SUDORS Case Report - Retrieving and Refiling Records

State Unintentional Drug Overdose Reporting System (SUDORS)

Att D SUDORS_Data_Elements

OMB: 0920-1128

Document [docx]
Download: docx | pdf



Attachment D


SUDORS Data Elements





Table 1: SUDORS key injury and toxicology data elements

Incident information

Incident type

Incident category (Automatically generated)

Case status: Incident follow-up or complete

Number of source documents in incident (Optional)

Number of persons in incident

Number of weapons in incident

Date supervisor checked incident (Optional)

Date supervisor rechecked incident (Optional)

Narrative of the incident

Data sources used for case abstraction (Optional)

Abstractor name (Optional)

Document notes

Document type (Optional)

Source agency requested from (Optional)

Date record requested (Optional)

Date record re-requested (Optional)

Date record received (Optional)

Date record abstracted/imported (Optional)

Date entered data checked (Optional)

Document determined to be unavailable (Optional)

Document notes field (Optional)

Victim information

Abstractor assigned manner of death

Manner of death on death certificate

Manner of death per coroner/medical examiner

Person type

Age

Age unit

Sex

White

Black or African American

Asian

Native Hawaiian or Pacific Islander

American Indian or Alaskan Native

Unspecified Race

Hispanic/Latino/Spanish

Country of residence

State of residence

County of residence

City of residence

Zip code of residence

US Census block group of residence (Optional)

US Census tract of residence (Optional)

Birth state, territory, or country

Birth country, if other

Current or former military personnel

Marital status

Relationship status

Sex of partner

Victim was pregnant

Place of death

Place of death, if other

Date pronounced dead

Victim information (Continued)

Date of death

State or territory of death

Immediate cause of death text

Cause leading to immediate cause of death text

Next antecedent cause of death text

Underlying cause of death text

Other significant conditions contributing to death

How injury occurred

Underlying cause of death ICD-10 code

ICD10 4th (character)

ICD10 5th (character)

Autopsy performed

State or territory where injury occurred

County where injury occurred (FIPS code)

City where injury occurred (FIPS code)

Date of injury

Time of injury

Type of location where injured

Injured at work

Injured at victim’s home

US Census block group of injury (Optional)

US Census tract of injury (Optional)

Survival time no. of units

Unit of time used in survival time

Education by degree

Number years of education

Usual occupation code

Usual occupation text

Current occupation text

Kind of business/industry code

Usual industry text

Multiple conditions cause of death codes on death certificate 1-10

Height

Weight

Transgender

Sexual orientation

Recent release from an institution

ZIP code of injury

EMS at scene

Homeless status

Housing instability

Victim in custody when injured

Day of birth (Optional)

First initial of last name (Optional)

Last 4 digits of coroner/medical examiner report number (Optional)

Last 4 digits of death certificate number (Optional)

Children present and/or witnessed fatal injury

Alcohol use suspected when injured

Toxicology

Toxicology information unavailable

No substance(s) given as cause of death

Date specimens were collected

Time specimens were collected

Name of substance

Category of substance (Automatically generated)

Code for substance (Automatically generated)

Toxicologic test performed to detect the substance

Results of toxicologic test for the substance

Substance contributed to death

Person for whom substance was prescribed

Weapons

Weapon type


Table 1: SUDORS key injury and toxicology data elements (continued)

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 present

Toxicology Comments

Hospital information

Victim seen in ED

Victim admitted to inpatient care

First external cause of injury code from hospital (Optional)

Second external cause of injury code from hospital (Optional)


Suicide and undetermined intent circumstance variables that can be completed for unintentional or undetermined intent drug overdose deaths (*Indicates crisis information collected with a checkbox)

