MONICA Manual, Part IV, Section 3

Event Registration Data
TEST CASE HISTORY FORM
STROKE EVENTS
Form: M
Version: 4          13.6.86 		FOR MDC USE ONLY
Seq.no:

Received:
A Form identification and version number |_9|_3|_4|
B MONICA Collaborating Centre name |__|__|
C Form coded by: name |__|__|
D Test case serial number |__|__|__|__|__|
E Date of starting to code record (day,month,year) |__|__||__|__||__|__|
7 SEX |__|        EXAM9 Computerised A T |__|
8 DDBIRTH |__|__||__|__||__|__| EXAM10 Single photon E S |__|
9 DONSET |__|__||__|__||__|__| EXAM11Other |__|
10 MANAGE management |__| 15 IATRO Possible iatrogenic |__|
11 SURVIV at 28 days |__| 16 CLIND1 |__|__|__|__|
12 TYPE of stroke |__|__|__|__| 17 CLIND2 |__|__|__|__|
13 DIACAT diagnostic category |__| 18 CLIND3 |__|__|__|__|
14 EXAM1 Physician |__| 19 PRESTR |__|
EXAM2 Neurologist |__| 20 DDEATH |__|__||__|__||__|__|
EXAM3 Lumbar puncture |__| 21 SURT days of survival |__|__|
EXAM4 Angiography |__| 22 NECP necropsy performed |__|
EXAM5 Brain scan |__| 23 NECD1 |__|__|__|__|
EXAM6 Electroencephalogram |__| 24 NECD2 |__|__|__|__|
EXAM7 Echoencephalography |__| 25 NECD3 |__|__|__|__|
EXAM8 Electrocardiogram |__| 26 ICDVER ICD version used |__|

General and specific instructions

This test case history form has exactly the same format as the Core Data Transfer Format - Stroke Events with the exception of items A,B,C,D,E which replace items 1,2,3,4,5 in the latter. However, it is designed for coding test case histories directly on to paper forms without the use of magnetic tape. These should be sent directly to the MONICA Quality Control Centre in Dundee or the MONICA Data Centre in Helsinki according to the instructions provided with the test case histories or other enquiry. By these means small quantities of coded data can be sent at one time, particularly for quality control tests.

When using this form the coding instructions for items 8-27 should be taken from the Specific Instructions for the Core Data Transfer Format - Stroke Events. In addition item B should be coded as for item 3, CENTRE. Local codes should be used for item C, coder, and Item D, Test Case Serial Number, should be that on the test material. Item E, Date of Starting to Code Record is as stated.

Blanks are not allowed in any field on this form, and all boxes should be filled only with permissible characters which are 0,1,2,3,4,5,6,7,8,9.

Before sending off coded forms:

  1. make sure that all codes are legible
  2. make sure that all fields have been filled
  3. ensure that any corrections are clear. These should be done with a horizontal line - through the incorrect item, and the correct answer written alongside and not on top
  4. ensure that you have kept photostats of what is sent but send the originals for coding (unfortunately photostats are often of poor quality and may be badly aligned)
  5. complete a packing list and make sure that both what is sent and what is retained is a complete set of coded forms.