[tte_dia_septale])/2),1)

624 tte_dia_trmax


Tricuspid regurgitation maximal velocitycm/s; No tricuspid regurgitation = none; Unknown = NA;

text

625 tte_rv_peaks


Section Header: Right ventricular function

TDI: RV peak systolic velocity of right ventricle tricuspid annuluscm/s; Unknown = NA;

text

626 tte_rv_tapse


Tricuspid annular plane systolic excursion (TAPSE)mm; unknown = NA

text

627 tte_valve_def


Section Header: Valves

Valvular heart diseaseSelect the specific valve if the stenosis orregurgitation is classified as ≥ moderate. Mild valvular diseaseshould not be recorded. Classification according to:Baumgartner H, Hung J, Bermejo J, Chambers JB, Evangelista A,Griffin BP, Lung B, Otto CM, Pellikka PA, Quiñones M.Echocardiographic assessment of valve stenosis: EAE/ASErecommendations for clinical practice. J Am SocEchocardiogr 2009;22:1–23. Lancellotti P, Tribouilloy C,Hagendorff A, Moura L, Popescu BA, Agricola E, Monin J-L,Pierard LA, Badano L, Zamorano JL, Sicari R, Vahanian A,Roelandt JRTC. European association of echocardiographyrecommendations for the assessment of valvular regurgitation.Part 1: Aortic and pulmonary regurgitation (native valvedisease). Eur J Echocardiogr 2010;11:223–244. Lancellotti P,Moura L, Pierard LA, Agricola E, Popescu BA, Tribouilloy C,Hagendorff A, Monin JL, Badano L, Zamorano JL, Sicari R,Vahanian A, Roelandt JRTC. European association ofechocardiography recommendations for the assessment ofvalvular regurgitation. Part 2: Mitral and tricuspid regurgitation(native valve disease). Eur J Echocardiogr 2010;11:307–332. Zoghbi WA, Enriquez-Sarano M, Foster E, Grayburn PA, KraftCD, Levine RA, Nihoyannopoulos P, Otto CM, Quinones MA,Rakowski H, Stewart WJ, Waggoner A, Weissman NJ.Recommendations for Evaluation of the Severity ofNative Valvular Regurgitation with Two-dimensional andDoppler Echocardiography. J Am SocEchocardiogr 2003;16:777-802. Select the specific valve if the stenosis or regurgitation is classified as≥moderate. Mild valvular disease should not be recorded.

descriptive

628 tte_valve_analysis Outcomes of valve analysis radio

1 There were abnormalities




2 No abnormalities

629 tte_valve_abnormal

Show the field ONLY if:[tte_valve_analysis] = '1'

Which valves were abnormal? checkbox

1 tte_valve_abnormal___1 Aortic valve

2 tte_valve_abnormal___2 Mitral valve

3 tte_valve_abnormal___3 Pulmonary valve

4 tte_valve_abnormal___4 Tricuspid valve

630 tte_valve_aortic_s

Show the field ONLY if:[tte_valve_abnormal(1)] = '1'

Aortic valve: stenosis dropdown

0 none

1 sclerosis

2 mild

3 moderate

4 severe

99 Unknown

631 tte_valve_aortic_r


Aortic valve: regurgitation dropdown

0 none

1 minimal

2 mild

3 moderate

4 severe

99 Unknown

632 tte_valve_aortic_veg


Aortic valve: vegetation? dropdown

0 No

1 Yes

633 tte_valve_mitral_s


Mitral valve: stenosis dropdown

0 none

1 sclerosis

2 mild

3 moderate

4 severe

99 Unknown

634 tte_valve_mitral_r


Mitral valve: regurgitation dropdown

0 none

1 minimal

2 mild

3 moderate

4 severe

99 Unknown

635 tte_valve_mitral_veg


Mitral valve: vegetation dropdown

0 No

1 Yes

636 tte_valve_pulm_s


Pulmonary valve: stenosis dropdown

0 none

1 sclerosis

2 mild

3 moderate

4 severe

99 Unknown



637 tte_valve_pulm_r


Pulmonary valve: regurgitation dropdown

0 none

1 minimal

2 mild

3 moderate

4 severe

99 Unknown

638 tte_valve_pulm_veg


Pulmonary valve: vegetation? dropdown

0 No

1 Yes

639 tte_valve_tricus_s


Tricuspid valve: stenosis dropdown

0 none

1 sclerosis

2 mild

3 moderate

4 severe

99 Unknown

640 tte_valve_tricus_r


Tricuspid valve: regurgitation dropdown

0 none

1 minimal

2 mild

3 moderate

4 severe

99 Unknown

641 tte_valve_tricus_veg


Tricuspid valve: vegetation? dropdown

0 No

1 Yes

642 tte_valve_intervention

Show the field ONLY if:[tte_valve_analysis] = '1'

Prior valve intervention text

643 tte_pe


Section Header: Pericardial effusion

Pericardial effusion

radio

0 None

1 Mild (< 10mm)

2 Moderate (10-20mm)

3 Large (>20mm)

4 Cardiac tamponade

-1 Unknown

644 tte_vscan


Section Header: Handheld ultrasound

Handheld ultrasound: Abnormal findings

radio

1 Yes

0 No


645 tte_vscan_outcome


Handheld ultrasound: Outcomes notes

646 toe_protocol


Section Header: Transoesophageal echocardiography

Transoesophageal echocardiography protocol

checkbox

1 toe_protocol___1 Left ventricular function

2 toe_protocol___2 Right ventricular function

3 toe_protocol___3 Valve analysis




647 toe_lvef_est

Show the field ONLY if:[toe_protocol(1)] = '1'

Estimated left ventricular ejection fractionLVEF in %

dropdown

1 Hyperdynamic (>70%)

2 Normal function (>53%)

3 Mild dysfunction (40-53%)

4 Moderate dysfunction (30-39%)

5 Severe dysfunction (< 30%)

648 toe_lvef_location

Show the field ONLY if:[toe_lvef_est] = '3' or [toe_lvef_est] = '4' or [toe_lvef_est] = '5'

Localization of myocardial dysfunction radio

1 Global dysfunction

2 Regional dysfunction

649 toe_lvef_wms_figure

Show the field ONLY if:[toe_lvef_location] = '2'

descriptive

650 toe_lvef_wms

Show the field ONLY if:[toe_lvef_location] = '2'


1 toe_lvef_wms___1 1

















651 toe_rvef_est


Estimated right ventricular ejection fractionLVEF in %

dropdown

1 Hyperdynamic

2 Normal function

3 Mild dysfunction

4 Moderate dysfunction

5 Severe dysfunction

652 toe_valve_analysis


Outcomes of valve analysis radio

1 There were abnormalities

2 No abnormalities

653 toe_valve_abnormal

Show the field ONLY if:[toe_valve_analysis] = '1'

Which valves were abnormal? checkbox

1 toe_valve_abnormal___1 Aortic valve

2 toe_valve_abnormal___2 Mitral valve

3 toe_valve_abnormal___3 Pulmonary valve

4 toe_valve_abnormal___4 Tricuspid valve

654 toe_valve_aortic_s Aortic valve: stenosis dropdown



Show the field ONLY if:[toe_valve_abnormal(1)] = '1'

