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CRF1A part 3
Mathew Thorpe edited this page Aug 30, 2021
·
1 revision
| Variable / Field Name | Section Header | Field Type | Field Label | Choices or Calculations |
|---|---|---|---|---|
| crf1a3_version | radio | CRF1 Version Completed | 1, Unversioned ; 2, 1.0 ; 3, 1.1 ; 4, 1.2 ; 5, 1.3 ; 6, 1.4 ; 7, 1.5 ; 8, 2.0 | |
| crf1a_o2_supp | Respiratory Support given at any point during COVID-19 admission | radio | a) Supplemental oxygen | 1, Yes ; 0, No ; 2, N/K |
| crf1a_o2_cpapv | radio | b) Continuous Positive Airway Pressure Ventilation | 1, Yes ; 0, No ; 2, N/K | |
| crf1a_o2_blniv | radio | c) Bi-Level Non-Invasive Ventilation | 1, Yes ; 0, No ; 2, N/K | |
| crf1a_o2_hfn | radio | d) High Flow Nasal O2 | 1, Yes ; 0, No ; 2, N/K | |
| crf1a_o2_imv | radio | e) Invasive Mechanical Ventilation | 1, Yes ; 0, No ; 2, N/K | |
| crf1a_o2_ecmo | radio | f) Extra-Corporeal Membrane Oxygenation | 1, Yes ; 0, No ; 2, N/K | |
| crf1a_treat_at | Were any of the following treatments given during hospitalisation? | radio | a) Antibiotic therapy | 1, Yes ; 0, No ; NK, N/K |
| crf1a_treat_ss | radio | b) Systemic (oral or IV) steroids | 1, Yes ; 0, No ; NK, N/K | |
| crf1a_treat_tdac | radio | c) Therapeutic dose anti-coagulation | 1, Yes ; 0, No ; NK, N/K | |
| crf1a_treat_proning | radio | d) Proning | 1, Yes ; 0, No ; NK, N/K | |
| crf1a_treat_rrt | radio | e) Renal replacement therapy | 1, Yes ; 0, No ; NK, N/K | |
| crf1a_treat_tocil | radio | f) Tocilizumab | 1, Yes ; 0, No ; NK, N/K | |
| crf1a_treat_saril | radio | g) Sarilumab | 1, Yes ; 0, No ; NK, N/K | |
| crf1a_treat_remde | radio | h) Remdesivir | 1, Yes ; 0, No ; NK, N/K | |
| crf1a_add_diag_pemt | Were any of these additional diagnoses or complications made during hospitalisation? | radio | a) Pulmonary Embolism/micro thrombi | 1, Yes ; 0, No ; NK, N/K |
| crf1a_add_diag_cvvh | radio | b) Renal failure requiring CVVH or Haemodialysis | 1, Yes ; 0, No ; NK, N/K | |
| crf1a_add_diag_myoc | radio | c) Myocarditis | 1, Yes ; 0, No ; NK, N/K | |
| crf1a_add_diag_cmp | radio | d) Cardiomyopathy | 1, Yes ; 0, No ; NK, N/K | |
| crf1a_add_diag | radio | e) Coronary thrombosis | 1, Yes ; 0, No ; NK, N/K | |
| crf1a_studies | Was the patient enrolled in any COVID Studies during hospitalisation? | checkbox | 13) Was the patient enrolled in any COVID Studies during hospitalisation? | 1, GenOMICC ; 2, RECOVERY ; 22, RECOVERY-RS ; 3, REMAP-CAP ; 4, Synairgen SG016 ; 5, CAN-COVID ; 6, RUXCOVID ; 7, ACCORD-2 ; 8, PACA ; 9, Tocilizumab ; 10, REALIST ; 11, ACTT-EU/UK ; 12, Remdesivir Moderate ; 13, Remdesivir Severe ; 14, COVACTA ; 15, TACTIC-R ; 16, C-19-ACS ; 17, ILIAD-7-UK ; 18, LIBERATE ; 19, ATOMIC2 ; 20, STOP-COVID ; 21, Other |
| crf1a_genomicc_id | text | GenOMICC ID | ||
| crf1a_studies_other | notes | Other COVID IMP studies enrolled | ||
| crf1a_egfr_low | Please provide the following values if measured: | radio | 14.a) Lowest measured eGFR | 1, Enter exact value ; 2, >90 mL/min/1.73m2 ; 3, N/K |
| crf1a_egfr_low_value | text | 14.a) Lowest measured eGFR: Value | ||
| crf1a_egfr_low_date | text | 14.a) Lowest measured eGFR: Date of sample | ||
| crf1a_alt_high | radio | 14.b) Highest measured ALT | 1, Enter exact value ; NK, N/K | |
| crf1a_alt_high_less_great | dropdown | 14.b) Highest measured ALT - Select if test result provided is not an exact value | 1, < (Less than) ; 2, > (Greater than) | |
