This form structure is an organized set of data definitions for a copyrighted form

 General Details

Title:
Alcohol Use Disorders Identification Test: Self-Report Version (AUDIT)
Short Name:
AUDIT_FITBIR
Description:
The AUDIT consists of 10 items which are used to assess excessive drinking, signs of dependence and harmful use in the past year. Recommended by CDISC for TBI (TAUG TBI)
Disease:
Traumatic Brain Injury
Organization:
NINDS
Required Program Form:
No
Standardization:
Standard NINDS CDE
Labels:
Form Type:
Clinical Assessment
Publication Date:
2014-11-14
Version:
1.3
Date Created:
2014-10-31
Owner:
Number of Data Elements:
19
eForms:
N

 Documentation


 Groups & Attached Data Elements

Logically grouped data elements with defined frequency at which they repeat.

# Title Short Description Variable Name Required? Type
1 GUID   Global Unique ID which uniquely identifies a subject GUID Required CDE
2 Subject identifier number   An identification number assigned to the participant/subject within a given protocol or a study. SubjectIDNum Optional CDE
3 Age in years   Value for participant's subject age recorded in years. AgeYrs Recommended CDE
4 Visit date   Actual interview or visit date VisitDate Recommended CDE
5 Site name   The name of the site for the study SiteName Recommended CDE
6 Days since baseline   The number of days since baseline DaysSinceBaseline Optional CDE
7 Case control indicator   Indicator of whether subject is in the case or control arm of the study CaseContrlInd Optional CDE
8 General notes text   General notes GeneralNotesTxt Optional CDE

Additional Element Groups

Listed below are your additional element groups.

AUDIT (Repeat Infinitely)

# Title Short Description Variable Name Required? Type
1 Alcohol Use Disorders Identification Test (AUDIT) - Drink contain alcohol frequency score  Score for the frequency with which the subject consumes alcoholic drinks. AUDITDrnkContainAlcFreqScore Recommended CDE
2 Alcohol Use Disorders Identification Test (AUDIT) - Alcohol drink typical day number score  Score for the number of drinks the subject consumes on a day he or she is drinking. AUDITAlcDrnkTypclDayNumScore Recommended CDE
3 Alcohol Use Disorders Identification Test (AUDIT) - More than 6 alcohol drink frequency score  Score for the frequency with which the subject consumes six or more alcoholic drinks on a single occasion. AUDITMoreThan6AlcDrnkFreqScore Recommended CDE
4 Alcohol Use Disorders Identification Test (AUDIT) - Cannot stop drink alcohol frequency score  Score for the frequency within the last year with which the subject found himself or herself unable to stop drinking once he or she started. AUDITCantStopDrnkAlcFreqScore Recommended CDE
5 Alcohol Use Disorders Identification Test (AUDIT) - Fail normal activity drink frequency score  The frequency with which the subject found himself or herself unable to perform normal tasks due to drinking. AUDITFailNrmlActDrnkFreqScore Recommended CDE
6 Alcohol Use Disorders Identification Test (AUDIT) - Morning drink after frequency score  The frequency with which the subject found himself or herself in need of an alcoholic drink in the morning due to a heavy drinking session the night before. AUDITMornDrnkAftDrnkFreqScore Recommended CDE
7 Alcohol Use Disorders Identification Test (AUDIT) - Guilt remorse after drink frequency score  Score for the frequency within the last year with which the subject found himself or herself with feelings or guilt or remorse after drinking. AUDITGltRmrseAftrDrnkFreqScore Recommended CDE
8 Alcohol Use Disorders Identification Test (AUDIT) - Cannot remember night before frequency score  Score for the frequency within the last year with which the subject was unable to remember what happened the previous night due to drinking. AUDITCantRmbrNghtBefrFreqScore Recommended CDE
9 Alcohol Use Disorders Identification Test (AUDIT) - Drink injury indicator score  Score for the indicator of whether someone that the subject knows was injured due to his or her drinking. AUDITDrnkInjIndScore Recommended CDE
10 Alcohol Use Disorders Identification Test (AUDIT) - Relative friend doctor concern indicator score  Score for the indicator of whether a relative, friend, doctor, or other health care workers has been concerned about the subject's drinking or suggested the subject cut down. AUDITReltvFrndDrCncrnIndScore Recommended CDE
11 Alcohol Use Disorders Identification Test (AUDIT) - Total score  The subject/participant's AUDIT total score (0-40) AUDITTotalScore Recommended CDE

 Change History

 Administrative Change History