0 none

1 sclerosis

2 mild

3 moderate

4 severe

99 Unknown

655 toe_valve_aortic_r


Aortic valve: regurgitation dropdown

0 none

1 minimal

2 mild

3 moderate

4 severe

99 Unknown

656 toe_valve_aortic_veg


Aortic valve: vegetation radio

0 No

1 Yes

657 toe_valve_mitral_r


Mitral valve: regurgitation dropdown

0 none

1 minimal

2 mild

3 moderate

4 severe

99 Unknown

658 toe_valve_mitral_s


Mitral valve: stenosis dropdown

0 none

1 sclerosis

2 mild

3 moderate

4 severe

99 Unknown

659 toe_valve_mitral_veg


Mitral valve: vegetation? radio

0 No

1 Yes

660 toe_valve_pulm_r


Pulmonary valve: regurgitation dropdown

0 none

1 minimal

2 mild

3 moderate

4 severe

99 Unknown

661 toe_valve_pulm_s


Pulmonary valve: stenosis dropdown

0 none

1 sclerosis

2 mild

3 moderate

4 severe

99 Unknown

662 toe_valve_pulm_veg Pulmonary valve: vegetation? radio



! Collapse


0 No

1 Yes

663 toe_valve_tricus_r


Tricuspid valve: regurgitation dropdown

0 none

1 minimal

2 mild

3 moderate

4 severe

99 Unknown

664 toe_valve_tricus_s


Tricuspid valve: stenosis dropdown

0 none

1 sclerosis

2 mild

3 moderate

4 severe

99 Unknown

665 toe_valve_tricus_veg


Tricuspid valve: vegetation? radio

0 No

1 Yes

666 capacity_echocardiography_optional_complete


Complete?

dropdown

0 Incomplete

1 Unverified

2 Complete

Instrument: CAPACITY - Cardiac MRI (OPTIONAL) (capacity_cardiac_mri_optional)

667 cmr_date Date of cardiac MRIdd-mm-yyyy

text (date_dmy)

668 cmr_images Images availableAlso select no if only written report is available (e.g. from another center)

radio

1 Yes

0 No


669 cmr_height_unit Section Header: Height & Weight

Height

radio

1 Meters

2 Inch


670 cmr_height_meter

Show the field ONLY if:[cmr_height_unit] = '1'


text (number, Min: 0.40, Max: 2.40)

671 cmr_height_inch

Show the field ONLY if:[cmr_height_unit] = '2'

Height (inch)inches

text (number)

672 cmr_weight_unit Weight radio

1 kilogram

2 pound

673 cmr_weight_kg

Show the field ONLY if:[cmr_weight_unit] = '1'

Weight (kilogram)kg

text (number)

674 cmr_weight_pound Weight (pound)lb

text (number)



675 cmr_bsa_kgm

Show the field ONLY if:[cmr_height_meter] > 0 and [cmr_weight_kg] > 0

Body surface aream^2

calcCalculation: round(((([cmr_weight_kg])^(0.425)) *(([cmr_height_meter]*100)^(0.725)) * 0.007184),2)

676 cmr_bsa_inchpound

Show the field ONLY if:[cmr_height_inch] > 0 and [cmr_weight_pound] > 0

Body surface aream^2

calcCalculation:round(((([cmr_weight_pound]*0.45359237)^(0.425)) *(([cmr_height_inch]*2.54)^(0.725)) * 0.007184),2)

677 cmr_report ReportYou can copy-paste the report. Make sure the text is anonymized.

notes

678 cmr_tesla Strength of the magnetic field (Tesla)Unknown = NA

text (number)

679 cmr_protocol CMR protocol checkbox, Required

1 cmr_protocol___1 Left ventricular function(REQUIRED)

2 cmr_protocol___2 Right ventricular function

3 cmr_protocol___3 Late gadoliniumenhancement

4 cmr_protocol___4 Stress CMR

5 cmr_protocol___5 T1 mapping

6 cmr_protocol___6 T2 mapping

680 cmr_left_lvef

Show the field ONLY if:[cmr_protocol(1)] = '1'

Section Header: Left ventricular function

Left ventricle: Ejection fraction%

text (number)

681 cmr_left_edv


Left ventricle: Enddiastolic volumemL

text (number)

682 cmr_left_esv


Left ventricle: Endsystolic volumemL

text (number)

683 cmr_left_sv


Left ventricle: Stroke volumemL

calcCalculation: round( [cmr_left_edv]-[cmr_left_esv])

684 cmr_right_lvef


Section Header: Right ventricular function

Right ventricle: Ejection fraction%

text (number)

685 cmr_right_edv


Right ventricle: Enddiastolic volumemL

text (number)

686 cmr_right_esv


Right ventricle: Endsystolic volumemL

text (number)

687 cmr_right_sv


Right ventricle: Stroke volumemL

calcCalculation: round( [cmr_right_edv]-[cmr_right_esv])

688 cmr_lge_figure


Section Header: Additional investigations

Layer of late gadolinium enhancementHyperenhancementpatters that one may encounter in clinical practice.Adaptedfrom: Mahrholdt et al. (2005); doi: 10.1093/eurheartj/ehi258

descriptive

689 cmr_de_layer


Layer of late gadolinium enhancement checkbox

0 cmr_de_layer___0 None

1 cmr_de_layer___1 Subendocardial

2 cmr_de_layer___2 Transmural

3 cmr_de_layer___3 Midmyocardial



4 cmr_de_layer___4 Subepicardial

5 cmr_de_layer___5 Global endocardial

690 cmr_lge_loc_figure

Show the field ONLY if:[cmr_de_layer(1)] = '1' or [cmr_de_layer(2)] = '1' or [cmr_de_layer(3)] = '1' or [cmr_de_layer(4)] = '1'

Localization of late gadolinium enhancement descriptive

691 cmr_lge_localization

Show the field ONLY if:[cmr_de_layer(1)] = '1' or [cmr_de_layer(2)] = '1' or [cmr_de_layer(3)] = '1' or [cmr_de_layer(4)] = '1'


1 cmr_lge_localization___1 1

















692 cmr_stress


Stress CMR: Signs of ischemia? radio

0 No

1 Yes

99 Unknown

693 cmr_t1_native


T1-mapping: Native T1 (Overall) text (number)

694 cmr_t1_ht


Hematocrite on day of examination%; Not available = NA

text (number)

695 cmr_t1_ecv


T1-mapping: Extracellular volume%; Not available = NA

text (number)

696 cmr_t1_remarks


T1-mapping: Remarks text

697 cmr_t2_time


T2-mapping: T2 time (overall)ms

text

698 cmr_other_cardiac Section Header: Other findings

Cardiac findings

notes

699 cmr_other_extracardiac Extracardiac findings notes

700 capacity_cardiac_mri_optional_complete


Complete?

