Unique Numbers for Entry Forms
Method of Transmission of Entry Form to CC
Date of Randomization
Unique Number From Outcome Database
Hours Since Injury
Systolic Blood Pressure [mmHg]
Respiratory Rate [/min]
Central Capillary Refille Time [s]
Heart Rate [/min]
Glasgow Coma Score Eye Opening
Glasgow Coma Score Motor Response
Glasgow Coma Score Verbal Response
Glasgow Coma Score Total
Date of Death
Main Cause of Death
Description of Other Cause of Death
Status of Patient at Outcome if Alive
Date of discharge, transfer to other hospital or day 28 from randomization
Condition of Patient at Outcome if Alive
Number of Days Spent in ICU
Significant Head Injury
Neurosurgery Done
Chest Surgery Done
Abdominal Surgery Done
Pelvis Surgery Done
Pulmonary Embolism
Deep Vein Thrombosis
Stroke
Surgery for Bleeding
Myocardial Infarction
Gastrointestinal Bleeding
Complete Loading Dose of Trial Drug Given
Complete Maintenance Dose of Trial Drug Given
Blood Products Transfusion
Number of Units of Red Call Products Transfused
Number of Units of Fresh Frozen Plasma Transfused
Number of Units of Platelets Transfused
Number of Units of Cryoprecipitate Transfused
Recombinant Factor VIIa Given
Treatment Box Number
Treatment Pack Number