SUDORS Data Elements

Att D. DataElements SUDORS.docx

State Unintentional Drug Overdose Reporting System (SUDORS)

SUDORS Data Elements

OMB: 0920-1128

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Attachment D


SUDORS Data Elements


NVDRS Variables Also Collected in SUDORS


There are no standard paper data collection forms to be used by states because states will be abstracting information from electronic or paper vital statistics or Coroner and Medical Examiner (CME) records into the CDC web-based data system. This is a list of data elements that NVDRS is already designed to collect and that will be collected by the SUDORS system for drug overdose deaths.


Incident Information

Date of addition/change

Version of software

Incident type

Case status

Number of source documents in incident

Number of persons in incident

Number of weapons in incident

Date supervisor checked incident

Date supervisor rechecked incident

Supervisor note field

Number of non-fatally shot persons in incident

Narrative of the incident


Document notes

Document type

Person who entered record

Source agency requested from

Date record requested/expected/sought

Date record re-requested/re-searched

Date record received

Date record abstracted/imported

Date entered data checked

Document determined to be unavailable

Document notes field


Person Information (Victim)

abstractor Assigned Manner of death

Person type

Age

Age unit

Sex

White

Black

Asian

Native Hawaiian or Pacific Islander

American Indian

Other Race

Unspecified Race

Hispanic/Latino/Spanish

Country of residence

State of residence



Victim Information

County of residence

City of residence

Zip code of residence

US Census block group of residence

US Census tract of residence

Birth place

Country of birth if not listed

Ever served in US armed forces (veteran)

Marital status

Place of death

Place of death if other

Date pronounced dead

Date of death

State of death

Immediate cause of death text

Cause leading to immediate cause text

Next antecedent cause of death text

Underlying cause of death text

Underlying cause of death ICD-10 code

ICD10 4th (character)

ICD10 5th (character)

Autopsy performed

Person was pregnant

Manner of death

Date of injury

Time of injury

Type of location where injured

Injured at work

State of injury FIPS code

County of injury

City of injury FIPS code

US Census block group of injury

US Census tract of injury

Survival time no. of units

Unit of time used in survival time

Education

Number years of education

Usual occupation code

Usual occupation text

Kind of business/industry code

Usual industry text

Multiple conditions on death certificate 1-10

Height

Weight

Transgender

Sexual orientation

Recent release from an institution

Victim Information (Continued)

Coroner/Medical Examiner

ZIP code of injury

At person’s home

EMS at scene

Homeless status

Current occupation

Victim in custody when injured


Toxicology

Alcohol use suspected

Date specimens were collected

Time specimens were collected

Name of poison

Type of poison (Automatically generated)

Code for poison (Automatically generated)

Patient drug obtained for

Cause of death


Summary Toxicology

Testing for alcohol

Alcohol test results

Blood alcohol concentration results

Testing for amphetamines

Amphetamine test results

Testing for antidepressants

Antidepressant test results

Testing for cocaine

Cocaine test results

Testing for marijuana

Marijuana test results

Testing for opiate(s)

Opiate test results

Testing for anticonvulsants

Anticonvulsants test results

Testing for antipsychotic

Antipsychotic test results

Testing for barbiturates

Barbiturates test results

Testing for benzodiazepines

Benzodiazepines test results

Testing for muscle relaxants

Muscle relaxants test result

Testing for carbon monoxide

Carbon monoxide results

Carbon monoxide source, if CO

Toxicology Comment



Suicide and Undetermined Circumstance Variables that Can Be Completed for Unintentional Drug Overdoses (*Indicates Crisis Information Collected with Checkbox) )

Circumstances known

Current depressed mood

Current mental health problem*

Type of first metal illness diagnosed

Type of second metal illness diagnosed

Other mental health diagnosis

Current treatment for mental illness

Ever treated for mental illness

Alcohol problem*

Other substance problem*

Other addiction*

Person left a suicide note

Disclosed intent to commit suicide

History of suicide attempts

Crisis in past two weeks

Physical health problem*

Intimate partner violence*

Intimate partner problem*

Family relationship problem*

Other relationship problem*

Job problem*

School problem*

Financial problem*

Suicide of friend or family*

Other death of friend or family

Recent criminal legal problem*

Other legal problems*

Perpetrator of violence in the past month

Victim of violence in the past month

Anniversary of a traumatic event

History of abuse as a child

Eviction/loss of home*

Disclosed suicidal intent to whom

History of expressed suicidal intent/thoughts

Physical fight (2 people)

Argument

Timing of argument

Disaster exposure

Other circumstance


Hospital Information

Victim seen in ED

Victim admitted to inpatient care

First external cause of injury code from hospital

Second external cause of injury code from hospital



Variables Collected Only by NUDORS

These variables are only collected on unintentional drug overdose deaths.



Type of Drug Poisoning

Type of Drug Poisoning


Substance Abuse

Previous drug overdose

Treatment for substance abuse

History of opioid/heroin abuse

Scene indications of drug abuse


Prescription Information

Use of prescription morphine

Number of opioid prescriptions in 30 days preceding injury

Number of pharmacies dispensing opioids to decedent in __180 days preceding injury

Number of doctors writing opioid prescriptions to the __decedent in the 180 days preceding injury

Response to Drug Overdose

Naloxone/Opioid antagonist administered

Bystanders present at time of overdose


Other

Route of drug exposure

Treated for pain at time of injury



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