Instructions for Case Report Form

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Active Bacterial Core Surveillance (ABCs)

Instructions for Case Report Form

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2008 ABCs Case Report Form

Instruction Sheet

Revised: January, 2008


GENERAL INSTRUCTIONS


Where to look for information necessary to complete case report form:

The minimum sources of information that should be used to complete the following form are 1) the admission history and physical (H&P), 2) the discharge summary (or DC Summary), and 3) the face sheet. In the H&P, useful information (including underlying or prior illnesses) is often listed under the heading Past Medical History (PMH). Other portions of the medical chart, such as laboratory or radiology reports, will often have useful information; however, reviewing these other sections is not required for the completion of the case report form.


Where to send completed form:

Each site to add information here.


Patient identifier information (NOT transmitted to CDC)

Note: information found on patient intake or face sheet in medical chart or hospital computer database



Name


Patient’s name: Last name, first name, middle initial



Phone


Patient’s home phone number, including area code



Address


Patient’s home address, including Number, Street, City, State and ZIP Code

If “Homeless”, enter this on Address line


Nursing Home


Name of nursing home in which patient currently resides (on screen only)



Chart number


Patient chart number


Information obtained for cases with any invasive ABCs organism identified

Note: Items 1-4 are filled out by ABCs personnel, except as indicated.



1. State


Use 2 letter postal code (e.g., NY) of patient’s state of residence (except for California which uses “EB” & “SF”).



2. County



Patient's county of residence



3. State ID



ABCs case unique identifier. Each ABCs site has its own system of assigning a unique ID to each case. In general, the first 2 spaces designate the location and are followed by 5 numbers. This state ID is assigned by the ABCs personnel.

Note that this State ID is used for every bacterial isolate from the same illness episode for that case.

IMPORTANT: The state ID links all information pertaining to this particular isolate including the CRF, the lab isolate form, and forms used for special studies.



4a. Hospital/lab ID where culture identified



ABCs laboratory unique identifier. Each ABCs site has its own system of assigning a unique ID to each hospital or lab. Please note name of hospital or lab on the form; the hospital/lab ID will be assigned by ABCs personnel.

This field refers to the hospital or reference laboratory where the original patient specimen was identified from primary culture.



4b. Hospital ID where patient treated



Hospital where patient received treatment for infection due to the ABCs pathogen; may be different than 4a; most commonly is hospital of discharge.

Please note the name of the hospital; the hospital ID will be assigned by ABCs personnel. Note: The patient does not need to be hospitalized in order to have a treatment hospital indicated.



5. Was patient hospitalized?



If Yes, indicate dates of admission and discharge. If a case is transferred from another hospital, please use the date of admission from the first hospital and use the date of discharge from the second hospital. If the patient is admitted through the ER into an acute care hospital, the date of admission is the date of the ER visit.


If patient is discharged to a long-term rehabilitation unit, other long-term care facility or hospice, please use the date of transfer to the rehabilitation unit as the date of discharge. Likewise, if a patient is admitted from a long-term rehabilitation unit, other long-term care facility or hospice, please use the date of transfer to the acute care facility as the date of admission.


NOTE: ER visits and outpatient visits are not hospitalizations. If the patient is admitted following an ER or outpatient visit then the patient has been hospitalized.



NOTE: For a patient to be considered hospitalized, culture date should occur no more than 7 days before hospital admission date.



6a. Was patient transferred from another hospital?



Indicate if patient was transferred from another acute care hospital prior to receiving treatment at the hospital where the chart is being reviewed. (If the patient was admitted from a long-term care facility, see instructions for 5 as above.)



6b. Hospital ID



The acute care hospital from which the patient was transferred. Please note the name of the hospital; the hospital ID will be assigned by ABCs personnel.



7. Was patient a resident of a nursing home or other chronic care facility at time of first positive culture?



Includes nursing home, long term care facility and other chronic (where the patient has lived for at least 30 days) care facilities where the patient has been living. This does not refer to facilities where the patient receives daily outpatient therapy nor does it include prisons, group homes, rehabilitation hospitals or assisted living facilities.





8. Date of birth



Patient’s date of birth; use 4 digit year.




