Stroke/Transient ischemic attack (TIA) data elements
| Variable . | Level 1 (basic) . | Level 2 (intermediate) . | Level 3 (comprehensive) . |
|---|---|---|---|
| Date of acute stroke/TIA | Date acute stroke/TIA diagnosed: DD/MM/YYYY | Date acute stroke/TIA diagnosed: DD/MM/YYYY | Date acute stroke/TIA diagnosed: DD/MM/YYYY |
| Antithrombotic therapy at time of event | Antithrombotic therapy form | Antithrombotic therapy form | Antithrombotic therapy form |
| Stroke/TIA subtype | Select one: ☐ TIA ☐ Stroke (select one type below) ☐ Ischemic stroke ☐ Hemorrhagic stroke ☐ Unknown | Select one: ☐ TIA ☐ Stroke (select one type below) ☐ Ischemic stroke Etiology of ischeimc stroke (select one): ☐ Cardioembolic ☐ Small vessel disease ☐ Large vessel disease ☐ Other identified cause ☐ Undetermined etiology Was ischemic stroke complicated by hemorrhagic transformation? ☐ No ☐ Yes ☐ Unknown ☐ Hemorrhagic stroke ☐ Unknown | Select one: ☐ TIA ☐ Stroke (select one type below) ☐ Ischemic stroke Etiology of ischemic stroke (select one): ☐ Cardioembolic (select all that apply) ☐ Atrial fibrillation/flutter ☐ Acute MI (<2 wk) ☐ Intracardiac thrombus ☐ Rheumatic mitral stenosis ☐ Sick sinus syndrome ☐ Dilated cardiomyopathy ☐ Prosthetic heart valve ☐ Akinesis of ventricular wall ☐ Ischemic cardiomyopathy (EF <28%) ☐ Paradoxical embolism ☐ Other ☐ Small vessel disease ☐ Large vessel disease ☐ Other identified cause ☐ Undetermined etiology Was ischemic stroke complicated by hemorrhagic transformation? ☐ No ☐ Yes ☐ Unknown ☐ Hemorrhagic stroke (select all that apply) ☐ Lobar ☐ Basal ganglia ☐ Brainstem ☐ Intraventricular involvement ☐ Cerebellum ☐ Other (specify): ____________ ☐ Unknown ☐ Unknown |
| Cardiovascular risk factors | Select all that apply: ☐ Known cardiovascular disease (coronary artery disease, peripheral arterial disease, cerebrovascular disease) ☐ Hypertension ☐ Diabetes mellitus ☐ Current smoker ☐ Former smoker ☐ Hypercholesterolemia ☐ Obesity | ||
| Presenting symptoms | Select one: ☐ No ☐ Yes (select one) ☐ Focal symptom ☐ Non–focal symptom ☐ Other neurologic symptom ☐ Unknown | Select one: ☐ No ☐ Yes (select one) ☐ Focal symptom ☐ Non–focal symptom ☐ Other neurologic symptom ☐ Unknown | |
| Duration of symptoms | Select one: ☐ 24 h or longer ☐ Less than 24 h ☐ Unknown | ||
| Neuroimaging | Was neuroimaging done for this event? ☐ No ☐ Yes ☐ Unknown | Was neuroimaging done for this event? ☐ No ☐ Yes (indicate type of image, select all that apply) ☐ Single brain CT scan ☐ Multiple brain CT scans separated in time ☐ MRI ☐ Diffusion-weighted MRI ☐ Unknown | Was neuroimaging done for this event? ☐ No ☐ Yes (indicate type of image, select all that apply) ☐ Single brain CT scan (select one) ☐ Positive ☐ Negative ☐ Result not available ☐ Multiple brain CT scans separated in time (select one) ☐ Positive ☐ Negative ☐ Result not available ☐ MRI (select one) ☐ Positive ☐ Negative ☐ Result not available ☐ Diffusion-weighted MRI (select one) ☐ Positive ☐ Negative ☐ Result not available ☐ Unknown |
| Reperfusion treatment | Did the patient undergo reperfusion treatment of this stroke: ☐ No (medical management) ☐ Yes ☐ Unknown | Did the patient undergo reperfusion treatment of this stroke: ☐ No (medical management) ☐ Yes (select all that apply): ☐ Mechanical thrombectomy ☐ Systemic thrombolytic therapy ☐ Other (specify): ____________ ☐ Unknown | Did the patient undergo reperfusion treatment of this stroke: ☐ No (medical management) ☐ Yes (select all that apply): ☐ Mechanical thrombectomy ☐ Systemic thrombolytic therapy ☐ Other (specify): ____________ ☐ Unknown |
| Antithrombotic treatment of stroke/TIA | Antithrombotic therapy form |