dropdown

0 Incomplete

1 Unverified



! Collapse

2 Complete

Instrument: CAPACITY - CT (thorax/coronaries/PET/lung angiography) (OPTIONAL)(capacity_ct_thoraxcoronariespetlung_angiography_op)

701 ct_protocol CT protocol checkbox

1 ct_protocol___1 Thorax

2 ct_protocol___2 Coronary

3 ct_protocol___3 PET-CT

4 ct_protocol___4 Pulmonary angiography

702 ct_thorax_date

Show the field ONLY if:[ct_protocol(1)] = '1'

Section Header: CT-thorax

Date of CT-thoraxdd-mm-yyyy

text (date_dmy)

703 ct_thorax_report


CT-thorax: Copy of original report notes

704 ct_thorax_lunglesion


CT-thorax: Lesion(s) in lung(s) described? radio

1 Yes

0 No

-1 Unknown

705 ct_thorax_covid19


CT suspected for COVID-19 radio

1 Yes

0 No

-1 Unknown

706 ct_thorax_location

Show the field ONLY if:[ct_thorax_lunglesion] = '1'

Lung lesion(s): Location radio

1 Unilateral

2 Bilateral

-1 Unknown

707 ct_thorax_distribution


Lung lesion(s): Distribution radio

1 Central

2 Peripheral

3 Both

-1 Unknown

708 ct_thorax_nrlesion


Lesions involved radio

1 Single lesion

2 Multiple lesions

3 Diffuse

709 ct_thorax_lesion_feature


Main features radio

1 Ground glass opacity

2 Consolidation

3 Linear opacity

4 Mixed type

-1 Unknown

710 ct_thorax_otherfeatures


Other features described in report checkbox

1 ct_thorax_otherfeatures___1 Interstitialchanges

2 ct_thorax_otherfeatures___2 (broncho)vascularthickening

3 ct_thorax_otherfeatures___3 nodules

4 ct_thorax_otherfeatures___4 pleural effusion

5 ct_thorax_otherfeatures___5 pleural thickening



6 ct_thorax_otherfeatures___6 fibrosis

7 ct_thorax_otherfeatures___7 calcifications

8 ct_thorax_otherfeatures___8 lymphadenopathy

99 ct_thorax_otherfeatures___99 other

711 ct_thorax_features_spec

Show the field ONLY if:[ct_thorax_otherfeatures(99)] = '1'

Describe other features text

712 ct_thorax_heart


Cardiac abnormalities described? radio

1 Yes

2 No

-1 Unknown

713 ct_thorax_heart_abn

Show the field ONLY if:[ct_thorax_heart] = '1'

Cardiac abnormalities radio

1 Pericardial effusion

2 Thickening pericardium

99 Other

714 ct_thorax_heart_abn_spec

Show the field ONLY if:[ct_thorax_heart_abn] = '99'

Specify cardiac abnormalities text

715 ct_coro_date


Section Header: Coronary CT

Date of coronary CTdd-mm-yyyy

text (date_dmy)

716 ct_coro_contrast


Contrast used? radio

1 Yes

2 No

717 ct_coro_report


Coronary CT: Copy of original report notes

718 ct_coro_agatston


Calcium score (Agatston)1-10 is minimal; 11-100 is mild; 101-400 is moderate; >400 is severe

text (number)

719 ct_coro_cad


Coronary artery disease radio

0 None

1 Non-significant coronary artery lesions

2 Significant coronary artery lesions

-1 Unknown

720 petct_date


Section Header: PET-CT

Date of PET-CTdd-mm-yyyy

text (date_dmy)

721 petct_report


PET-CT: Copy of original report notes

722 petct_suppression


Adequate glucose metabolism suppression radio

1 Yes

0 No

-1 Unknown

723 petct_heart


PET-CT: Pathophysiological uptake in the heart radio

1 Yes

0 No

-1 Unknown



! Collapse

724 petct_heart_abn

Show the field ONLY if:[petct_heart] = '1'

Pathophysiological uptake in the heart: Suspected for radio

1 Sarcoid

2 Myocarditis

99 Other

725 petct_heart_abn_spec

Show the field ONLY if:[petct_heart_abn] = '99'

Specify pathophysiological uptake in the heart (suspected for): text

726 petct_lungs


PET-CT: Pathophysiological uptake in the lungs radio

1 Yes

0 No

-1 Unknown

727 petct_lungs_abn

Show the field ONLY if:[petct_lungs] = '1'

Pathophysiological uptake in the lungs: Suspected for radio

1 Sarcoid

2 Pneumonia

99 Other

728 petct_lungs_abn_spec

Show the field ONLY if:[petct_lungs_abn] = '99'

Specify pathophysiological uptake in the lungs (suspected for): text

729 petct_uptake


Pathophysiological uptake in other regions radio

0 No

1 Yes

-1 Unknown

730 petct_uptake_oth

Show the field ONLY if:[petct_uptake] = '1'

Pathophysiological uptake in other regions checkbox

1 petct_uptake_oth___1 Head-neck

2 petct_uptake_oth___2 Abdomen

3 petct_uptake_oth___3 Skeleton

99 petct_uptake_oth___99 Other

731 petct_uptake_oth_spec

Show the field ONLY if:[petct_uptake_oth(99)] = '1'

Specify region of pathophysiological uptake text

732 ct_pulm_date


Section Header: CT pulmonary angiography

Date of CT pulmonary angiographydd-mm-yyyy

text (date_dmy)

733 ct_pulm_report


CT pulmonary angiography: Copy of original report notes

734 ct_pulm_pe


Pulmonary embolism(s)? radio

1 Yes

0 No

-1 Unknown

735 ct_pulm_pe_loc

Show the field ONLY if:[ct_pulm_pe] = '1'

Location of pulmonary embolism(s) radio

1 Central

2 Peripheral

-1 Unknown

736 capacity_ct_thoraxcoronariespetlung_angiography_op_complete


Complete?

dropdown

0 Incomplete

1 Unverified

2 Complete

Instrument: CAPACITY - Invasive Cardiac Procedures (OPTIONAL) (capacity_invasive_cardiac_procedures_optional)



737 invasive_cag Section Header: Coronary angiography

Coronary angiography

radio

1 Yes

0 No


738 invasive_cag_date

Show the field ONLY if:[invasive_cag] = '1'

Date of coronary angiographydd-mm-yyyy

text (date_dmy)Custom alignment: RH

739 invasive_cag_abn

Show the field ONLY if:[invasive_cag] = '1'

Coronary angiography: abnormalitiesSignificant CAD is defined by invasive coronary angiography as >50% stenosisof the left main stem, >70% stenosis in a major coronary vessel, or 30% to 70%stenosis with fractional flow reserve ≤0.8.

checkbox

0 invasive_cag_abn___0 No abnormalities

4 invasive_cag_abn___4 Non-significant coronaryartery disease

1 invasive_cag_abn___1 Significant coronaryartery disease

2 invasive_cag_abn___2 Thrombus

3 invasive_cag_abn___3 Dissection of coronaryartery

740 invasive_cag_segments

Show the field ONLY if:[invasive_cag_abn(1)] = '1' or [invasive_cag_abn(2)] = '1' or [invasive_cag_abn(3)] = '1'