9a. Age



Patient’s age at the time of collection of the first positive invasive culture. If patient’s age is 30 days to 11 months, indicate age in months. If patient is 12 months or older, indicate age in years. Examples: 34 days of age should be coded as Age=1 and Unit=2 (see 9b); 14 months of age should be coded as Age=1 and Unit=3 (see 9b).



9b. Age units



Indicate if age is in days, months or years (see explanation above).



10. Sex



Male or female



11a. Ethnicity




Ethnicity of patient as noted in chart or reported by physician or ICP. Check one EVEN IF race already indicated. For example, many whites are also Hispanic or Latino. Do not make assumptions based on name. If not noted or unsure, check "unknown."


(Some institutions combine race/ethnic coding. For example, they might define a person’s race as “Hispanic or Latino”. In this case race would be coded “unknown” on the CRF, and ethnicity would be “Hispanic or Latino”.)




11b. Race



Race of patient as noted in chart or reported by physician or ICP. Multiple boxes can be checked. If race is unknown, please indicate.

12a. Weight


Optional

Indicate weight in pounds (lbs) and ounces (oz) OR in kilograms (kg)


12b. Height


Optional

Indicate height in feet (ft) and inches (in) OR in centimeters (cm)




13. Type of Insurance

Optional

Check ALL types of insurance as noted in the hospital chart.



Clarifications of insurance types:



Medicare: the national health insurance program for people 65 years and older (also covers some people under the age of 65 with disabilities and people with end-stage renal disease).

Military/VA (Veterans Administration): patient receives federal medical care due to current or past military status.

Medicaid/state assistance program: program that pays for medical assistance for certain people with low incomes and resources. State assistance programs are those state programs that provide medical coverage to individuals who are otherwise uninsured or uninsurable.

Other: includes options such as “private-pay” (i.e., service is not covered by state or federal government; patient generally pays out of pocket at time of service and may or may not be reimbursed later by a private insurance company).




14. Outcome



If the patient was seen in the ER or outpatient office and was alive upon leaving the ER or office, mark “survived” even if they died shortly after. For hospitalized patients, base outcome on the patient’s status at discharge.



15. At the time of first positive culture, was the patient pregnant or postpartum?










Fetal outcome:


Indicate whether the patient was pregnant or postpartum at the time of collection of the first positive invasive culture. For this surveillance project, the postpartum period is defined as the 30 days following a delivery or miscarriage.


If the baby (not the mother) had a GBS infection and the baby is the case being investigated and reported, this question should not be answered.


If case is pregnant or postpartum, indicate ONE of the possible fetal outcomes. If the baby survived but it was unknown if the baby was ill, check #1 (i.e., survived, no apparent illness).



Clarifications of fetal outcomes:

Live birth/neonatal death: infant born alive but died < 30 days of age.

Abortion/stillbirth: not born alive, even if death occurred during labor.

Specifically, abortion in this instance means death of a fetus before 20 weeks of gestation or when < 500 grams in weight from natural causes. Stillbirth means fetal death (from natural causes) occurring after 20 weeks of gestation or when the fetus is > 500 grams in weight.

Induced abortion: fetal death due to a deliberate medical procedure.


Clarification of cases where GBS is isolated from a stillborn infant:

If clinical illness is reported for a stillborn, no case report form is needed for the infant (fetus). The only time a "stillborn" might be linked with a GBS case report form is if the mother has GBS and then has a septic abortion; in this case the fetal outcome would be "abortion/stillbirth." If the illness is thought to have occurred in a liveborn infant, a case report form should be generated, and the form can indicate the fetal outcome (which may be death).

If the gestational age is <22 weeks, this is considered below the age of fetal viability; if GBS infection results in death of the fetus, it must be considered a maternal case with the fetal outcome indicated as "abortion/stillbirth."






16. If patient <1 month of age, gestational age and birth weight



Complete gestational age and birthweight for any newborn from which a positive invasive culture was taken, if this fetus/infant was given a separate identity. This question refers to live births only. Products of conception that were cultured (such as placenta), but not identified as “baby” are part of the mother’s culture history.


Indicate gestational age in weeks and birth weight in grams. If gestational age is unknown, write 99" for weeks. If birth weight in grams is not available, write weight in lbs/oz and it can be converted at data entry; if birth weight is not known, enter 9999" for birth weight.



