Stroke Trials Registry

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Stroke Trial Data Entry Form
This form may be used by trial coordinators and principal investigators to add clinical trial information for the Stroke Trials Registry. Please fill out as much information as is available.
Fields marked * are required.

TRIAL IDENTIFICATION

Trial ID:

New Trial

NCT#		ISRCTN#

* Scientific Trial Name

Acronym or Abbreviation

TRIAL ADMINISTRATION

* Coordinator or Principal Investigator

Coordinator Address

* Contact Email

Contact Address

* Sponsor(s)

* Trial Location(s)

TRIAL DESIGN

* Trial Purpose

* Interventions

* Study Design

* Inclusion Criteria

* Exclusion Criteria

* Patient Involvement

Primary Outcome Measure

Secondary Outcome Measure


Min Age		Max Age


Maximum Time from Onset		Followup Duration


Number of Patients (planned)		Number of Centers (planned)


Number of Patients (actual)		Number of Centers (actual)

TRIAL STATUS


Trial Phase		Trial Type


Trial Status		Publication Status


recruiting patients		recruiting centers


Date Enrollment Started		Date Enrollment Completed


Date First Presented		Date First Published

Results

Sources (text only)

Comments

Internet Stroke Center at Washington University:
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