Affected coronary artery segments (please see figure below forcorresponding numbers)

checkbox

1 invasive_cag_segments___1 1















741 invasive_cag_segmfigure


Coronary artery segments descriptive

742 cag_intervention


What treatment was initiated? checkbox

1 cag_intervention___1 Conservative

2 cag_intervention___2 PCI

3 cag_intervention___3 CABG


743 cag_int_pci

Show the field ONLY if:[cag_intervention(2)] = '1'

If PCI was performed, specify which artery or arteries checkbox

1 cag_int_pci___1 LAD

2 cag_int_pci___2 RCA

3 cag_int_pci___3 LCX

4 cag_int_pci___4 LM

744 invasive_biopsy Section Header: Myocardial biopsy

Myocardial biopsy

radio

1 Yes

0 No



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745 invasive_biopsy_date

Show the field ONLY if:[invasive_biopsy] = '1'

Date of myocardial biopsydd-mm-yyyy

text (date_dmy)

746 invasive_biopsy_abn

Show the field ONLY if:[invasive_biopsy] = '1'

Myocardial biopsy: Abnormalities radio

1 Yes

0 No

747 invasive_biopsy_abn_spec

Show the field ONLY if:[invasive_biopsy_abn] = '1'

Myocardial biopsy: Specifiy abnormalities notes

748 invasive_hemodynamic Section Header: Invasive hemodynamic measurements

Invasive hemodynamic measurements

radio

1 Yes

0 No

749 date_inv_hemo

Show the field ONLY if:[invasive_hemodynamic] = '1'

Date of invasive hemodynamic measurementsdd-mm-yyyy

text (date_dmy)

750 invasive_hd_outcome

Show the field ONLY if:[invasive_hemodynamic] = '1'

Invasive hemodynamic measurements: Outcome notes

751 capacity_invasive_cardiac_procedures_optional_complete


Complete?

dropdown

0 Incomplete

1 Unverified

2 Complete

Instrument: CAPACITY - Cardiac COVID-19 complications (REQUIRED) (capacity_cardiac_covid19_complications_required)

752 carcomp Cardiac complications after diagnosis of COVID-19 checkbox

0 carcomp___0 None

1 carcomp___1 Myocarditis

2 carcomp___2 Pericarditis

3 carcomp___3 Endocarditis

4 carcomp___4 Heart failure

5 carcomp___5 Cardiac ischemia

6 carcomp___6 Arrhythmia

7 carcomp___7 Pulmonary embolism

99 carcomp___99 Other

753 carcomp_myocarditis_def

Show the field ONLY if:[carcomp(1)] = '1'

Definition of myocarditis The gold standard for myocarditis isan endomyocardial biopsy. Clinically suspected myocarditis isdiagnosed if patient has an abnormal cardiac magneticresonance scan consistent with a diagnosis of myocarditis AND≥1 of the symptoms presented under clinical presentation AND≥1 diagnostic criteria listed below, in the absence ofangiographically detectable coronary artery disease (coronaryluminal narrowing ≥ 50%) and known pre-existingcardiovascular disease or extra-cardiac causes that couldexplain the syndrome (e.g. valve disease, congenital heartdisease, hyperthyroidism, etc.)Reference: Caforio et al (2013)doi: 10.1093/eurheartj/eht210yyyy-mm-dd;

descriptive

754 carcomp_myocarditis_date_sympt


Myocarditis: date of onset of symptomsdd-mm-yyyy

text (date_dmy)

755 carcomp_myocarditis_date


Myocarditis: date of diagnosisdd-mm-yyyy

text (date_dmy)



[carcomp(1)] = '1'

756 carcomp_pericarditis_def


Definition of pericarditisReference: Adler et al (2015) doi:10.1093/eurheartj/ehv318yyyy-mm-dd;

descriptive

757 carcomp_pericarditis_date_symp


Pericarditis: date of onset of symptomsdd-mm-yyyy

text (date_dmy)

758 carcomp_pericarditis_date


Pericarditis: date of diagnosisdd-mm-yyyy

text (date_dmy)

759 carcomp_endocarditis_def


Endocarditis Infective endocarditis is defined according to themodified Dukes criteria (See attachment). Reference: Habib etal (2015) doi: 10.1093/eurheartj/ehv319yyyy-mm-dd;

descriptive

760 carcomp_endocarditis_date_symp


Endocarditis: date of onset of symptomsdd-mm-yyyy

text (date_dmy)

761 carcomp_endocarditis_date


Endocarditis: date of diagnosisdd-mm-yyyy

text (date_dmy)

762 carcomp_hf


Heart failure checkbox

1 carcomp_hf___1 Left-sided

2 carcomp_hf___2 Right-sided

763 carcomp_hf_date_symp


Heart failure: date of onset of symptomsdd-mm-yyyy

text (date_dmy)

764 carcomp_hf_date


Heart failure: date of diagnosisdd-mm-yyyy

text (date_dmy)

765 carcomp_hf_provocation


Heart failure: provoked by? notes

766 carcomp_ischemia_def


Definitions of cardiac ischemia Acute coronary syndrome (typeI ischaemia): charachterized by artherosclerotic plaque rupture,ulceration, fissure, erosion or dissection with resultingintraluminal thrombus in one or more coronary arteriesleading to a decreased myocardial blood flow and/or distalembolization and subsequent myocardial necrosis. Type IIischaemia: defined as myocardial necrosis in which a conditionother than coronary plaque instability results in an imbalancebetween myocardial oxygen supply and demand.

descriptive

767 carcomp_ischemia


Cardiac ischemia radio

1 Acute coronary syndrome

2 Type II ischemia

768 carcomp_ischemia_date_symp


Cardiac ischemia: date of onset of symptomsdd-mm-yyyy

text (date_dmy)

769 carcomp_ischemia_date


Cardiac ischemia: date of diagnosisdd-mm-yyyy

text (date_dmy)

770 carcomp_arrhythmia


Arrhythmia / Conduction disorder checkbox

1 carcomp_arrhythmia___1 Supraventriculartachycardia



2 carcomp_arrhythmia___2 Ventriculararrhythmias

3 carcomp_arrhythmia___3 Sinus nodedysfunction

4 carcomp_arrhythmia___4 Conductiondisorders

99 carcomp_arrhythmia___99 Other

771 carcomp_arrhythmia_date_symp


Arrhythmia: date of onset of symptomsdd-mm-yyyy

text (date_dmy)

772 carcomp_arrhythmia_date


Arrhythmia: date of diagnosisdd-mm-yyyy

text (date_dmy)

773 carcomp_arrhythmia_svt

Show the field ONLY if:[carcomp_arrhythmia(1)] = '1'

