CDE Detailed Report

Disease: Spinal Muscular Atrophy
Sub-Domain: General Health History
CRF: Surgical and Hospitalization History - SMA

Displaying 1 - 20 of 20
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 External Id Loinc External Id Snomed External Id caDSR External Id CDISC
C04804 Hospital discharge date and time HospitDischgDateTime Date (and time, if applicable and known) the participant/subject was discharged from the hospital Date (and time, if applicable and known) the participant/subject was discharged from the hospital Discharge Date (MM/YYYY) or Age (approximate) Date or Date & Time

Record the discharge date for each hospitalization episode. Record the date/time according to the ISO 8601, the International Standard for the representation of dates and times (http://www.iso.org/iso/home.html). The date/time should be recorded to the level of granularity known (e.g., year, year and month, complete date plus hours and minutes, etc.). If date unknown, use approximate age.

No references available Adult;Pediatric Supplemental 3.00 2013-07-25 08:54:08.2 Surgical and Hospitalization History - SMA General Health History Participant History and Family History

Free-Form Entry

C12680 Hospitalization non-surgical elective indicator HosptlizatnNonSurgElectvInd Indicator of whether the enumerated non-surgical hospitalization was elective Indicator of whether the enumerated non-surgical hospitalization was elective Elective? Yes;No;Unknown Yes;No;Unknown Alphanumeric

Record if hospitalization was elective (versus emergent)

No references available Adult;Pediatric Supplemental 3.00 2013-07-25 08:54:08.2 Surgical and Hospitalization History - SMA General Health History Participant History and Family History

Single Pre-Defined Value Selected

C05106 Surgical or therapeutic procedure start date and time SurgTherapuProcStartDateTime Date (and time, if applicable and known) on which the surgical or therapeutic procedure started Date (and time, if applicable and known) on which the surgical or therapeutic procedure started Date(s) - list all (MM/YYYY) or Age (approximate) Date or Date & Time

Record the date/time according to the ISO 8601, the International Standard for the representation of dates and times (http://www.iso.org/iso/home.html). The date/time should be recorded to the level of granularity known (e.g., year, year and month, complete date plus hours and minutes, etc.).

No references available Adult;Pediatric Supplemental 3.00 2013-07-25 08:54:08.2 Surgical and Hospitalization History - SMA General Health History Participant History and Family History

Free-Form Entry

C12681 Hospitalization non-surgical ventilation indicator HospitlNonSurgVentilatnInd Indicator of whether the participant/subject was ventilated while in the hospital for the specified non-surgical reason Indicator of whether the participant/subject was ventilated while in the hospital for the specified non-surgical reason Ventilated? Yes;No;Unknown Yes;No;Unknown Alphanumeric

Choose one for each hospitalization episode

No references available Adult;Pediatric Supplemental 3.00 2013-07-25 08:54:08.2 Surgical and Hospitalization History - SMA General Health History Participant History and Family History

Single Pre-Defined Value Selected

C05108 Surgical or therapeutic procedure type SurgTherapProcedurTyp Type of surgical or therapeutic procedure received by the participant/subject Type of surgical or therapeutic procedure received by the participant/subject Past Surgical History Appendicectomy;Cholecystectomy;Colostomy;Ileostomy;Feeding tube placement;Fundoplication;Scoliosis surgery;Tendon release;Tympanostomy tubes;Tracheostomy;Airway surgery;Other surgery, specify;Unknown;Diagnostic;Anterior temporal lobectomy (ATL);Anterior temporal lobectomy plus (ATL+);Amygdalohippocampectomy;Lesionectomy;Lesionectomy plus (Lesionectomy +);Extratemporal resection (Topectomy);Multi-lobar resection;Hemispherectomy;Vagus nerve stimulation (VNS) surgery;Corpus callosotomy;Multiple subpial transaction;Radiosurgery;Therapeutic brain stimulation;Other, specify;Appendicostomy;Appendectomy;Neurological surgery;Bony orthopedic surgery Appendicectomy;Cholecystectomy;Colostomy;Ileostomy;Feeding tube placement;Fundoplication;Scoliosis surgery;Tendon release;Tympanostomy tubes;Tracheostomy;Airway surgery;Other surgery, specify;Unknown;Diagnostic surgery;Anterior temporal lobectomy (ATL);Anterior temporal lobectomy plus (ATL+);Amygdalohippocampectomy;Lesionectomy;Lesionectomy plus (Lesionectomy +);Extratemporal resection (Topectomy);Multi-lobar resection;Hemispherectomy;Vagus nerve stimulation (VNS) surgery;Corpus callosotomy;Multiple subpial transaction;Radiosurgery;Therapeutic brain stimulation;Other, specify;Appendicostomy (antegrade colonic anema);Appendectomy;Neurological surgery;Bony orthopedic surgery Alphanumeric

Additional lines and other surgeries should be added as appropriate

International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM): http://www.cdc.gov/nchs/icd/icd9cm.htm Adult;Pediatric Supplemental 3.00 2013-07-25 08:54:08.2 Surgical and Hospitalization History - SMA General Health History Participant History and Family History

