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APPENDIX VIII (CONT.)
Item
Variable name
Text Prompt
Field Type
Legal Values
G. Non-Treatment with Thrombolytics
79
ContraWarn
Documented Exclusions (Contraindications) or Relative Exclusions (Warnings) for not initiating IV Thrombolytic in the 0-3 hr treatment window
Numeric
1 = Yes
0 = No
80
ContraWarn2
Documented Exclusions (Contraindications) or Relative Exclusions (Warnings) for not initiating IV Thrombolytic in the 3-4.5 hr treatment window
Numeric
1 = Yes
0 = No
Exclusions (Contraindications)
81, 81_2
NonTrtBl, NonTrtBl2
Active internal bleeding
Numeric
1 = Yes
0 = No
82, 82_2
NonTrtCT, NonTrtCT2
CT demonstrates multilobar infarction (hypodensity >1/3 cerebral hemisphere)
Numeric
1 = Yes
0 = No
83, 83_2
NonTrtHxHem,
NonTrtHxHem2
History of intracranial hemorrhage, intracranial neoplasm, arteriovenous malformation or aneurysm
Numeric
1 = Yes
0 = No
84, 84_2
NonTrtPlat, NonTrtPlat2
Acute bleeding diathesis (low platelet count, increased PTT, INR ≥ 1.7 or use of NOAC. This includes: Platelet count <100 000/mm 3 ; Heparin received within 48 hours resulting in abnormally elevated aPTT greater than the limit or normal; current use of anticoagulant with INR >1.7 or PT >15 seconds; current use of direct thrombin inhibitors or direct factor Xa inhibitors with elevated sensitive laboratory tests (such as aPTT, INR, platelet count, and ECT; TT; or appropriate factor Xa activity assays)
Numeric
1 = Yes
0 = No
85, 85_2
NonTrtTr, NonTrtTr2
Recent intracranial or spinal surgery, significant head trauma or stroke in previous 3 months
Numeric
1 = Yes
0 = No
87, 87_2
NonTrtBP, NonTrtBP2
Elevated blood pressure (systolic >185 or diastolic >110 mmHg) despite treatment
Numeric
1 = Yes
0 = No
89, 89_2
NonTrtSuHem, NonTrtSuHem2
Symptoms may suggest subarachnoid hemorrhage
Numeric
1 = Yes
0 = No
89a, 89a_2
NonTrtAP
NonTrtAP2
Arterial puncture at noncompressible site in previous 7 days
Numeric
1 = Yes
0 = No
92, 92_2
NonTrtG
NonTrtG2
Blood glucose concentration <50mg/dL (2.7 mmol/L)
Numeric
1 = Yes
0 = No
APPENDIX VIII (CONT.)
Item
Variable name
Text Prompt
Field Type
Legal Values
Relative Exclusions (Warnings)
91, 91_2
NonTrtNC, NonTrtNC2
Care team unable to determine eligibility
Numeric
1 = Yes
0 = No
94, 94_2
NonTrtOH, NonTrtOH2
IV or IA thrombolysis/thrombectomy at an outside hospital prior to arrival
Numeric
1 = Yes
0 = No
96, 96_2
NonTrtIL, NonTrtIL2
Life expectancy < 1 year or severe co-morbid illness or CMO on admission
Numeric
1 = Yes
0 = No
97, 97_2
NonTrtMI, NonTrtMI2
Recent myocardial infarction (within previous 3 months)
Numeric
1 = Yes
0 = No
98, 98_2
NonTrtPreg, NonTrtPreg2
Pregnancy
Numeric
1 = Yes
0 = No
99, 99_2
NonTrtFr, NonTrtFr2
Patient/family refused
Numeric
1 = Yes
0 = No
100, 100_2
NonTrtSM, NonTrtSM2
Stroke severity too mild
Numeric
1 = Yes
0 = No
102, 102_2
NonTrtRI, NonTrtRI2
Rapid improvement
Numeric
1 = Yes
0 = No
88, 88_2
NonTrstS, NonTrtS2
Seizure at onset with postictal residual neurological impairments
Numeric
1 = Yes
0 = No
86, 86_2
NonTrtSurg, NonTrtSurg2
Major surgery or serious trauma within previous 14 days
Numeric
1 = Yes
0 = No
102a, 102a_2
NonTrtRecHem2
Recent gastrointestinal or urinary tract hemorrhage (within previous 21 days)
Numeric
1 = Yes
0 = No
Hospital-Related or Other Factors:
103, 103_2
NonTrtA, NonTrtA2
Delay in patient arrival
Numeric
1 = Yes
0 = No
104, 104_2
NonTrtDDx, NonTrtDDx2
Delay in stroke diagnosis
Numeric
1 = Yes
0 = No
105, 105_2
NonTrtTD, NonTrtTD2
In-hospital Time Delay , In-hospital Time Delay2
Numeric
1 = Yes
0 = No
106, 106_2
NonTrtIV, NonTrtIV2
No IV access
Numeric
1 = Yes
0 = No
107, 107_2
NonTrtOt, NonTrtOt2
Other (specify)
Text
Total 25 characters
H. Medical History
108
MedHisAF
Atrial Fib/Flutter - history
Numeric
1 = Yes
0 = No
109
MedHisMI
Myocardial infarction (MI) or coronary artery disease (CAD) -history
Numeric
1 = Yes
0 = No
110
MedHisCS
Carotid stenosis - history
Numeric
1 = Yes
0 = No
111
MedHisPG
Current pregnancy or pregnancy or within 6 weeks after delivery or termination of pregnancy
Numeric
1 = Yes
0 = No
112
MedHisDM
Diabetes Mellitus - history
Numeric
1 = Yes
0 = No
113
MedHisDrug
Drugs - history
Numeric
1 = Yes
0 = No
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