17. Types of infection


(See Table 1)



Check ALL that apply to this episode of infection. Do not include previously existing or chronic infections. “Bacteremia without focus” should be chosen ONLY if no other type of infection is noted besides bacteremia. If no type of infection is indicated in the medical chart, “Unknown” should be selected.


Further instructions and definitions of terms are in Table 1 at end of this document.


If the final diagnosis of a patient’s illness is not the same as the admitting diagnosis, consider only the final (or discharge) diagnosis. Often the admitting diagnosis of a patient’s illness is unknown and clarified only in the discharge summary or discharge diagnosis. (For example, a patient may be admitted with the provisional diagnosis of “pneumonia” but actually found to have “asthma”.)



18a. Bacterial species isolated from sterile site



Indicate invasive ABCs organism isolated.

NOTE: If a case has more than one invasive ABCs surveillance organism isolated, separate State IDs must be assigned, separate case report forms must be completed for each organism, and each entered individually into the database.

18b. Other bacterial species isolated from sterile site

Specify any non-ABCs organisms identified from the same sterile source on the same culture date as the first positive invasive culture.


19. Sterile site(s)



Indicate ALL sterile sites from which the ABCs organism was isolated. (See below for further clarifications.) If isolated from an internal body site or other normally sterile site, please specify the site. Internal body site should be specified as one of the following: lymph node, brain, heart, liver, spleen, vitreous fluid, kidney, pancreas, or ovary. Please note that this list is not exhaustive; sterile sites not included on this list should be captured under the “other normally sterile site” field. Please discuss all questionable sterile sites with CDC.


Specimens from skin infections such as skin abscesses, boils or furuncles or specimens from middle ear, amniotic fluid, placenta, sinus, wound, lung, gallbladder, appendix, cornea, cord blood or throat are not considered sterile sites for any ABCs organism and should not be indicated as the only specimen from which the pathogen was isolated. (ABSCESS CURRENTLY UNDER DISCUSSION)


Clarifications:

Pleural fluid: includes “chest fluid”, thoracentesis fluid


Peritoneal fluid: includes abdominal fluid, ascites. If ruptured appendix or perforated bowel is noted in the medical chart, a case report form should not be completed as contamination of peritoneal fluid is likely.


Joint: includes synovial fluid; fluid, needle aspirate or culture of any specific joint (knee, ankle, elbow, hip, wrist). (There is no need to enter the specific joint in the “other” field. If you would like to indicate the specific joint, do so in “Comments” section.)


Bone: includes bone marrow


Muscle: includes tissue or biopsy that is surgically obtained (considered an acceptable sterile site for GAS only)

Internal Body Site: specimen obtained from surgery or aspirate from one of the following: lymph node, brain, heart, liver, spleen, vitreous fluid, kidney, pancreas, or ovary.


Note: while skin abscesses do not meet the sterile site criteria, an abscess specimen obtained from a normally sterile body site will be counted as a case for surveillance. The “internal body site” field should be used if the abscess is obtained from one of the organs in the pick list under this field (e.g., a brain abscess should be coded as “internal body site, brain”). If the abscess is obtained from a body site that is not in the pick list, please list the site and write the word “abscess” in the “other, specify” field (“abscess” alone is not an acceptable sterile site.)


If the culture is taken <12 hrs after death, autopsy specimens may be considered sterile sites. Autopsy specimen should be discussed with CDC on a case-by-case basis. Cultures taken >12 hrs after death will not be considered sterile site cultures for ABCs purposes.



20. Date of first positive culture



Indicate the date of collection of the first positive invasive culture of a normally sterile site, not the date when the culture was first noted to have growth.



21. Other site(s) from which organism isolated: (placenta, amniotic fluid, middle ear, sinus, wound, other site)



For ABCs organisms, indicate if the pathogen was isolated from any of these other sites on the same culture date as the sterile site culture (#19). If other site is marked, please specify in the space provided.


NOTE: A case report form is generated only when the pathogen is isolated from one of the sterile sites as indicated in question 19, regardless if the pathogen is also isolated from one of these other sites. Two exceptions to this rule exist.

Exception 1: if GBS is isolated from the placenta and/or amniotic fluid ONLY and a fetal death occurs, it is considered a case and a case report form should be completed.

Exception 2: if GAS is isolated from a wound AND is accompanied by necrotizing fasciitis or STSS (streptococcal toxic shock syndrome), it is considered a case and a case report form should be completed.