| Variable . | Level 1 (basic) . | Level 2 (intermediate) . | Level 3 (comprehensive) . |
|---|---|---|---|
| Date of acute stroke/TIA | Date acute stroke/TIA diagnosed: DD/MM/YYYY | Date acute stroke/TIA diagnosed: DD/MM/YYYY | Date acute stroke/TIA diagnosed: DD/MM/YYYY |
| Antithrombotic therapy at time of event | Antithrombotic therapy form | Antithrombotic therapy form | Antithrombotic therapy form |
| Stroke/TIA subtype | Select one: ☐ TIA ☐ Stroke (select one type below) ☐ Ischemic stroke ☐ Hemorrhagic stroke ☐ Unknown | Select one: ☐ TIA ☐ Stroke (select one type below) ☐ Ischemic stroke Etiology of ischeimc stroke (select one): ☐ Cardioembolic ☐ Small vessel disease ☐ Large vessel disease ☐ Other identified cause ☐ Undetermined etiology Was ischemic stroke complicated by hemorrhagic transformation? ☐ No ☐ Yes ☐ Unknown ☐ Hemorrhagic stroke ☐ Unknown | Select one: ☐ TIA ☐ Stroke (select one type below) ☐ Ischemic stroke Etiology of ischemic stroke (select one): ☐ Cardioembolic (select all that apply) ☐ Atrial fibrillation/flutter ☐ Acute MI (<2 wk) ☐ Intracardiac thrombus ☐ Rheumatic mitral stenosis ☐ Sick sinus syndrome ☐ Dilated cardiomyopathy ☐ Prosthetic heart valve ☐ Akinesis of ventricular wall ☐ Ischemic cardiomyopathy (EF <28%) ☐ Paradoxical embolism ☐ Other ☐ Small vessel disease ☐ Large vessel disease ☐ Other identified cause ☐ Undetermined etiology Was ischemic stroke complicated by hemorrhagic transformation? ☐ No ☐ Yes ☐ Unknown ☐ Hemorrhagic stroke (select all that apply) ☐ Lobar ☐ Basal ganglia ☐ Brainstem ☐ Intraventricular involvement ☐ Cerebellum ☐ Other (specify): ____________ ☐ Unknown ☐ Unknown |
| Cardiovascular risk factors | Select all that apply: ☐ Known cardiovascular disease (coronary artery disease, peripheral arterial disease, cerebrovascular disease) ☐ Hypertension ☐ Diabetes mellitus ☐ Current smoker ☐ Former smoker ☐ Hypercholesterolemia ☐ Obesity | ||
| Presenting symptoms | Select one: ☐ No ☐ Yes (select one) ☐ Focal symptom ☐ Non–focal symptom ☐ Other neurologic symptom ☐ Unknown | Select one: ☐ No ☐ Yes (select one) ☐ Focal symptom ☐ Non–focal symptom ☐ Other neurologic symptom ☐ Unknown | |
| Duration of symptoms | Select one: ☐ 24 h or longer ☐ Less than 24 h ☐ Unknown | ||
| Neuroimaging | Was neuroimaging done for this event? ☐ No ☐ Yes ☐ Unknown | Was neuroimaging done for this event? ☐ No ☐ Yes (indicate type of image, select all that apply) ☐ Single brain CT scan ☐ Multiple brain CT scans separated in time ☐ MRI ☐ Diffusion-weighted MRI ☐ Unknown | Was neuroimaging done for this event? ☐ No ☐ Yes (indicate type of image, select all that apply) ☐ Single brain CT scan (select one) ☐ Positive ☐ Negative ☐ Result not available ☐ Multiple brain CT scans separated in time (select one) ☐ Positive ☐ Negative ☐ Result not available ☐ MRI (select one) ☐ Positive ☐ Negative ☐ Result not available ☐ Diffusion-weighted MRI (select one) ☐ Positive ☐ Negative ☐ Result not available ☐ Unknown |
| Reperfusion treatment | Did the patient undergo reperfusion treatment of this stroke: ☐ No (medical management) ☐ Yes ☐ Unknown | Did the patient undergo reperfusion treatment of this stroke: ☐ No (medical management) ☐ Yes (select all that apply): ☐ Mechanical thrombectomy ☐ Systemic thrombolytic therapy ☐ Other (specify): ____________ ☐ Unknown | Did the patient undergo reperfusion treatment of this stroke: ☐ No (medical management) ☐ Yes (select all that apply): ☐ Mechanical thrombectomy ☐ Systemic thrombolytic therapy ☐ Other (specify): ____________ ☐ Unknown |
| Antithrombotic treatment of stroke/TIA | Antithrombotic therapy form |
EF, ejection fraction; TIA, transient ischemic attack.