Circumstances available from Coroner/Medical Examiner

Current depressed mood

Current diagnosed mental health problem*

Type of first mental illness diagnosed

Type of second mental illness diagnosed

Other mental health diagnosis

Current mental health/substance abuse treatment

Ever treated for mental health or substance abuse problem

Non-adherence to mental health/substance abuse treatment

Alcohol problem*

Other substance abuse problem*

Other addiction*

History of traumatic brain injury

Disaster exposure*

Person left a suicide note

Recently disclosed suicidal thoughts/plans

Disclosed suicidal intent to whom

History of suicide attempts

History of expressed suicidal thoughts or plans

History of non-suicidal self-injury/self-harm

Suicide of friend or family (Optional)*^

Other crisis in past two weeks or upcoming two weeks

Non-suicide death of friend or family (Optional)*^

Contributing physical health problem (Optional)*^

Intimate partner violence (Optional)*^

Intimate partner problem (Optional)*^

Family relationship problem (Optional)*^

Caregiver burden (Optional)^

Family stressor (Optional)^

Household known to local authorities (Optional)^

Victim known to authorities (Optional)^

Other relationship problem (Optional)*^

Job problem (Optional)*^

School problem (Optional)*^

Financial problem (Optional)*^

Contributing criminal legal problem (Optional)*^

Civil legal problems (Optional)*^

Previous perpetrator of violence in the past month (Optional)^

Previous victim of violence in the past month (Optional)^

Anniversary of a traumatic event (Optional)^

Abuse or neglect led to death (Optional)^

History of abuse or neglect as a child (Optional)^

Eviction/loss of home (Optional)*^

Physical fight (2 people) (Optional)^

Argument (Optional)^

Timing of most recent argument (Optional)^

Prior Child Protective Services (CPS) report on a child victim’s household (Optional)^

Substance abuse in child victim’s household (Optional)^

Living transition/loss of independent living (Optional)^



^Recipients also funded by the National Violent Death Reporting System (CDC-RFA-CE18-1804) are required to collect additional circumstance data elements (listed as optional in the table) as well as law enforcement data elements (not listed in table) on drug overdose deaths of undetermined intent. While these data are not required as part of SUDORS, these data will be shared with the CDC SUDORS team.

Table 2: Unique SUDORS data elements collected on drug overdose deaths

Case classification

SUDORS case

SUDORS Case Classification (Automatically generated)

No coroner/medical examiner report available

Drug overdose/poisoning

Type of drug poisoning

Date last known alive before overdose

Time last known alive before overdose

Date found unresponsive

Time found unresponsive

Substance use/misuse and treatment history

Previous drug overdose

Previous overdose occurred 0-2 days prior

Previous overdose occurred 3-7 days prior

Recent opioid use relapse

Recent emergency department or urgent care visit

Treatment for substance use disorder

Inpatient/outpatient rehabilitation

Medication-assisted treatment, or MAT (with cognitive/behavioral therapy)

Medication-assisted treatment, or MAT (without cognitive/behavioral therapy)

Medication-assisted treatment, or MAT (cognitive/behavioral therapy unknown)#

Cognitive/behavioral therapy

Narcotics Anonymous

Other type of substance use disorder treatment

Involved with criminal justice system (perpetrator)