| crf1a_alt_high_value | text | 14.b) Highest measured ALT: Value | ||
| crf1a_alt_high_date | text | 14.b) Highest measured ALT: Date of sample | ||
| crf1a_bnp_done | radio | 14.c) BNP Measurements i) Was BNP or NT-proBNP measured during admission? |
1, Yes ; 0, No ; NK, N/K | |
| crf1a_bnp_type | radio | 14.c) BNP Measurements ii) What measure was used? |
1, NT-proBNP ; 2, BNP | |
| crf1a_bnp_unit | radio | 14.c) BNP Measurements iii) What units were used? |
1, pg/ml ; 2, other | |
| crf1a_bnp_unit_other | text | 14.c) BNP Measurements Unit |
||
| crf1a_bnp_high_less_great | dropdown | 14.c) BNP Measurements iv) Highest level recorded during admission - Select if test result provided is not an exact value |
1, < (Less than) ; 2, > (Greater than) | |
| crf1a_bnp_high | text | 14.c) BNP Measurements iv) Highest level recorded during admission: Value |
||
| crf1a_bnp_high_date | text | 14.c) BNP Measurements iv) Highest level recorded during admission: Date of sample |
||
| crf1a_bnp_last | radio | 14.c) BNP Measurements v) Level of last measurement prior to discharge |
1, Enter exact value ; 2, Same as highest level | |
| crf1a_bnp_last_less_great | dropdown | 14.c) BNP Measurements v) Level of last measurement prior to discharge - Select if test result provided is not an exact value |
1, < (Less than) ; 2, > (Greater than) | |
| crf1a_bnp_last_value | text | 14.c) BNP Measurements v) Level of last measurement prior to discharge: Value |
||
| crf1a_bnp_last_date | text | 14.c) BNP Measurements v) Level of last measurement prior to discharge: Date of sample |
||
| crf1a_trop_done | radio | 14.d) Troponin Measurements i) Was Troponin measured during admission? |
1, Yes ; 0, No ; NK, N/K | |
| crf1a_trop_type | radio | 14.d) Troponin Measurements ii) What measure of Troponin was used? |
1, cTnI ; 2, cTnT ; 3, hs-cTnI ; 4, hs-cTnT | |
| crf1a_trop_unit | radio | 14.d) Troponin Measurements iii) What units were used? |
1, ng/ml ; 2, other | |
| crf1a_trop_unit_other | text | 14.d) Troponin Measurements Unit |
||
| crf1a_trop_first_less_great | dropdown | 14.d) Troponin Measurements iv) First level recorded during hospital admission - Select if test result provided is not an exact value |
1, < (Less than) ; 2, > (Greater than) | |
| crf1a_trop_first | text | 14.d) Troponin Measurements iv) First level recorded during hospital admission |
||
| crf1a_trop_first_date | text | 14.d) Troponin Measurements iv) First level recorded during hospital admission: Date of sample |
||
| crf1a_trop_high | radio | 14.d) Troponin Measurements v) Highest level recorded during admission |
1, Enter exact value ; 2, Same as first level | |
| crf1a_trop_high_less_great | dropdown | 14.d) Troponin Measurements v) Highest level recorded during admission - Select if test result provided is not an exact value |
1, < (Less than) ; 2, > (Greater than) | |
| crf1a_trop_high_value | text | 14.d) Troponin Measurements v) Highest level recorded during admission: Value |
||
| crf1a_trop_high_date | text | 14.d) Troponin Measurements v) Highest level recorded during admission: Date of sample |
||
| crf1a_haema_not_done | Haematology results panel (at admission) | checkbox | Please tick any test that is NOT DONE | 1, Haemoglobin (Hb) ; 2, White Blood Cell (WBC) count ; 3, Neutrophil count ; 4, Lymphocyte count ; 5, Eosinophil count ; 6, Platelet (PLT) count ; 7, Mean cell volume (MCV) ; 8, INR ; 9, APTT ; 10, D-dimer level ; 11, Fibrinogen level |
