Study ID # |
Yes |
ER Visit Date |
Yes / Yes |
Admission Date |
Yes |
ICU Admission Date |
Yes |
Discharge Date |
Yes |
ICU Discharge Date |
Yes |
Gender |
Yes / Yes |
Date of Birth |
Yes / Yes |
Race |
Yes / Yes |
II Chief Complaint
|
Questionnaire Name
|
Further Analysis / Used
|
PULMONARY |
Yes / Yes |
CARDIAC |
Yes |
DEMATOLOGIC |
Yes |
OPTHALMOLOGIC |
Yes |
EAR, NOSE, THROAT |
Yes |
OTHER |
Yes |
III. Past Medical History and Symptoms
|
Questionnaire Name
|
Further Analysis / Used
|
MEDICATIONS |
Yes |
HISTORY OR PREVIOUS HOSPITALIZATION FOR PULMONARY DISEASE |
Yes |
IV. Data from Emergency Room
|
Questionnaire Name
|
Further Analysis / Used
|
Date |
Yes / Yes |
Time |
Yes |
Vital: Temp |
Yes |
BP |
Yes / Yes |
BP |
Yes |
Respiratory rate |
Yes / Yes |
Heart rate |
Yes / Yes |
Time |
|
O2 Sat |
Yes / Yes |
On room Air |
Yes / Yes |
On liters of O2 via nasal canula (NC) or face mask |
Yes |
On 100% non-rebreather (NRB) |
Yes |
On continuous Positive Airway Pressure (CPAP)with |
Yes |
On ventilator with___%O2 |
Yes |
Notes from Emergency Room |
Yes / Yes |
Physical Exam
|
Questionnaire Name
|
Further Analysis / Used
|
Eye |
Yes / Yes |
Red |
Yes |
Other |
Yes |
Ear, Nose, Throat |
Yes / Yes |
Rhinorrhea |
Yes |
Other |
Yes / Yes |
|
Yes / Yes |
Pulmonary |
Yes |
Tachupnea |
Yes |
Cough |
Yes / Yes |
Cyanosis |
Yes |
Decreased breath sounds |
Yes |
Stridor |
Yes |
Wheezing |
Yes / Yes |
Crackles |
Yes |
Rhonchi |
Yes |
Intercostals retractions |
Yes |
Cepitus |
Yes |
Other |
Yes |
Cardiac |
Yes |
Tachycardia |
Yes |
Murmur |
Yes |
Dematology |
Yes |
Burn |
Yes / Yes |
Other |
Yes / Yes |
|
Data from Repeat ER Visit or Admission H&P
|
Questionnaire Name
|
Further Analysis / Used
|
Date |
Yes |
Time |
Yes |
Vitals: Temp |
Yes |
Ht |
Yes |
Wt |
Yes |
BP |
Yes |
BP |
Yes |
Respiratory rate |
Yes / Yes |
Heart rate |
Yes / Yes |
O2 Sat |
Yes / Yes |
On room Air |
Yes |
On liters of O2 via nasal canula (NC) or face mask |
Yes |
On 100% non-rebreather (NRB) |
Yes |
On continuous Positive Airway Pressure (CPAP)with |
Yes |
On ventilator with ___%O2 |
Yes |
Ventilator other |
Yes |
|
Physical Exam
|
Questionnaire Name
|
Further Analysis / Used
|
Eye |
Yes |
Red |
Yes |
Other |
Yes |
Ear, Nose, Throat |
Yes |
Other |
Yes |
Pulmonary |
Yes |
Tachupnea |
Yes |
Cough |
Yes |
Cyanosis |
Yes |
Decreased breath sounds |
Yes |
Stridor |
Yes |
Wheezing |
Yes |
Crackles |
Yes |
Rhonchi |
Yes |
Intercostals retractions |
Yes |
Cepitus |
Yes |
Other |
Yes / Yes |
Cardiac |
Yes |
Tachycardia |
Yes |
Dermatology |
Yes |
Other |
Yes |
Outcomes
|
Questionnaire Name
|
Further Analysis / Used
|
Outcome |
Yes |
Chlorine exposure |
Yes |
Other Disease |
|
Primary Diagnosis |
Yes / Yes |
Tests/Procedures
|
Questionnaire Name
|
Further Analysis / Used
|
EKG Date |
Yes / Yes |
Brochoscopy 1ST Date |
Yes / Yes |
Pulmonary Date |
Yes / Yes |
Consults
|
Questionnaire Name Further Analysis / Used
|
Pulmonology Yes |
Dermatology Yes |
Opthalmology Yes / Yes |
Abstracted Information Not on Graniteville Abstraction Form but included in Dataset
|
Abstracted Data
|
Further Analysis / Used
|
Victim transportation method |
Yes / Yes |
Repeat admission boolean |
|
First Symptoms |
Yes / Yes |
Outcome Category |
Yes / Yes |
Decontamination Location |
Yes |
ICU boolean |
Yes |
Number of days in ICU |
Yes |
Hospitalized |
Yes |
Days in hospital |
Yes |
Person exposed |
Yes |
Distance in miles from site |
Yes |