Supraventricular tachycardia checkbox

1 carcomp_arrhythmia_svt___1 Paroxysmalatrial fibrillation

2 carcomp_arrhythmia_svt___2 Persistent atrialfibrillation

3 carcomp_arrhythmia_svt___3 Permanentatrial fibrillation

4 carcomp_arrhythmia_svt___4 Atrial flutter

5 carcomp_arrhythmia_svt___5 Atrialtachycardia

6 carcomp_arrhythmia_svt___6 AV (nodal)reentrytachycardia

7 carcomp_arrhythmia_svt___7 Other

-1 carcomp_arrhythmia_svt____1 Not otherwisespecified

774 carcomp_arrhyth_svt_other

Show the field ONLY if:[carcomp_arrhythmia_svt(7)] = '1'

Define other supraventricular tachycardia text

775 carcomp_arrhyth_svt_def


Definitions of supraventricular tachycardias Atrial fibrillation: Acardiac arrhythmia arising from the atrium with an atrial rate>300 bpm and an irregularly irregular ventricular response inthe presence of conduction. * Paroxysmal: Self-terminating, inmost cases within 48 hours. Some AF paroxysms may continuefor up to 7 days. AF episodes that are cardioverted within 7days should be considered paroxysmal.* Persistent: AF thatlasts longer than 7 days, including episodes that areterminated by cardioversion, either with drugs or by directcurrent cardioversion, after 7 days or more.* Permanent: AFthat is accepted by the patient (and physician). Hence, rhythmcontrol interventions are, by definitions, not pursued inpatients with permanent AF. Atrial flutter: a reentranttachycardia following a counterclockwise (typical) or clockwise(reverse typical) rotation pattern around the tricuspid annulusresulting in a sawtooth pattern of atrial activation on inferiorECG leads. Atrial tachycardia: A usually regular cardiacarrhythmia arising from the atrium with a rate >100 bpm (cyclelength < 600 ms). AV nodal reentry tachycardia: A regular SVTwhich results from reentry within the AV node and/orperinodal atrial tissue AV reentry tachycardia: A reentrantarrhythmia whose circuit involves the atrium, the AV node, theventricles, and one or more accessory AV connections

descriptive

776 carcomp_arrhythmia_vt


Ventricular arrhythmia checkbox

1 carcomp_arrhythmia_vt___1 Non-sustainedventriculartachycardia



2 carcomp_arrhythmia_vt___2 Sustainedventriculartachycardia

3 carcomp_arrhythmia_vt___3 Ventricularfibrillation

777 carcomp_arrhythmia_vt_def


Definitions of ventricular arrhythmias Non-sustainedventricular tachycardia: =>3 consecutive premature ventricularcomplexes with a rate >100/min, lasting < 30 seconds.Sustained ventricular tachycardia: Ventricular tachycardiawhich lasts 30 second or more, or les than 30 seconds whenterminated electrically or pharmacologically Ventricularfibrillation: Rapid, usually more than 300bpm (cycle length:180ms or less), grossly irregular ventricular rhythm withmarked variability in QRS cycle lenght, morphology, andamplitude.

descriptive

778 carcomp_conduct


Conduction disorder checkbox

1 carcomp_conduct___1 First degree AV block

2 carcomp_conduct___2 Second degree AVblock

3 carcomp_conduct___3 Third degree AV block

4 carcomp_conduct___4 Left bundle branchblock

5 carcomp_conduct___5 Right bundle branchblock

6 carcomp_conduct___6 Nonspecificintraventricularconduction delay

7 carcomp_conduct___7 Pre-excitation

8 carcomp_conduct___8 Long QT syndrome

-1 carcomp_conduct____1 Not otherwisespecified

779 carhist_arrhyth_cond_def_2


Definitions of conduction disorders First degree AV block: PRinterval >200ms Second degree AV block: i) Mobitz I:progressive PR prolongation and shortening of RR interval untilP-wave is blocked. Pause after blocked P-wave is less thantwice the PP interval. PR following block is shorter than PRimmediately preceding block. ii) Mobitz II: Regualr sinus/atrialrhythm with intermittent non-conducted P-waves. Constand PRinterval in the conducted beat. Third degree AV block:Characterized by independent atrial and ventricular complexeswith atrial rate usually exceeding ventricular rate. Left bundlebranch block: QRS duration of 120ms or longer with: Delayedonset of intrinsicoid deflection in 1, V5 and V6 >60 ms. Broadand notched or slurred R waves in I, aVL, V5, and V6. rS or QScomplexes in right precordial leads. ST-segment and T-waves inopposite polarity to the major QRS deflection. Right bundlebranch block: QRS duration of 120ms or longer and: rsR' or rSR'complexes in V1 and V2. Delayed onset of intrinsicoiddeflection in V1 and V2 >50 ms. Broad, slurred S-wave in 1, V5and V6. Secondary ST-T-wave changes. Nonspecificintraventricular conduction delay: QRS duration of 110ms ormore with morphology different from LBBB or RBBB. Pre-exitation: An ECG pattern characterized by a short PR interval, awidened QRS complex, and a delta wave. A pre-exitationpattern on the ECG is evidence of the presence of ananomalous AV connection, which results in ventricularactivation prior to what would have occurred through thenormal His-Purkinje system. The PR interval is typically >120ms. Long QT syndrome: QTc =>480ms in repeated 12-leadECGs in the absence of secondary causes for QT prolongation.

descriptive

780 carcomp_arrhythmia_other

Show the field ONLY if:[carcomp_arrhythmia(99)] = '

Specify arrhythmia text



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1'

781 pulm_emb_date


Pulmonary embolism: date of onset of symptomsdd-mm-yyyy

text (date_dmy)

782 pulm_emb_date_diag


Pulmonary embolism: date of diagnosisdd-mm-yyyy

text (date_dmy)

783 carcomp_other


Other cardiac complications notes

784 carcomp_other_date_symp


Other cardiac complications: date of onset of symptomsdd-mm-yyyy

text (date_dmy)

785 carcomp_other_date


Other cardiac complications: date of diagnosisdd-mm-yyyy

text (date_dmy)

786 capacity_cardiac_covid19_complications_required_complete


Complete?

dropdown

0 Incomplete

1 Unverified

2 Complete

Instrument: CAPACITY - Cardiac outcome: 7 day follow-up (REQUIRED) (capacity_cardiac_outcome_7_day_followup_required)

787 fu7d_admission Is patient still hospitalized?Count from first day of first COVID-related admission in any hospital

radio

1 Yes

0 No


788 fu7d_cvcompl_cons

Show the field ONLY if:[fu7d_admission] = '1'

Was cardiology consulted within the first 7 days of admission(count days from the first presentation at the first hospital)?

radio

1 Yes

0 No

-1 Unknown


789 fu7d_cvcompl

Show the field ONLY if:[fu7d_cvcompl_cons] = '1'

Did cardiovascular complications occur within the first 7 daysof admission (count days from the first presentation at the firsthospital)?

radio

1 Yes

0 No

-1 Unknown


790 fu7d_cvcomp_note

Show the field ONLY if:[fu7d_cvcompl] = '1'

Please register the cardiovascular complications in the datacollection instrument 'CAPACITY - Cardiovascular COVID-19complications'

descriptive

791 fu7d_cvcompl_death


Did cardiovascular complications cause cardiac death withinthe first 7 days of admission (count days from the firstpresentation at the first hospital)?

