| crf_emergency_version |
|
radio |
CRF Emergency Visit Version Completed |
1, Unversioned ; 2, 1.0 ; 3, 1.1 ; 4, 2.0 |
| crfev_date |
|
text |
Date of completion |
|
| crfev_symptoms |
Presenting symptoms |
checkbox |
Presenting symptoms |
1, 1. Shortness of breath/difficulty breathing ; 2, 2. Cough ; 3, 3. Fatigue ; 4, 4. Fever ; 5, 5. Chest pain ; 6, 6. Palpitations ; 7, 7. Dizziness/lightheadness ; 8, 8. Fainting/blackouts ; 9, 9. Leg/ankle swelling ; 10, 10. Gastrointestinal symptoms (e.g. diarrhoea, vomiting, abdominal pain) ; 11, 11. Neurological symptoms (including limb weakness, speech disturbance) ; 12, 12. Mental health related symptoms (including panic attacks, suicidal thoughts, overdose) ; 13, 13. Confusion, altered level of consciousness ; 14, 14. Urinary tract symptoms ; 15, 15. Trauma/injuries/fractures ; 16, 16. Others (specify) |
| crfev_symptoms_other |
|
notes |
Other presenting symptom(s) |
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| crfev_date_visit |
Hospital visit details |
text |
Date of visit/admission |
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| crfev_date_discharge |
|
text |
Date of discharge |
|
| crfev_stay_days |
|
calc |
Length of stay |
datediff([crfev_date_visit], [crfev_date_discharge], "d", "dmy") |
| crfev_itu_hdu_adm |
|
radio |
ITU/HDU admission |
1, Yes ; 0, No ; 2, Unknown |
| crfev_med_change |
|
radio |
Any change in medications? |
1, Yes ; 0, No ; 2, Unknown |
| crfev_dis_diagnosis |
|
checkbox |
Diagnosis given upon discharge |
1, COVID related ; 2, Non-COVID related |
| crfev_dis_diagnosis_detail |
|
notes |
Diagnosis given upon discharge - Details |
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| crfev_cxr_done |
Basic investigations |
radio |
a) Chest XR |
1, Yes ; 0, No |
| crfev_ecg_done |
|
radio |
b) ECG |
1, Yes ; 0, No |
| crfev_xr_result |
|
checkbox |
Chest X-Ray result |
1, Normal ; 2, Extensive persistent changes >1/3 lung involvement ; 3, Suggestive of fibrotic lung disease ; 4, Indeterminate ; 5, Other |
| crfev_ecg_result |
|
checkbox |
ECG result |
1, Sinus rhythm ; 2, Atrial fibrillation/flutter ; 3, ST segment/T wave changes ; 4, RBBB ; 5, LBBB |
| crfev_ecg_hr |
|
text |
ECG result: Heart rate |
|
| crfev_blood_done |
Blood tests and imaging |
radio |
Any blood tests performed on admission? |
1, Yes ; 0, No ; 2, Unknown |
| crfev_other_inv_done |
|
radio |
Any other investigations/procedures completed? |
1, Yes ; 0, No ; 2, Unknown |
| crfev_blood_desc |
|
yesno |
If any blood tests performed, please enter results in the Laboratory Results Collection Log - Routine blood tests |
1, Yes ; 0, No |
| crfev_add_inv_resp |
Additional investigations/procedures |
checkbox |
Respiratory |
1, Spirometry ; 2, Full pulmonary function tests ; 3, Fractional exhaled nitric oxide (FeNO) ; 4, Nijmegen questionnaire ; 5, Incremental shuttle walk test (ISWT) ; 6, Six-minute walk test ; 7, Cardio-pulmonary exercise test ; 8, CT chest with contrast ; 9, HRCT ; 10, CTPA ; 11, Pulmonary perfusion scan |
| crfev_add_inv_card |
|
checkbox |
Cardiac |
1, Cardiac MRI ; 2, Echocardiogram ; 3, 24/48 hrs tape ; 4, Right heart catheterisation ; 5, Coronary angiogram/CT angiogram ; 6, Cardiac perfusion scan |
