CDASH RYZE Example.Electrocardiogram

This example shows a CRF that collects electrocardiogram data utilizing a local reader.

Order	Question Text	Prompt	Case Report Form Completion Instructions	Type	Collection Variable	Tabulation Target	Mapping Instructions	Controlled Terminology CodeList Name	Permissible Values
1	Was the ECG performed?	ECG Performed	Indicate whether or not an ECG or specific ECG test was done.	Text	EGSTAT		(NY)	Yes; No
2	What was the method used for the ECG?	Method	Record the method used for the ECG.	Text	EGMETHOD		(EGMETHOD)	6 Lead Standard; 8 Lead Standard; 10 Lead Standard; 12 Lead Standard
3	What was the position of the subject during the ECG measurement?	Position	Record the position of the subject during the ECG.	Text	EGPOS		(POSITION)	Supine; Sitting
4	What was date of the ECG?	ECG Date	Record the date ECG was done using this format.	Date	EGDTC
5	What was the Mean Heart Rate?	ECG Mean Heart Rate	Record the test result.	Integer	EGHRMN_EGORRES	EGORRES	EGORRES where EGTESTCD = "EGHRMN"
6	What was the unit of the Mean Heart Rate?	Unit	Record or select the original unit in which these data were collected, if not pre-printed on CRF.	Text	EGHRMN_EGORRESU	EGORRES	EGORRESU where EGTESTCD = "EGHRMN"	(Unit)	beats/min
7	What was the Aggregate PR Interval?	PR Interval, Aggregate	Record the test result.	Integer	PRAG_EGORRES	EGORRES	EGORRES where EGTESTCD = "PRAG"
8	What was the unit of the Aggregate PR Interval?	Unit	Record or select the original unit in which these data were collected, if not pre-printed on CRF.	Text	PRAG_EGORRESU	EGORRESU where EGTESTCD = "PRAG"	(Unit)		msecs
9	What was the Aggregate QRS Duration?	QRS Duration, Aggregate	Record the test result.	Integer	QRSAG_EGORRES	EGORRES where EGTESTCD = "QRSAG"
10	What was the unit of the Aggregate QRS Duration?	Unit	Record or select the original unit in which these data were collected, if not pre-printed on CRF.	Text	QRSAG_EGORRESU	EGORRESU where EGTESTCD = "QRSAG"	(Unit)		msecs
11	What was the Aggregate QT Interval?	QT Interval, Aggregate	Record the test result.	Integer	QTAG_EGORRES	EGORRES where EGTESTCD = "QTAG"
12	What was the unit of the Aggregate QT Interval result?	Unit	Record or select the original unit in which these data were collected, if not pre-printed on CRF.	Text	QTAG_EGORRESU	EGORRESU where EGTESTCD = "QTAG"	(Unit)		msecs
13	What was the Aggregate QTca Interval?	QTca Interval, Aggregate	Record the test result.	Integer	QTCAAG_EGORRES	EGORRES where EGTESTCD = "QTCA"
14	What was the unit of the Aggregate QTca Interval?	Unit	Record or select the original unit in which these data were collected, if not pre-printed on CRF.	Text	QTCAAG_EGORRESU	EGORRESU where EGTESTCD = "QTCA"	(Unit)		msecs
15	What was the overall interpretation of the ECG?	Interpretation	Record the the test result.	Text	INTP_EGORRES	EGORRES where EGTESTCD = "INTP"	(NORMABNM)	Normal; Abnormal
16	Was the ECG clinically significant?	Clinically Significant	Record whether ECG results were clinically significant.	Text	EGCLSIG		(NY)	Yes; No

Page tree

CDASH RYZE Example.Electrocardiogram