radio

1 Yes

0 No

-1 Unknown


792 fu7d_cvcompl_hospadm

Show the field ONLY if:[fu7d_cvcompl] = '1' and [fu7d_cvcompl_death] <> '1'

Are the cardiovascular complications the reason / one of thereasons the patient is still hospitalized?

radio

1 Yes

2 No

-1 Unknown



! Collapse

! Collapse


793 capacity_cardiac_outcome_7_day_followup_required_complete


Complete?

dropdown

0 Incomplete

1 Unverified

2 Complete

Instrument: CAPACITY - Cardiac outcome: 30 day follow-up (REQUIRED) (capacity_cardiac_outcome_30_day_followup_required)

794 fu30d_admission Is patient still hospitalized?Count from first day of first COVID-related admission in any hospital

radio

1 Yes

0 No


795 fu30d_cvcompl_cons

Show the field ONLY if:[fu30d_admission] = '1'

Was cardiology consulted within the first 30 days of admission(count days from the first presentation at the first hospital)?

radio

1 Yes

0 No

-1 Unknown


796 fu30d_cvcompl

Show the field ONLY if:[fu30d_cvcompl_cons] = '1'

Did cardiovascular complications occur within the first 30 daysof admission (count days from the first presentation at the firsthospital)?

radio

1 Yes

0 No

-1 Unknown


797 fu30d_cvcomp_note


Please register the cardiovascular complications in the datacollection instrument 'CAPACITY - Cardiovascular COVID-19complications'

descriptive

798 fu30d_cvcompl_death


Did cardiovascular complications cause cardiac death withinthe first 30 days of admission (count days from the firstpresentation at the first hospital)?

radio

1 Yes

0 No

-1 Unknown


799 fu30d_cvcompl_hospadm

Show the field ONLY if:[fu30d_cvcompl] = '1' and [fu30d_cvcompl_death] <> '1'

Are the cardiovascular complications the reason / one of thereasons the patient is still hospitalized?

radio

1 Yes

2 No

-1 Unknown


800 capacity_cardiac_outcome_30_day_followup_required_complete


Complete?

dropdown

0 Incomplete

1 Unverified

2 Complete

Instrument: CAPACITY - Discharge (REQUIRED) (capacity_discharge_required)

801 capdis_outcome Outcome dropdown, Required

1 Discharged alive

3 Transfer to other facility

4 Death

5 Palliative discharge

6 Unknown



802 capdis_date Is the outcome date known radio, Required

1 Yes

2 No

803 capdis_outcomedate

Show the field ONLY if:[capdis_date] = '1'

Outcome datedd-mm-yyyy; if discharge: in case of readmissions, use date of last discharge


804 capdis_death

Show the field ONLY if:[capdis_outcome] = '4'

Cause of death dropdown

1 Cardiac

2 Other

99 Unknown

805 capdis_death_obduct


Is or will autopsy be performed? radio

1 Yes

0 No

806 capdis_obduction_outcome

Show the field ONLY if:[capdis_death_obduct] = '1'

Outcomes of autopsy notes

807 capdis_transsitename


If Transferred: Facility name dropdown, Required





















9 Erasmus MC

42 Flevoziekenhuis



















13 Maastricht UMC+




74 MC Slotervaart

73 MC Zuiderzee




55 Nij Smellinghe




10 Radboudumc



58 Rivas Zorggroep







900 Spijkenisse MC






30 Tergooi

23 Treant Zorggroep

1 UMC Groningen

7 UMC Utrecht

201 UZ Antwerpen








29 Zuyderland MC



-1 Other

808 capdis_transsitestudy


If Transferred: Is the transfer facility a study site? dropdown

1 Yes

2 No

3 N/A

809 capdis_transsitepatientnr

Show the field ONLY if:[capdis_transsitestudy] = '1'

If a Study Site: Participant number at new facility dropdown

1 Same as the above

2 Different

810 transfer_subjid_v2

Show the field ONLY if:[capdis_transsitestudy] = '2'

If Different, Participant number at the new facility text, Required

811 capdis_selfcare

Show the field ONLY if:[capdis_outcome] = '1' or [capdis_outcome] = '3' or [capdis_outcome] = '5'

Ability to self-care at discharge versus before illness dropdown, Required

1 Same as before illness

2 Worse

3 Better

4 N/A

812 capdis_department At any time during hospitalization, was patient admitted to oneof the following departments?

checkbox

1 capdis_department___1 Intensive care ormedium care (ICU,MCU)

2 capdis_department___2 Cardiac care unit (CCU)

3 capdis_department___3 General ward

813 capdis_department_icu

Show the field ONLY if:[capdis_department(1)] = '1'

Duration of ICU or MCU admission (days)days

text (number)

814 capdis_department_ccu


Duration of CCU admission (days)days

text (number)

815 capdis_chloroquine At any time during hospitalization, was patient treated with(hydro)chloroquine

radio

0 No

1 Yes

-1 Unknown

816 capdis_chloroquine_inid

Show the field ONLY if:[capdis_chloroquine] = '1'

Date inititiation (hydro)chloroquine treatment text (date_dmy)

817 capdis_chloroquine_end

Show the field ONLY if:[capdis_chloroquine] = '1'

Was (hydro)chloroquine treatment ended/terminated duringadmission?

radio

0 No

1 Yes

-1 Unknown

818 capdis_chloroquine_endd

Show the field ONLY if:[capdis_chloroquine_end] = '1'

Date end/termination (hydro)chloroquine treatment text (date_dmy)

819 capdis_treat_mechvent


Section Header: At any time during hospitalization, did the patient receive /undergo

Invasive ventilation

radio (Matrix)

1 Yes

2 No

NA Unknown

820 capdis_treat_niv


Non-invasive ventilation radio (Matrix)

1 Yes



[capdis_department(1)] = '1' or [capdis_department(2)] = '1'

2 No

NA Unknown

821 capdis_treat_ecmo


Extracorporeal membrane oxygenation (ECMO) radio (Matrix)

1 Yes

2 No

NA Unknown

822 capdis_treat_iabp


Intra-aortic balloon pump (IABP) / Impella radio (Matrix)

1 Yes

2 No

NA Unknown

823 capdis_treat_inotrop

Show the field ONLY if:[capdis_department(1)] = '1' or [capdis_department(2)] = '1'

Vasopressor or inotropic support radio (Matrix)

1 Yes

2 No

NA Unknown

824 capdis_treat_pde5

Show the field ONLY if:[capdis_department(1)] = '1' or [capdis_department(2)] = '1'

Phosphodiesterase inhibitor (e.g. milrinon, enoximon) radio (Matrix)

1 Yes

2 No

NA Unknown

825 capdis_post_oxygen

Show the field ONLY if:[capdis_outcome] = '1' or [capdis_outcome] = '3'

Section Header: Post discharge treatment:

Oxygen therapy


1 YES

2 NO

3 N/A

826 capdis_post_dialysis


Dialysis / renal treatment? radio (Matrix), Required

1 YES

2 NO

3 N/A

827 capdis_post_other


Other intervention or procedure? radio (Matrix), Required

1 YES

2 NO

3 N/A

828 other_cmtrt_v2

Show the field ONLY if:[capdis_post_other]='1'

If YES: Specify (multiple permitted) text, Required

829 capdis_ai_echo Section Header: Have the following cardiac investigations been performedduring hospital admission?