| crf1a_haemo_less_great | dropdown | Haemoglobin (Hb) - Select if test result provided is not an exact value | 1, < (Less than) ; 2, > (Greater than) | |
| crf1a_haemoglobin | text | Haemoglobin (Hb) | ||
| crf1a_wbc_less_great | dropdown | White Blood Cell (WBC) Count - Select if test result provided is not an exact value | 1, < (Less than) ; 2, > (Greater than) | |
| crf1a_wbc | text | White Blood Cell (WBC) count | ||
| crf1a_neutro_less_great | dropdown | Neutrophil Count - Select if test result provided is not an exact value | 1, < (Less than) ; 2, > (Greater than) | |
| crf1a_neutrophil_count | text | Neutrophil count | ||
| crf1a_lympho_less_great | dropdown | Lymphocyte Count - Select if test result provided is not an exact value | 1, < (Less than) ; 2, > (Greater than) | |
| crf1a_haema_lymph | text | Lymphocyte count | ||
| crf1a_eos_less_great | dropdown | Eosinophil Count - Select if test result provided is not an exact value | 1, < (Less than) ; 2, > (Greater than) | |
| crf1a_eosinophil_count | text | Eosinophil count | ||
| crf1a_plt_less_great | dropdown | Platelet (PLT) Count - Select if test result provided is not an exact value | 1, < (Less than) ; 2, > (Greater than) | |
| crf1a_platelet_plt_count | text | Platelet (PLT) count | ||
| crf1a_mcv_less_great | dropdown | Mean Cell Volume (MCV) - Select if test result provided is not an exact value | 1, < (Less than) ; 2, > (Greater than) | |
| crf1a_mcv | text | Mean cell volume (MCV) | ||
| crf1a_inr_less_great | dropdown | INR - Select if test result provided is not an exact value | 1, < (Less than) ; 2, > (Greater than) | |
| crf1a_inr | text | INR | ||
| crf1a_aptt_less_great | dropdown | APTT - Select if test result provided is not an exact value | 1, < (Less than) ; 2, > (Greater than) | |
| crf1a_aptt | text | APTT | ||
| crf1a_d_dimer_less_great | dropdown | D-dimer level - Select if test result provided is not an exact value | 1, < (Less than) ; 2, > (Greater than) | |
| crf1a_d_dimer_unit | radio | D-dimer level - Measurement | 1, ug/mL or mg/L ; 2, ng/mL or ug/L | |
| crf1a_d_dimer_assay | radio | D-dimer level - Measurement | 1, FEU ; 2, DDU | |
| crf1a_d_dimer_level | text | D-dimer level | ||
| crf1a_fib_less_great | dropdown | Fibrinogen level - Select if test result provided is not an exact value | 1, < (Less than) ; 2, > (Greater than) | |
| crf1a_fibrinogen | text | Fibrinogen level | ||
| crf1a_biochem_not_done | Biochemistry panel (at admission) | checkbox | Please tick any test that is NOT DONE | 1, Sodium (Na) ; 2, Potassium (K) ; 3, Urea ; 4, Creatinine ; 5, eGFR ; 6, Alanine aminotransferase (ALT) ; 7, Alkaline phosphatase (ALP) ; 8, Total Bilirubin ; 9, CRP ; 10, Ferritin ; 11, Magnesium (mg) ; 12, Serum Cortisol ; 13, Procalcitonin ; 14, Interleukin-6 |
| crf1a_na_less_great | dropdown | Sodium (Na) - Select if test result provided is not an exact value | 1, < (Less than) ; 2, > (Greater than) | |
| crf1a_na | text | Sodium (Na) | ||
| crf1a_k_less_great | dropdown | Potassium (K) - Select if test result provided is not an exact value | 1, < (Less than) ; 2, > (Greater than) | |
| crf1a_k | text | Potassium (K) | ||
| crf1a_urea_less_great | dropdown | Urea - Select if test result provided is not an exact value | 1, < (Less than) ; 2, > (Greater than) | |
| crf1a_urea | text | Urea | ||
| crf1a_creat_less_great | dropdown | Creatinine - Select if test result provided is not an exact value | 1, < (Less than) ; 2, > (Greater than) | |