Multiple Pre-Defined Values Selected

C17971 Hospitalization non surgical number HosptlizatnNonSurgNum Number used to identify the non-surgical hospitalization being described Number used to identify the non-surgical hospitalization being described Hospitalization Number Numeric Values No references available Adult;Pediatric Supplemental 3.00 2013-07-25 08:54:08.2 Surgical and Hospitalization History - SMA General Health History Participant History and Family History

Free-Form Entry

1 99
C05408 Hospital admission date and time HospitlAdmissDateTime Date (and time, if applicable and known) the participant/subject was admitted to the hospital Date (and time, if applicable and known) the participant/subject was admitted to the hospital Admission Date (MM/YYYY) or Age (approximate) Date or Date & Time

Record the admission date for each hospitalization episode. Record the date/time according to the ISO 8601, the International Standard for the representation of dates and times (http://www.iso.org/iso/home.html). The date/time should be recorded to the level of granularity known (e.g., year, year and month, complete date plus hours and minutes, etc.). If date unknown, use approximate age.

No references available Adult;Pediatric Supplemental 3.00 2013-07-25 08:54:08.2 Surgical and Hospitalization History - SMA General Health History Participant History and Family History

Free-Form Entry

C18765 Surgical or therapeutic procedure other text SurgTherapProcedurOTH The free-text field related to 'Surgical or therapeutic procedure type' specifying other text. Type of surgical or therapeutic procedure received by the participant/subject The free-text field related to 'Surgical or therapeutic procedure type' specifying other text. Type of surgical or therapeutic procedure received by the participant/subject Other, specify Alphanumeric

Additional lines and other surgeries should be added as appropriate

International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM): http://www.cdc.gov/nchs/icd/icd9cm.htm Adult;Pediatric Supplemental 1.00 2014-05-27 13:34:46.0 Surgical and Hospitalization History - SMA General Health History Participant History and Family History 4000

Free-Form Entry

C06025 Surgical or therapeutic procedure performed indicator SurgTherProcedurPerfInd Indicator whether the participant/subject has undergone the selected surgical procedure Indicator whether the participant/subject has undergone the selected surgical procedure Yes/No Yes;No;Unknown Yes;No;Unknown Alphanumeric

For each type of surgical procedure indicate if it was ever performed

No references available Adult;Pediatric Supplemental 3.00 2013-07-25 08:54:08.2 Surgical and Hospitalization History - SMA General Health History Participant History and Family History

Single Pre-Defined Value Selected

C18805 Hospitalization other text HospitOTH The free-text field related to 'Hospitalization reason' specifying other text. Reason why the participant/subject was hospitalized, excluding all surgeries The free-text field related to 'Hospitalization reason' specifying other text. Reason why the participant/subject was hospitalized, excluding all surgeries Other, specify Alphanumeric

Record the letter corresponding to the reason applicable in the "Reasons" list. For "Other, specify", also record the other reason the subject/participant was admitted to the hospital.

No references available Adult;Pediatric Supplemental 3.00 2013-07-25 08:54:08.2 Surgical and Hospitalization History - SMA General Health History Participant History and Family History 4000

Free-Form Entry

C08018 Surgery age value SurgAgeVal Age of the participant/subject at the time of the selected surgical procedure Age of the participant/subject at the time of the selected surgical procedure Date(s) - list all (MM/YYYY) or Age (approximate) Numeric Values

This value can be captured in years or months.

No references available Adult;Pediatric Supplemental 3.00 2013-07-24 11:38:01.2 Surgical and Hospitalization History - SMA General Health History Participant History and Family History

Free-Form Entry

0 99
C18868 Surgical history procedure scoliosis other text SurgHistProcedurScoliosisOTH The free-text field related to 'Surgical history procedure scoliosis type' specifying other text. Type of surgical procedure the participant/ subject has undergone for the treatment of scoliosis The free-text field related to 'Surgical history procedure scoliosis type' specifying other text. Type of surgical procedure the participant/ subject has undergone for the treatment of scoliosis Other, specify Alphanumeric

Choose all that apply. Only answer if 'Scoliosis surgery' is answered Yes.

No references available Adult;Pediatric Supplemental 3.00 2013-07-25 08:54:08.2 Surgical and Hospitalization History - SMA General Health History Participant History and Family History 4000

Free-Form Entry

C10609 Hospitalization reason HospitRsn Reason why the participant/subject was hospitalized, excluding all surgeries Reason why the participant/subject was hospitalized, excluding all surgeries Reason Pneumonia or Respiratory;Failure to Thrive;Dehydration;Other, specify;Trauma;Infection other than pneumonia;Fracture;Seizures;Cardiomyopathy/Arrhythmia Pneumonia or Respiratory;Failure to Thrive;Dehydration;Other, specify;Trauma;Infection other than pneumonia;Fracture;Seizures;Cardiomyopathy/Arrhythmia Alphanumeric

Record the letter corresponding to the reason applicable in the "Reasons" list. For "Other, specify", also record the other reason the subject/participant was admitted to the hospital.

