Data Dictionary Demo - Stroke

Clinical Form

Please complete all required fields marked with an asterisk (*)

Indicate stroke type
Stroke severity as measured by the NIH Stroke Scale (NIHSS) Report the raw (uncategorized) NIHSS score
Indicate the estimated stroke severity category by the NIH Stroke Scale (NIHSS) NIHSS categories: NIHSS score 0 = Category 1: No stroke symptoms NIHSS score 1-4 = Category 2: Minor NIHSS score 5-15 = Category 3: Moderate NIHSS score 16-20 = Category 4: Moderate to severe NIHSS score 21-42 = Category 5: Severe Note: if no NIHSS score was recorded and/or insufficient documentation exists to abstract the full score, then indicate a category based on symptom severity.
Indicate the patient’s level of consciousness measured on hospital arrival
Indicate the duration of the symptoms measured on hospital arrival
Indicate how the diagnosis was made
Indicate if the patient received intravenous thrombolytic therapy Intravenous tissue plasminogen activator
Indicate the date of thrombolytic therapy
Indicate if the patient underwent thrombectomy Endovascular mechanical clot removal
Indicate the date of thrombectomy
Indicate if the patient underwent hemicraniectomy
Indicate the date of hemicraniectomy
Indicate if the patient developed symptomatic intracerebral hemorrhage after treatment of ischemic stroke with intravenous thrombolysis?
Indicate if the patient developed symptomatic intracerebral hemorrhage after treatment of ischemic stroke with thrombectomy?
Indicate the degree of disability or dependence by obtaining the smRSq The link to the smRSq flow chart and instructions for use can be found in this Reference Guide on page 11