22. Underlying causes or prior illness


(See Table 2)



Check ALL underlying illnesses or prior conditions as noted in hospital chart or by reporting physician or ICP.


Exception: As of January 1, 2004, check "AIDS"=1 if a) AIDS is listed in the chart OR b) if HIV+ is indicated AND the CD4 count was EVER less than 200, even if AIDS is not listed in the chart. The lowest CD4 count is often listed in the admission history and physical or discharge summary.


Any listed condition should be considered a “prior” condition except when it is obvious that the condition no longer exists OR when the condition is a new condition that occurred during the current illness.


At least ONE box should be checked. Check “none” if a chart is available and no underlying causes are found. Check “unknown” if no chart was available for review and no underlying diseases are known.


For substance abuse questions (current smoker, alcohol abuse, and IVDU), check “yes” if the substance abuse is current OR if the timing of the use is unknown (i.e., “history of alcohol abuse”) and “no” if the substance abuse is clearly indicated as “former” or never existed.


Examples:

What is in chart: Underlying illness or prior condition?

h/o heart failure yes

h/o acute leukemia yes

h/o smoking yes

h/o smoking, stopped 10 years ago no

h/o colon cancer yes

acute renal failure no

chronic renal failure yes

h/o chemotherapy yes


*If question remains about classification of past malignancy, contact CDC.



Further instructions, definitions of terms and abbreviations are in Tables 2 - 4 at the end of this document.






ORGANISM-SPECIFIC QUESTIONS


HAEMOPHILUS INFLUENZAE



23. Receipt of Hib vaccine?




For any patient <15 years of age with Hib or serotype unknown, indicate doses of Hib vaccine received. If yes, for each dose write date given, vaccine name and manufacturer, and vaccine lot number.


Note: For all dates, if “day” of month is unknown, enter “15". If "month" is not known, use Comment field to indicate year of Hib vaccination and include the phrase "month unknown"



23b. Were records obtained to verify vaccination history?




It is only necessary to verify vaccination history for cases <5 years of age. If available/accessible, state vaccination registries may be used to verify information on vaccination history. If state registries are not available/accessible OR vaccination history is missing from the state registry, vaccination history should be verified by the child’s healthcare provider.



Clarifications:

Healthcare provider – includes primary care physicians, pediatricians, or public health clinics



24. Serotype



Haemophilus influenzae serotype determined by the primary culture laboratory. If the primary culture laboratory does not perform serotyping, indicate serotype determined at other laboratory within the EIP site (either reference lab or state lab). If not tested or unknown, please indicate such.


NEISSERIA MENINGITIDIS



25. Serogroup



Neisseria meningitidis serogroup as determined by the primary culture laboratory. If the primary culture laboratory does not perform serogrouping, indicate serogroup determined at other laboratory within the EIP site (either reference lab or state lab). If not tested or unknown, please indicate such.



26. Is patient currently attending college?



For patients who are 15-24 years old at time of collection of invasive culture check “yes” if the patient attends college. If not, check no; if unknown, mark “unknown”. If the patient is age less than 15 or is older than 24 years, leave the question blank.


NOTE: “college” is not to be specifically defined but instead will be as self-identified by the case.



27. Did patient receive meningococcal vaccine?

Did the patient receive meningococcal vaccine? If yes, indicate which meningococcal vaccine(s) was (were) given by checking the appropriate box (es). If the vaccine name/manufacturer is unknown, please check ‘Not Known’.


NOTE: Although unlikely, it is possible that the patient received two doses of meningococcal vaccine. If the patient received two doses of either Menomune or Menactra, list the date and lot number for the most recent dose under the appropriate name (Menomune or Menactra) and the first of the two doses under “other”. Please also specify the vaccine name under “other”.


If “day” of month is unknown, enter “15”. If "month" is not known, use Comment field to indicate year of meningococcal vaccination and include the phrase "month unknown".




STREPTOCOCCUS PNEUMONIAE



28. Receipt of pneumococcal conjugate vaccine?


Did the patient <15 years of age receive the (typically 7- or 9-valent) pneumococcal conjugate vaccine?


Note: If yes, for each dose write dates given, vaccine name and manufacturer, and vaccine lot numbers. If “day” of month is unknown, enter “15". If "month" is not known, use Comment field to indicate year of pneumococcal conjugate vaccination and include the phrase "month unknown".