No references available Adult;Pediatric Supplemental 3.00 2013-07-25 08:54:08.2 Surgical and Hospitalization History - SMA General Health History Participant History and Family History

Multiple Pre-Defined Values Selected

C18869 Surgical history procedure tendon release other text SurgHistProcedurTendnReleasOTH The free-text field related to 'Surgical history procedure tendon release type' specifying other text. Type of surgical procedure the participant/ subject has undergone for tendon release The free-text field related to 'Surgical history procedure tendon release type' specifying other text. Type of surgical procedure the participant/ subject has undergone for tendon release Other, specify Alphanumeric

Choose all that apply. Only answer if 'Tendon release surgery' is answered Yes.

No references available Adult;Pediatric Supplemental 3.00 2013-07-25 08:54:08.2 Surgical and Hospitalization History - SMA General Health History Participant History and Family History 4000

Free-Form Entry

C12674 Surgical history procedure scoliosis type SurgHistProcedurScoliosisTyp Type of surgical procedure the participant/ subject has undergone for the treatment of scoliosis Type of surgical procedure the participant/ subject has undergone for the treatment of scoliosis If Yes, type of scoliosis surgery Non-extendable rod;Extendable rod;Vertical Expandable Prosthetic Titanium Rib;Fusion;Other, specify Non-extendable rod;Extendable rod;Vertical Expandable Prosthetic Titanium Rib (VEPTR);Fusion;Other, specify Alphanumeric

Choose all that apply. Only answer if 'Scoliosis surgery' is answered Yes.

No references available Adult;Pediatric Supplemental 3.00 2013-07-25 08:54:08.2 Surgical and Hospitalization History - SMA General Health History Participant History and Family History

Multiple Pre-Defined Values Selected

C21668 ICD-10-CM code SurgTherapuProcICD10CMCode Code from the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) for the selected surgical procedure Code from the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) for the selected surgical procedure Reason Other, specify Other specify Alphanumeric

If the data will be shared, code each surgical procedure using ICD-10-CM

International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM): http://www.cdc.gov/nchs/icd/icd10cm.htm#icd2016 Adult;Pediatric Supplemental 1.00 2013-08-28 16:08:00.453 Surgical and Hospitalization History - SMA General Health History Participant History and Family History

Multiple Pre-Defined Values Selected

C12675 Surgical history procedure tendon release type SurgHistProcedurTendnReleasTyp Type of surgical procedure the participant/ subject has undergone for tendon release Type of surgical procedure the participant/ subject has undergone for tendon release If Yes Achilles tendon;Hip release;Tensor fascia lata release;Knee release;Elbow release;Other, specify Achilles tendon;Hip release;Tensor fascia lata release;Knee release;Elbow release;Other, specify Alphanumeric

Choose all that apply. Only answer if 'Tendon release surgery' is answered Yes.

No references available Adult;Pediatric Supplemental 3.00 2013-07-25 08:54:08.2 Surgical and Hospitalization History - SMA General Health History Participant History and Family History

Multiple Pre-Defined Values Selected

C21669 Surgical therapeutic procedure ICD-10-CM other text SurgTherapuProcICD10CMOthTxt The free-text field related to 'Surgical or therapeutic procedure ICD-10-CM code' specifying other text. Code from the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) for the selected surgical procedure The free-text field related to 'Surgical or therapeutic procedure ICD-10-CM code' specifying other text. Code from the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) for the selected surgical procedure Other, specify Alphanumeric

If the data will be shared, code each surgical procedure using ICD-10-CM

International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM): http://www.cdc.gov/nchs/icd/icd10cm.htm#icd2016 Adult;Pediatric Supplemental 1.00 2014-05-27 13:34:46.0 Surgical and Hospitalization History - SMA General Health History Participant History and Family History 4000

Free-Form Entry

C12677 Surgical history procedure tympanostomy same ear count SrgHistProcdrTympnostSameEarCt Count of times that the participant/subject has undergone tympanostomy tube insertion in the same ear Count of times that the participant/subject has undergone tympanostomy tube insertion in the same ear If Yes, how many times in the same ear? Numeric Values

Only answer if 'Tympanostomy tubes' was answered Yes.

No references available Adult;Pediatric Supplemental 3.00 2013-07-25 08:54:08.2 Surgical and Hospitalization History - SMA General Health History Participant History and Family History

Free-Form Entry

1 42
C12678 Hospitalization non surgical total lifetime count HosptlNonSurgTtlLifetimCt Count of the total number of times that the participant/subject has been hospitalized for a non-surgical reason Count of the total number of times that the participant/subject has been hospitalized for a non-surgical reason Total number of hospitalizations in lifetime Numeric Values

No additional instructions

No references available Adult;Pediatric Supplemental 3.00 2013-07-25 08:54:08.2 Surgical and Hospitalization History - SMA General Health History Participant History and Family History

Free-Form Entry

0 99
CSV