| crfev_add_inv_haema |
|
checkbox |
Haematological |
1, Thyroid function tests ; 2, Blood borne viruses (BBV) screen ; 3, Haematinics |
| crfev_link_add_blood_haema |
|
yesno |
If Thyroid Function Tests or Haematinics (Haematological Profile) performed, please enter results in the Laboratory Results Collection Log - Additional Blood Tests.If BBV Screen performed, please enter results in the Laboratory Results Collection Log - Immunological Profile. |
1, Yes ; 0, No |
| crfev_add_inv_renal |
|
checkbox |
Renal |
1, USS abdomen ; 2, USS Kidneys ; 3, CT abdomen/pelvis ; 4, Urinalysis ; 5, Urine albumin: creatinine ratio ; 6, Urine protein: creatinine ratio ; 7, Renal biopsy |
| crfev_link_blood_urine |
|
yesno |
If Urinalysis, Urine albumin : creatinine ratio or Urine protein : creatinine ratio performed, please enter results in the Laboratory Results Collection Log - Urine Profile. |
1, Yes ; 0, No |
| crfev_add_inv_immu |
|
checkbox |
Immunological |
1, Vasculitis screen ; 2, Complements factors ; 3, Immunoglobulins ; 4, Rheumatoid factor/Anti-CCP |
| crfev_link_blood_immun |
|
yesno |
If any immunological procedures performed, please enter results in the Laboratory Results Collection Log - Immunological Profile. |
1, Yes ; 0, No |
| crfev_add_inv_neuro |
|
checkbox |
Neurology/Mental health |
1, CT brain ; 2, MRI brain ; 3, Nerve conduction studies ; 4, Mini-International Neuro-psychiatric ; 5, Interview (M.I.N.I.) ; 6, Columbia-Suicide Severity Rating Scale ; 7, Sleep Condition Indicator |
| crfev_add_inv_other |
|
notes |
Other tests |
|
| crfev_echo_date |
Additional investigations/procedures results |
text |
Echocardiogram: Date performed |
|
| crfev_echo_right |
|
radio |
Echocardiogram: Results - Right ventricle |
1, Normal ; 2, Mild dysfunction ; 3, Moderate dysfunction ; 4, Severe dysfunction ; 5, Unable to visualise |
| crfev_echo_left |
|
radio |
Echocardiogram: Results - Left ventricle |
1, Normal ; 2, Mild dysfunction ; 3, Moderate dysfunction ; 4, Severe dysfunction ; 5, Unable to visualise |
| crfev_echo_pap |
|
text |
Echocardiogram: Estimated PAP |
|
| crfev_tape_done |
|
yesno |
24/48 hours tape: Symptom diary completed |
1, Yes ; 0, No |
| crfev_tape_date |
|
text |
24/48 hours tape: Date performed |
|
| crfev_tape_finding |
|
checkbox |
24/48 hours tape: Findings |
1, Sinus rhythm ; 2, Atrial flutter/fibrillation ; 3, Significant bradycardia ; 4, Significant tachycardia ; 5, Heart block ; 6, Sinus pause > 3 seconds ; 7, Burden of ectopic > 10% |
| crfev_tape_heartblock |
|
text |
24/48 hours tape: Heart block details |
|
| crfev_nij_date |
|
text |
Nijmegen questionnaire: Date performed |
|
| crfev_nij_result |
|
text |
Nijmegen questionnaire: Result |
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| crfev_cpet_date |
|
text |
Cardio-pulmonary exercise test: Date performed |
|
| crfev_cpet_result |
|
text |
Cardio-pulmonary exercise test: Result (Peak Vo2) |
|
| crfev_feno_date |
|
text |
Fractional exhaled nitric oxide (FeNO): Date performed |
|
| crfev_feno_result |
|
text |
Fractional exhaled nitric oxide (FeNO): Result |
|