GROUP A STREPTOCOCCUS



29. Did patient have surgery in last 7 days?



Did the patient have any surgery in the 7 days prior to collection of the first positive invasive GAS culture (the date of specimen collection)? If YES, give date of surgery.




30. Did patient deliver a baby in last 7 days?



Did the patient deliver a baby in the 7 days prior to the date of collection of the first positive invasive GAS culture (the date of specimen collection)? If YES, give date of delivery.


31. GAS-specific underlying conditions


For each, indicate whether or not the patient had one or more of these conditions in the 7 days prior to the date of collection of the first positive invasive GAS culture.


For “surgical wound”, check the box if any surgical wound was noted in the chart or by the physician. This refers to any surgical wound present when the positive GAS culture was collected. (For example, check the box even if the surgery occurred 2 weeks prior to the isolate collection, as long as the wound was still present during the current GAS infection.)


Clarifications:


Penetrating Trauma - trauma that breaks the skin (e.g., knife wound)



Blunt Trauma - trauma that does not break the skin (e.g., falling down stairs and sustaining some bruises, getting hit by a baseball bat)


Comments



32. Comments



Use this space to add other information that might not have fit the choices provided or to enhance existing information.




To be filled out by ABCs personnel only



33. Audit



Was the case first identified through the audit? Check “yes” or “no”.


34. CRF status


What is the current status of the case report form in terms of completion?



35. Recurrent disease



Indicate whether or not this patient was previously infected by the same pathogen as in a previous case report.


For Streptococcus pneumoniae, the specimen from this current case must have been isolated 8 or more days after any previous case due to the same pathogen.

For all other pathogens, the specimen from this current case must have been isolated 30 or more days after any previous case due to the same pathogen.



36. Date of report



Indicate the date reported to the ABCs site. This is the date that the ABCs personnel were first notified or made aware of this case.

Table 1:

TYPES OF INFECTION CAUSED BY ORGANISM,

DEFINITIONS



Term


Definition


Bacteremia without focus


bloodstream infection without any other type of infection indicated


Meningitis/

encephalitis


inflammation of the membranes of the brain or spinal cord

(To list this as the type of infection caused by the ABCs organism, “meningitis” must be listed in the chart as a diagnosis made by a health care provider, the ABCs pathogen must be isolated from CSF, or a CSF gram stain must be positive for one of the ABCs pathogens. The following CSF abnormalities alone are not acceptable: any abnormal protein level or an increase in white blood cells (WBC))


Otitis media


middle ear infection


Pneumonia


inflammation or infection of the lung. Aspiration pneumonia and community-acquired pneumonia are acceptable types of pneumonia. If reviewing radiology reports (which is not required), radiographic findings that indicate pneumonia include the following: bronchopneumonia, consolidation, and infiltrate. Atelectasis, pulmonary edema and pleural effusion alone should not be considered evidence of pneumonia


Epiglottitis


inflammation of the epiglottis


HUS


Hemolytic Uremic Syndrome: syndrome characterized by fever, thrombocytopenia, microangiopathic hemolytic anemia, hypertension and varying degrees of acute renal failure


Abscess (not skin)


circumscribed collection of pus; this can be in a collection of pus in an organ (i.e., liver) or within the deeper tissues under the skin


Peritonitis


inflammation of the lining of the abdominal cavity


Pericarditis


inflammation of the membrane around the heart


Septic abortion


abortion in which the conceptus and upper genital tract (e.g., uterus) are infected


Chorioamnionitis


inflammation of the membrane surrounding the fetus


Septic arthritis


infection of a joint (i.e., wrist, knee, ankle, etc.)


Osteomyelitis


inflammation of bone marrow and adjacent bone (does not include mastoiditis)


Endocarditis


inflammation of the lining membrane of the heart ("endocardium"). This may involve only the membrane covering the heart valves or the lining of the chambers of the heart


Empyema


the presence of pus in a body cavity. Empyema usually refers to collections of pus in the space around the lungs (pleural cavity)


Endometritis


inflammation of the inner lining of the uterus


STSS


Streptococcal Toxic Shock Syndrome: rapidly progressing infection causing shock and injury to internal organs such as the kidneys, liver, and lungs

("Septic shock" is not necessarily equivalent to "toxic shock")