Echocardiography (excluding handheld ultrasound)


1 Yes

2 No

830 capdis_ai_cmr Cardiac MRI radio (Matrix), Required

1 Yes

2 No

831 capdis_ai_cag Coronary angiography radio (Matrix), Required

1 Yes

2 No

832 capdis_ai_biopsy Cardiac biopsy radio (Matrix), Required

1 Yes

2 No

833 capdis_ai_coronaryct Coronary CT radio (Matrix), Required

1 Yes

2 No



834 capdis_ai_ctthorax CT Thorax radio (Matrix), Required

1 Yes

2 No

835 capdis_ai_petct PET-CT radio (Matrix), Required

1 Yes

2 No

836 capdis_ai_spect SPECT radio (Matrix), Required

1 Yes

2 No

837 capdis_ai_trop Troponin radio (Matrix), Required

1 Yes

2 No

838 capdis_ai_bnp (NT-pro)BNP radio (Matrix), Required

1 Yes

2 No

839 capdis_ai_ckmb CK-MB radio (Matrix), Required

1 Yes

2 No

840 capdis_compl_ards Section Header: Did the following complication(s) occur during admission?

Acute respiratory distress syndrome (ARDS)

radio (Matrix)

1 Yes

0 No

841 capdis_compl_aki Acute Kidney Injury (AKI) radio (Matrix)

1 Yes

0 No

842 capdis_compl_shock Shock radio (Matrix)

1 Yes

0 No

843 capdis_covid_test Section Header: COVID-19 infection status

Was SARS-CoV-2 infection proven preceding/during admission?

radio, Required

1 Yes

0 No

844 capdis_covid_swap

Show the field ONLY if:[capdis_covid_test] = '1'

Positive swab radio

1 Yes

0 No


845 capdis_covid_swap_date


Swab datedd-mm-yyyy

text (date_dmy)

846 capdis_covid_ct


Positive CT Thorax radio

1 Yes

0 No


847 capdis_covid_ct_date

Show the field ONLY if:[capdis_covid_ct] = '1'

Date positive CT Thoraxdd-mm-yyyy

text (date_dmy)Custom alignment: RH

848 capacity_discharge_required_complete


Complete?

dropdown

0 Incomplete

1 Unverified



! Collapse

2 Complete

Instrument: ISARIC - Treatment (OPTIONAL) (isaric_treatment_optional)

849 icu_hoterm 6.1 ICU or High Dependency admission dropdown, Required

1 Yes

2 No

3 N/A

850 icu_hostdat

Show the field ONLY if:[icu_hoterm] = '1'

Date of ICU admissiondd-mm-yyyy


851 hoendat


Date of ICU discharge:dd-mm-yyyy


852 hodur


If YES, total duration (days) text (integer), Required

853 oxygen_cmoccur Section Header: At ANY time during hospitalisation, did the patientreceive/undergo

6.2. Oxygen therapy


1 YES

2 NO

3 N/A

854 noninvasive_proccur 6.3. Non-invasive ventilation ? (e.g. BIPAP, CPAP) radio (Matrix), Required

1 YES

2 NO

3 N/A

855 invasive_proccur 6.4. Invasive ventilation (any) ? radio (Matrix), Required

1 YES

2 NO

3 N/A

856 pronevent_prtrt 6.4.1. Prone ventilation radio (Matrix), Required

1 YES

2 NO

3 N/A

857 inhalednit_cmtrt 6.4.2. Inhaled Nitric Oxide radio (Matrix), Required

1 YES

2 NO

3 N/A

858 tracheo_prtrt 6.4.3. Tracheostomy inserted radio (Matrix), Required

1 YES

2 NO

3 N/A

859 extracorp_prtrt 6.5. Extracorporeal support radio (Matrix), Required

1 YES

2 NO

3 N/A

860 rrt_prtrt 6.6. Renal replacement therapy (RRT) or dialysis radio (Matrix), Required

1 YES

2 NO

3 N/A

861 inotrop_cmtrt 6.7. Inotropes / vasopressors radio (Matrix), Required



1 YES

2 NO

3 N/A

862 oxygen_prdur

Show the field ONLY if:[oxygen_cmoccur] = '1'

6.2a If yes oxygen therapy, total durationdays

text

863 noninvasive_prdur

Show the field ONLY if:[noninvasive_proccur] = '1'

6.3a If yes non-invasive ventilation, confirm durationdays

text

864 invasive_prdur

Show the field ONLY if:[invasive_proccur] = '1'

6.4a If yes invasive ventilation, confirm durationdays

text

865 extracorp_prdur

Show the field ONLY if:[extracorp_prtrt] = '1'

6.4a If yes extracorporeal support, confirm durationdays

text

866 inotrope_cmstdat

Show the field ONLY if:[inotrop_cmtrt] = '1'

If YES inotropes/vasopressors; First/Start Datedd-mm-yyyy


867 inotrope_cmendat

Show the field ONLY if:[inotrop_cmtrt] = '1'

If YES inotropes/vasopressors; Last/End datedd-mm-yyyy


868 other_cmyn 6.8 OTHER intervention or procedure radio, Required

1 Yes

2 No

3 N/A

869 other_cm

Show the field ONLY if:[other_cmyn] = '1'

IF YES OTHER intervention or procedure; SpecifyWrite 'N/A' for no additional procedure

text, Required

870 antiviral_cmyn Section Header: MEDICATION: While hospitalised or at discharge, were any ofthe following administered?

6.9 Antiviral agent?


1 Yes

2 No

3 N/A

871 antibiotic_cmyn 6.10. Antibiotic ? radio (Matrix), Required

1 Yes

2 No

3 N/A

872 corticost_cmyn 6.11. Corticosteroid ? radio (Matrix), Required

1 Yes

2 No

3 N/A

873 antifung_cmyn 6.12. Antifungal agent ? radio (Matrix), Required

1 Yes

2 No

3 N/A

874 antiviral_cmtrt

Show the field ONLY if:[antiviral_cmyn] = '1'

IF YES to antiviral agent dropdown

1 Ribavirin

2 Lopinavir/Ritonvir

3 Interferon alpha

4 Interferon beta

5 Neuraminidase inhibitors



! Collapse

! Collapse

6 Other

875 antiviral_cmtype

Show the field ONLY if:[antiviral_cmtrt] = '6'

If 'Other' antiviral agent; Specify type text

876 corticost_cmtrt

Show the field ONLY if:[corticost_cmyn] = '1'

If YES to Corticosteroid, specify type text, Required

877 corticost_cmdose


If YES to Corticosteroid, specify dose text, Required

878 corticost_cmroute


If YES to Corticosteroid, specify Route dropdown, Required

1 Oral

2 Intravenous

3 Inhaled

879 isaric_treatment_optional_complete


Complete?

