Cure Sickle Cell Initiative | Cure Sickle Cell

CDE Detailed Report

Disease: Sickle Cell Disease
Sub-Domain: Participant Characteristics
CRF: Hospitalization Form

6 results.

CDE ID	CDE Name	Variable Name	Definition	Short Description	Additional Notes (Question Text)	Permissible Values	Description	Data Type	Disease Specific Instructions	Disease Specific Reference	Population	Classification (e.g., Core)	Version Number	Version Date	CRF Name (CRF Module / Guideline)	Sub Domain Name	Domain Name	Size	Input Restrictions	Min Value	Max Value	Measurement Type	Source	Form Set	Form	Field	Domain	CDASH Variable	CDASH Definition	CDASH Label	Controlled Terminology	Prompt	Essentiality	Question Text	CDASH imp guidance	SDTM IG target	csDSR	PhenX	Data Type	CRF Completion Inst	SDTMIG Target Var	SDTMIG Target Map	Codelist Name	PVs	Pre Pop Value	Query Display	List Style
C17409	Visit date	VisitDate	Date of interview or visit (actually the date when data in the form were captured)	Date of interview or visit	Visit Date (yyyy/mm/dd)			Date or Date & Time			Adult;Pediatric	Supplemental	3.00	2013-06-21 00:00:00.0	Hospitalization Form	Participant Characteristics	General Health History		Free-Form Entry						DeBaun Forms		LB	VISDAT		Visit Date		Visit Date		What [is/was] the date of the visit?		N/A			Char	Record the [date/start date] of the visit using DD-MON-YYYY format.						Prompt
C60137	Event ad hoc identification number text	EventAdHocIDNumTxt	Text field allowing for alphanumeric ad-hoc event identification numbers.	Text field allowing for alphanumeric ad-hoc event identification numbers.	Ad Hoc Event ID			Alphanumeric			Adult;Pediatric	Supplemental	1.00	2021-01-15 14:28:33.0	Hospitalization Form	Participant Characteristics	General Health History	50	Free-Form Entry								HO	HOSPID		HO Sponsor-Defined Identifier		Event ID		What was the event ID?		HOSPID			Char	If collected on the CRF, sponsor may insert instructions to ensure each record has a unique identifier.						Prompt
C60138	Form data correction indicator	FormDataCorrectionInd	Indicator of whether the data collected on the form includes a correction of previously collected data.	Indicator of whether the data collected on the form includes a correction of previously collected data.	Correction	No;Yes	No;Yes	Alphanumeric			Adult;Pediatric	Supplemental	1.00	2021-01-15 14:33:02.0	Hospitalization Form	Participant Characteristics	General Health History		Single Pre-Defined Value Selected								HO	CORRECTED_HOYN		Any Corrections		Any Correction		Were any corrections made?		N/A			Char	Indicate whether any corrections were made to previously collected data.			(NY)	Yes; No		Prompt	Radio
C60139	Hospital admit date	HospitalAdmitDate	Date on which the subject/participant was admitted to a hospital.	Date on which the subject/participant was admitted to a hospital.	Date of Admission (yyyy/mm/dd)			Date or Date & Time			Adult;Pediatric	Supplemental	1.00	2021-01-15 14:35:46.0	Hospitalization Form	Participant Characteristics	General Health History		Free-Form Entry								HO	HOSPITAL_HOSTDAT		Healthcare Encounter Start Date		Admission Date		What was the hospital dmission date?		HOSTDTC			Char	Record the start date of the healthcare encounter (e.g., date of admission) using this format (DD-MON-YYYY).		HOSTDTC where HOTERM = HOSPITAL				Prompt
C60140	Hospital admit reason	HospitalAdmitRsn	Reason(s) for which the subject/participant was admitted to the hospital.	Reason(s) for which the subject/participant was admitted to the hospital.	Reason for admission	Acute chest syndrome;Asthma;Congestive heart failure;Infection;Pain;Renal failure;Stroke;Surgery;Other, specify:;Transient red cell aplasia;Transfusion Reaction;Splenic sequestration;Skin ulcers;Priapism;Gall bladder and liver disease;Eye problems;Chelation therapy;Osteomyelitis or osteonecrosis	Acute chest syndrome;Asthma;Congestive heart failure;Infection;Pain;Renal failure;Stroke;Surgery;Other, specify:;Transient red cell aplasia;Transfusion Reaction;Splenic sequestration;Skin ulcers;Priapism;Gall bladder and liver disease;Eye problems;Chelation therapy;Osteomyelitis or osteonecrosis	Alphanumeric			Adult;Pediatric	Supplemental	1.00	2021-01-15 14:39:54.0	Hospitalization Form	Participant Characteristics	General Health History		Multiple Pre-Defined Values Selected								HO	HOSPITAL_HOREAS		Reason for the Healthcare Encounter		Reason for the Hospital Admission		What was the reason for the hosptial admission?		SUPPHO.QVAL			Char	Provide the reason for the subject's hospital admission.		SUPPHO.QVAL where SUPPHO.QNAM = "HOREAS" and SUPPHO.QLABEL = "Reason for the Healthcare Encounter"				Prompt	Radio
C60141	Hospital admit reason other text	HospitalAdmitRsnOTH	The free-text field related to "Hospital admit reason", specifying other text.	The free-text field related to "Hospital admit reason", specifying other text.	If Other, specify			Alphanumeric			Adult;Pediatric	Supplemental	1.00	2021-01-15 14:54:46.0	Hospitalization Form	Participant Characteristics	General Health History	4000	Free-Form Entry								HO	HOSPITAL_HOREASO		Oth Reason for the Healthcare Encounter		Specify Other		If other is selected, specify?		SUPPHO.QVAL			Char	Provide the reason for the subject's hospital admission.		SUPPHO.QVAL where SUPPHO.QNAM = "HOREAS" and SUPPHO.QLABEL = "Reason for the Healthcare Encounter"				Question

6 results.