Necrotizing fasciitis


rapidly spreading and destructive infection of muscle and fat tissue


Puerperal sepsis


condition in which a woman has a fever for more than two consecutive days (exclusive of the first postpartum day) within the first 10 postpartum days


"Other"


Acceptable syndromes include (but are not limited to):

-endocarditis

-kidney infection (pyelonephritis)

-urinary tract infection

-sinusitis

-pharyngitis

-gangrene

-mastoiditis

-septic shock/sepsis/septicemia (“septicemia” may be coded as “bacteremia” IF the organism is isolated from the blood only)

Table 2:


SPECIFIC UNDERLYING DISEASES: DEFINITIONS, ABBREVIATIONS, AND CLARIFICATIONS



Current smoker


Includes a smoker of cigarettes or cigars, but does not include smoking crack or other illicit drugs. Smoking crack or other illicit drugs should be listed under “other”. (If a person quit smoking within the past 12 months, consider this person a current smoker.)


Multiple Myeloma


This cancer of the hematopoietic system results in "immunocompromised for life" so should be marked if any history.


Sickle Cell Anemia


Includes persons with HbSS, HbSC or HbS-beta thalassemia. Common abbreviations: SCD, SS disease, SC disease.


Immunoglobulin deficiency


Includes syndromes such as SCID (severe combined immunodeficiency), agammaglobulinemia, Ig, IgM, or IgG deficiencies, Wiskott-Aldrich Syndrome.


Immunosuppressive therapy


If the chemotherapy is ongoing, if patient is between cycles, or if within 2 weeks of completion, this should be checked.


Use of steroids is considered an underlying disease or condition only if they are long-term systemic steroids (this does NOT include topical creams, steroids used only for short course treatment such as one week, and inhaled steroids used for asthma).


Leukemia


This cancer of the hematopoietic system results in an "immunocompromised" condition. Includes CML (chronic myelogenous leukemia), CLL (chronic lymphocytic leukemia), AML (acute myelogenous leukemia), ALL (acute lymphocytic leukemia).


Hodgkin’s Disease


This cancer of the hematopoietic system results in "immunocompromised for life" so should be marked if any history.


Emphysema/COPD


COPD=chronic obstructive pulmonary disease. Includes chronic bronchitis.


Diabetes mellitus



Includes either type I or type II (both “insulin-dependent” and “adult-onset”). Also includes glucose intolerance and new-onset diabetes. Do not include patients noted as “pre-diabetic”. It is not necessary to look at the results of glucose tolerance test in laboratory results section of the chart for an indication of diabetes. Common abbreviations: DM, AODM, IDDM, NIDDM.







Renal failure/dialysis


This does not include acute renal failure or renal insufficiency. Includes end stage renal disease.


HIV/AIDS


If the case is HIV+ and the case’s CD4 count was ever <200, then mark “AIDS” as an underlying cause, even if AIDS is not a diagnosis noted in the chart. (The CD4 count from the current illness/admission being investigated may be used to determine if the person has AIDS and is most often listed in the admission history and physical or discharge summary; prior charts do not need to be reviewed).



Cirrhosis/liver failure


This does not include hepatitis A, hepatitis B, hepatitis C infection without liver failure and does not include acute liver failure.


Alcohol abuse


Includes ETOHA (ethanol abuse).


Atherosclerotic cardiovascular disease (ASCVD)/ CAD


This is also described as Arteriosclerotic Heart Disease, CAD (coronary artery disease), and CHD (coronary heart disease).


Heart failure/CHF


Congestive heart failure, including cardiomyopathy.


CSF leak


Cerebrospinal fluid leak


IVDU


Intravenous drug user


Cerebral Vascular Accident (CVA)/Stroke


Includes any history of CVA/Stroke. This does not include a history of a TIA (transient ischemic attack).


Cochlear implant


An electrode-containing device which is placed in the inner ear to activate auditory nerves.


Deaf/profound hearing loss


This does not include mild hearing loss.



Complement deficiency


Complement deficiencies are a group of disorders in which there is a reduced level of specific proteins that are needed for a normal immune response (“complement”). (Examples of specific complement deficiencies are: C1 qrs deficiency, C3 deficiency, C2-C4 deficiency, C5-9 deficiency.)