No evidence of current or past drug use/misuse

Heroin use history

Prescription opioid misuse history

Unspecified opioid use/misuse history

Fentanyl use history

Cocaine use history

Methamphetamine use history

Benzodiazepine misuse history

Cannabis (marijuana) use history

Drug use/misuse, substance unspecified

Other drug use/misuse history

Scene indications of drug use

Any evidence of drug use at scene

No evidence of drug use

Non-specific drug use evidence

Evidence of rapid overdose

Tourniquet around arm

Body position consistent with rapid overdose

Needle location

Witness report of rapid overdose

Other evidence of rapid overdose

No information on route of administration

Evidence of injection drug use

Track marks on victim

Needles/syringes at scene

Tourniquet at scene

Filters at scene

Cookers at scene

Witness report of injection drug use

Other evidence of injection drug use

Evidence of snorting/sniffing

Straws

Rolled paper or dollar bills

Razor blades

Powder on table/mirror

Powder on decedent’s nose

Witness report of snorting/sniffing

Other snorting/sniffing evidence

Evidence of smoking

Pipes

Tinfoil

Vape pens or e-cigarettes

Bon or bowl

Witness report of smoking

Other smoking evidence

Evidence of transdermal exposure

Evidence of ingestion

Evidence of suppository

Evidence of sublingual

Evidence of buccal

Evidence of unspecified drug type

Evidence of prescription drug use

Prescription drug(s) prescribed to victim

Prescription drug(s) not prescribed to victim

Prescription drug(s) with unknown prescription

Evidence of prescription drugs at scene

Pills/tablets at scene

Patch at scene

Prescription bottle at scene

Scene indications of drug abuse (continued)

Evidence of prescription drugs at scene (continued)

Liquid at scene

Lozenges/lollipops at scene

Prescription vial at scene

Witness report of prescription drug use

Other evidence of prescription drug use

Evidence of use of prescription fentanyl at scene or by witness report

Evidence of illicit drug use

Powder at scene

Witness report of illicit drug use

Counterfeit pills at scene

Tar at scene

Crystal at scene

Evidence of illicit drug packaging

Other illicit drug evidence

Response to drug overdose

Naloxone administered

Unknown whether naloxone administered

Naloxone not administered

Total number of naloxone doses by first responders/health care

Total number of naloxone doses by layperson(s)

Naloxone administered by unknown

Naloxone administered by law enforcement

Naloxone administered by EMS/fire

Naloxone administered by hospital (ED/inpatient)

Naloxone administered by other source

Naloxone administered by layperson

Layperson was person using drugs

Layperson was intimate partner

Layperson was friend

Layperson was other family

Layperson was roommate

Layperson was a stranger

Other type of layperson

Drug use witnessed

Bystander present at overdose

Person using drugs present as bystander

Intimate partner present as bystander

Other family present as bystander

Friend present as bystander

Stranger present as bystander

Roommate present as bystander

Medical professional present as bystander

Other type of bystander present

Bystander response other than naloxone

CPR performed during bystander response

Rescue breathing during bystander response

Sternal rub during bystander response

Stimulation during bystander response

Other type of bystander response



Table 2 Unique SUDORS data elements collected on drug overdose deaths (continued)

Response to drug overdose (continued)

Reasons for no or delayed response to overdose

Bystander did not recognize any abnormalities

Bystander was using substances or drinking alcohol and impaired

Public space and strangers didn’t intervene

Bystander reported abnormalities but did not recognize as overdose

Bystander spatially separated (i.e., different room)

Bystander was unaware that decedent was using drugs

No response-other

Presence of pulse on first-responder arrival

First responders responses excluding administering naloxone

CPR

Rescue breathing

Epinephrine administered

Transport to ED performed

Provided oxygen

Other first-responder intervention


Medical history

COPD (Chronic Obstructive pulmonary disease)

Asthma

Sleep apnea

Other breathing problem

Heart disease

Obesity

Hepatitis C

HIV/AIDS

History of major injury

Treated for pain at time of injury

Migraine

Back pain

Other pain

Prescription information

Use of prescription morphine

Prescription morphine narrative

Prescribed buprenorphine

Prescribed buprenorphine for pain

Prescribed buprenorphine for MAT

Prescribed buprenorphine for unknown reason

Prescribed methadone

Prescribed methadone for pain

Prescribed methadone for MAT

Prescribed methadone for unknown reason

Prescribed naltrexone

Prescribed fentanyl

Number of opioid prescriptions in 30 days preceding injury (Optional)

Number of pharmacies dispensing opioids to decedent in 180 days preceding injury (Optional)

Number of doctors writing opioid prescriptions to the decedent in the 180 days preceding injury (Optional)




2


File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorCDC User
File Modified0000-00-00
File Created2023-08-27

© 2024 OMB.report | Privacy Policy