dropdown

0 Incomplete

1 Unverified

2 Complete

Instrument: ISARIC - Core Additional Information (OPTIONAL) (isaric_core_additional_information_optional)

880 core_addinfo Section Header: Detail any additional (relevant) information NOT captured inthe CASE REPORT FORM

Additional Information

notes

881 isaric_core_additional_information_optional_complete


Complete?

dropdown

0 Incomplete

1 Unverified

2 Complete

Instrument: ISARIC - Outcome (OPTIONAL) (isaric_outcome_optional)

882 dsterm 7.1. Outcome: dropdown, Required

1 Discharged alive

2 Hospitalization

3 Transfer to other facility

4 Death

5 Palliative discharge

6 Unknown

883 dsstdtcyn Is the Outcome date known radio, Required

1 Yes

2 No

3 N/A

884 dsstdtc

Show the field ONLY if:[dsstdtcyn] = '1'

7.2. Outcome datedd-mm-yyyy


885 suppds_qval

Show the field ONLY if:[dsterm] = '1'

Section Header: 7.3. IF Discharged alive:

7.3.1. If Discharged alive:Ability to self-care at discharge versus before illness

dropdown, Required

1 Same as before illness

2 Worse

3 Better

4 N/A

886 oxygen_proccur


Section Header: Post discharge treatment:

7.3.2. Oxygen therapy


1 YES



[dsterm] = '1' 2 NO

3 N/A

887 renal_proccur


7.3.3. Dialysis / renal treatment? radio (Matrix), Required

1 YES

2 NO

3 N/A

888 other_cmoccur


7.3.4. Other intervention or procedure? radio (Matrix), Required

1 YES

2 NO

3 N/A

889 other_cmtrt

Show the field ONLY if:[other_cmoccur] = '1'

If YES: Specify (multiple permitted) text, Required

890 siteid


Section Header: 7.4. IF Transferred:

7.4.1. If Transferred: Facility name

dropdown, Required





















9 Erasmus MC

42 Flevoziekenhuis



















13 Maastricht UMC+




74 MC Slotervaart

73 MC Zuiderzee




55 Nij Smellinghe




10 Radboudumc



58 Rivas Zorggroep







900 Spijkenisse MC






30 Tergooi

23 Treant Zorggroep

1 UMC Groningen

7 UMC Utrecht

201 UZ Antwerpen








29 Zuyderland MC

-1 Other

891 siteyn 7.4.2. If Transferred: Is the transfer facility a study site? dropdown, Required



! Collapse


1 Yes

2 No

3 N/A

892 subjidcat

Show the field ONLY if:[siteyn] = '1'

7.4.3. If a Study Site: Participant number at new facility dropdown, Required

1 Same as the above

2 Different

893 transfer_subjid

Show the field ONLY if:[subjidcat] = '2'

If Different, Participant number at the new facility text, Required

894 isaric_outcome_optional_complete


Complete?

dropdown

0 Incomplete

1 Unverified

2 Complete

Instrument: ISARIC - Complications (OPTIONAL) (isaric_complications_optional)

895 viralpneu_ceterm Section Header: 4c. COMPLICATIONS: At any time during hospitalisation didthe patient experience:

4c.1. Viral Pneumoniae/pneumonitis


1 Yes

2 No

3 N/A

896 bactpneu_ceterm 4c.2. Bacterial pneumonia * must provide value radio (Matrix), Required

1 Yes

2 No

3 N/A

897 ards_ceterm 4c.3. Acute Respiratory Distress Syndrome radio (Matrix), Required

1 Yes

2 No

3 N/A

898 ardssev_ceterm

Show the field ONLY if:[ards_ceterm] = '1'

If YES, Acute Respiratory Distress Syndrome? radio, Required

1 Mild

2 Moderate

3 Severe

4 Unknown


899 pneumothorax_ceterm 4c.4. Pneumothorax radio (Matrix), Required

1 YES

2 NO

3 N/A

900 pleuraleff_ceterm 4c.5. Pleural effusion radio (Matrix), Required

1 YES

2 NO

3 N/A

901 cryptogenic_ceterm 4c.6 Cryptogenic organizing pneumonia (COP) radio (Matrix), Required

1 YES

2 NO

3 N/A

902 bronchio_ceterm 4c.7. Bronchiolitis radio (Matrix), Required

1 YES

2 NO



3 N/A

903 meningitis_ceterm 4c.8. Meningitis / Encephalitis radio (Matrix), Required

1 YES

2 NO

3 N/A

904 seizure_ceterm 4c.9. Seizure radio (Matrix), Required

1 YES

2 NO

3 N/A

905 stroke_ceterm 4c.10. Stroke / Cerebrovascular accident radio (Matrix), Required

1 YES

2 NO

3 N/A

906 heartfailure_ceterm 4c.11. Congestive heart failure radio (Matrix), Required

1 YES

2 NO

3 N/A

907 carditis_aeterm 4c.12.Myocarditis / Pericarditis radio (Matrix), Required

1 YES

2 NO

3 N/A

908 arrhythmia_ceterm 4c.13. Cardiac arrhythmia radio (Matrix), Required

1 YES

2 NO

3 N/A

909 ischaemia_ceterm 4c.14. Cardiac ischemia radio (Matrix), Required

1 YES

2 NO

3 N/A

910 cardiacarrest_ceterm 4c.15. Cardiac arrest radio (Matrix), Required

1 YES

2 NO

3 N/A

911 bacteraemia_ceterm 4c.16. Bacteraemia radio (Matrix), Required

1 YES

2 NO

3 N/A

912 coagulo_ceterm 4c.17. Coagulation disorder / Disseminated intravascularcoagulation


1 YES

2 NO

3 N/A

913 aneamia_ceterm 4c.18. Anaemia radio (Matrix), Required

1 YES

2 NO

3 N/A

914 rhabdomyolsis_ceterm 4c.19. Rhabdomyolysis / Myositis radio (Matrix), Required

1 YES

2 NO



3 N/A

915 renalinjury_ceterm 4c.20. Acute renal injury / Acute renal failure radio (Matrix), Required

1 YES

2 NO

3 N/A

916 gastro_ceterm 4c.21. Gastrointestinal hemorrhage radio (Matrix), Required

1 YES

2 NO

3 N/A

917 pancreat_ceterm 4c.22. Pancreatitis radio (Matrix), Required

1 YES

2 NO

3 N/A

918 liverdysfunction_ceterm 4c.23. Liver dysfunction radio (Matrix), Required

1 YES

2 NO

3 N/A

919 hyperglycemia_aeterm 4c.24. Hyperglycaemia radio (Matrix), Required

1 YES

2 NO

3 N/A

920 hypoglycemia_ceterm 4c.25. Hypoglycaemia radio (Matrix), Required

1 YES

2 NO

3 N/A

921 other_ceoccur 4c.26. Other radio (Matrix)

1 YES

2 NO

3 N/A

922 other_ceterm

Show the field ONLY if:[other_ceoccur] = '1'

If "Other"; Specify text (alpha_only), Required

923 isaric_complications_optional_complete


Complete?

dropdown

0 Incomplete

1 Unverified

2 Complete

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