| crf1a_creatinine | text | Creatinine | ||
| crf1a_biochem_egfr_90 | yesno | Is eGFR value > 90? | 1, Yes ; 0, No | |
| crf1a_egfr_int | text | eGFR | ||
| crf1a_alt_less_great | dropdown | Alanine aminotransferase (ALT) - Select if test result provided is not an exact value | 1, < (Less than) ; 2, > (Greater than) | |
| crf1a_alt | text | Alanine aminotransferase (ALT) | ||
| crf1a_alp_less_great | dropdown | Alkaline phosphatase (ALP) - Select if test result provided is not an exact value | 1, < (Less than) ; 2, > (Greater than) | |
| crf1a_alp | text | Alkaline phosphatase (ALP) | ||
| crf1a_bili_less_great | dropdown | Total Bilirubin - Select if test result provided is not an exact value | 1, < (Less than) ; 2, > (Greater than) | |
| crf1a_bilirubin | text | Total Bilirubin | ||
| crf1a_crp_less_great | dropdown | CRP - Select if test result provided is not an exact value | 1, < (Less than) ; 2, > (Greater than) | |
| crf1a_crp | text | CRP | ||
| crf1a_ferr_less_great | dropdown | Ferritin - Select if test result provided is not an exact value | 1, < (Less than) ; 2, > (Greater than) | |
| crf1a_ferritin | text | Ferritin | ||
| crf1a_mg_less_great | dropdown | Magnesium (mg) - Select if test result provided is not an exact value | 1, < (Less than) ; 2, > (Greater than) | |
| crf1a_mg | text | Magnesium (mg) | ||
| crf1a_ser_cor_less_great | dropdown | Serum Cortisol - Select if test result provided is not an exact value | 1, < (Less than) ; 2, > (Greater than) | |
| crf1a_serum_cortisol | text | Serum Cortisol | ||
| crf1a_procal_less_great | dropdown | Procalcitonin - Select if test result provided is not an exact value | 1, < (Less than) ; 2, > (Greater than) | |
| crf1a_procalcitonin | text | Procalcitonin | ||
| crf1a_inter6_less_great | dropdown | Interleukin-6 - Select if test result provided is not an exact value | 1, < (Less than) ; 2, > (Greater than) | |
| crf1a_interleukin_6 | text | Interleukin-6 | ||
| crf1a_aki_adm | Acute Kidney Injury Stage | radio | AKI Stage at admission | 0, None ; 1, Stage 1 ; 2, Stage 2 ; 3, Stage 3 |
| crf1a_high_aki_adm | radio | Highest AKI Stage during admission | 0, None ; 1, Stage 1 ; 2, Stage 2 ; 3, Stage 3 | |
| crf1a_isaric_enrol_yn | Co-enrolment in other observational studies | yesno | Has the patient been enrolled in the ISARIC-4C study? | 1, Yes ; 0, No |
| crf1a_isaric_id | text | ISARIC-4C ID |
Contents
Case Report Form Definitions
- Forms
- Timepoints
- PHOSP ID
- eConsent Tier 1
- eConsent Tier 2
- Informed Consent Form
- Split Tier Consent
- Eligibility Checklist
- CRF1A Part 1
- CRF1A Part 2
- CRF1A Part 3
- CRF1B
- CRF2A
- CRF2B
- CRF3A
- CRF3B
- CRF3C
- CRF4A
- CRF4B
- CRF Emergency Visit
- Adverse Event Log
- Withdrawals
- CRF Early Termination
- CRF Tier 2 Withdrawal
- Medications Log
- Activity Monitor Log
- Mental Health Assessment
- Nutrition
- Social History
- EQ-5D-5L
- GAD-7
- PHQ-9
- MRC Dyspnoea
- SARC-F
- GPPAQ
- Dyspnoea-12
- FACIT Fatigue
- PCL-5
- BPI
- NEADL
- MoCA
- Rockwood Clinical Frailty
- PSQI
- MEQ
- LCQ
- PFTs
- Walk Tests
- Tier 2 Core Test Checklist
- Tier 2 Research Samples
- Tier 2 Notification - Blood
- Tier 2 Notification - Oral Wash
- Tier 2 Notification - Sputum
- Tier 2 Notification - Urine
- QRISK3
- BIA
- DXA
- Muscle Strength
- SPPB
- Pre-PSQ
- PSQ
- Lab Log - Routine Blood
- Lab Log - Urine
- Lab Log - Immuno
- Lab Log - Additional Tests
- PCR Swab Tests