Obesity


The condition of being significantly overweight. It is usually applied to a condition of 30 percent or more over ideal body weight OR to individuals with a body mass index (BMI) of 30 or more. The obesity variable should not be checked in the underlying conditions section if there is no mention of obesity in the chart. Calculating an obese BMI value using the height and weight data should not be used to complete this variable.

Table 3:

GLOSSARY FOR COMMONLY NOTED UNDERLYING ACRONYMS AND SYNDROMES, AND ASSOCIATED ABCS UNDERLYING DISEASE OR ILLNESS




Acronyms/Symptoms/Syndromes/

Treatments




Associated ABCs underlying disease or illness


Agammaglobulinemia


Immunoglobulin deficiency


ALL (Acute Lymphocytic Leukemia)


Leukemia


AML (Acute Myelogenous Leukemia)


Leukemia


AODM (Adult Onset Diabetes Mellitus)


Diabetes mellitus


ASCVD


Atherosclerotic cardiovascular disease


CAD (Coronary Artery Disease)


Atherosclerotic cardiovascular disease


Cardiomyopathy


Heart failure/CHF


Cerebrospinal fluid leak


CSF leak


CHD (Chronic Heart Disease)


Atherosclerotic cardiovascular disease


CHF (Congestive Heart Failure)


Heart failure/CHF


CVA (Cerebral Vascular Accident)


Stroke/CVA


Chronic Bronchitis


Emphysema/COPD


Cigarettes


Current smoker


Cigars


Current smoker


CLL (Chronic Lymphocytic Leukemia)


Leukemia


CML (Chronic Myelogenous Leukemia)


Leukemia


COPD (Chronic Obstructive Pulmonary Disease)


Emphysema/COPD


Cortisone (steroid)*


Immunosuppressive therapy


Cortone (steroid)*


Immunosuppressive therapy


Decadron (steroid)*


Immunosuppressive therapy


Dexamethasone (steroid)*


Immunosuppressive therapy


DM


Diabetes mellitus


ETOHA (Ethanol abuse)


Alcohol abuse


HbS-beta thalassemia


Sickle Cell Anemia


HbSC


Sickle Cell Anemia


HbSS


Sickle Cell Anemia


Hydrocortisone (steroid)*


Immunosuppressive therapy


IDDM (Insulin-Dependent Diabetes Mellitus)


Diabetes mellitus


Ig deficiency


Immunoglobulin deficiency


IgG deficiency


Immunoglobulin deficiency


IgM deficiency


Immunoglobulin deficiency


IVDU


Intravenous drug user


Kenacort (steroid)*


Immunosuppressive therapy


Kenalog (steroid)*


Immunosuppressive therapy


Liver failure


Cirrhosis


Methylprednisolone (steroid)*


Immunosuppressive therapy


NIDDM (Non Insulin Dependent DM)


Diabetes mellitus


Pediapred (steroid)*


Immunosuppressive therapy


Prednisolone (steroid)*


Immunosuppressive therapy


Prednisone (steroid)*


Immunosuppressive therapy


Prelone (steroid)*


Immunosuppressive therapy


SCD (Sickle Cell Disease)


Sickle Cell Anemia


SC disease


Sickle Cell Anemia


SCID (Severe Combined Immunodeficiency)


Immunoglobulin deficiency


Solu-Cortef (steroid)*


Immunosuppressive therapy


SoluMedrol (steroid)*


Immunosuppressive therapy


SS disease


Sickle Cell Anemia


Steroids*


Immunosuppressive therapy


Triamicinalone (steroid)*


Immunosuppressive therapy


Wiskott-Aldrich Syndrome


Immunoglobulin deficiency

* Use of steroids are considered an underlying disease or condition ONLY if they are long-term systemic steroids (inhaled steroids are typically not considered an underlying disease or condition)


Table 4:


Commonly noted diseases or syndromes that are

*NOT*

considered an ABCs underlying disease or syndrome



Acute Liver Failure


Acute Renal Failure


Alzheimer’s Disease


Anemia


Atrial fibrillation




Gastroesophageal Reflux Disease (GERD)


Hepatitis A without liver failure


Hepatitis B without liver failure


Hepatitis C without liver failure


HTN (hypertension)


Inhaled steroids


Mental Illness


Organic Brain Syndrome


Senile dementia


Steroid Topical Creams


Steroid Short term Therapy (<8 days)


UTI (Urinary Tract Infection)



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