This form structure is an organized set of data definitions for a form that has not been copyrighted

 General Details

Title:
Brief Traumatic Brain Injury Screen (BTBIS)
Short Name:
BTBIS
Description:
The Brief Traumatic Brain Injury Screen (BTBIS) is a self-report measure to traumatic brain injury (TBI) in service members. References: Schwab KA, Ivins B, Cramer G, Johnson W, Sluss-Tiller M, Kiley K, Lux W, Warden D.J Screening for traumatic brain injury in troops returning from deployment in Afghanistan and Iraq: initial investigation of the usefulness of a short screening tool for traumatic brain injury. Head Trauma Rehabil. 2007 Nov-Dec;22(6):377-89.https://www.ncbi.nlm.nih.gov/pubmed/18025970
Disease:
General (For all diseases)
Required Program Form:
No
Standardization:
Standard NINDS CDE
Labels:
Form Type:
Clinical Assessment
Publication Date:
2015-06-01
Version:
1.2
Date Created:
2015-05-14
Owner:
Number of Data Elements:
17
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.

Form Administration Group (Repeat Infinitely)

# Title Short Description Variable Name Required? Type
1 Context type  The context to which the questions were answered ContextType Recommended CDE
2 Context type other text  The free-text related to ContextType specifying other text ContextTypeOTH Recommended CDE
3 Data source  Source of the data provided on the case report form DataSource Recommended CDE
4 Data source other text  The free-text field related to Data source specifying other text. Source of the data provided on the case report form DataSourceOTH Recommended CDE

Brief Traumatic Brain Injury Screen (BTBIS) (Repeat Infinitely)

# Title Short Description Variable Name Required? Type
1 Brief Traumatic Brain Injury Screen (BTBIS) - Injury during deployment type  The type of injury sustained during deployment, as part of the Brief Traumatic Brain Injury Screen (BTBIS). BTBISInjDeployTyp Recommended CDE
2 Brief Traumatic Brain Injury Screen (BTBIS) - Injury during deployment other text  The free-text related to 'BTBISInjDeployTyp' specifying other text BTBISInjDeployOTH Recommended CDE
3 Brief Traumatic Brain Injury Screen (BTBIS) - Injury result type  The type of result from injury during deployment, as part of the Brief Traumatic Brain Injury Screen (BTBIS). BTBISInjResultTyp Recommended CDE
4 Brief Traumatic Brain Injury Screen (BTBIS) - Symptom related to injury type  The type of symptom experienced related to head injury or concussion, as part of the Brief Traumatic Brain Injury Screen (BTBIS).. BTBISSymptomRelateInjTyp Recommended CDE
5 Brief Traumatic Brain Injury Screen (BTBIS) - Symptom related to injury other text  The free-text related to 'BTBISSymptomRelateInjTyp' specifying other text BTBISSymptomRelateInjOTH Recommended CDE

 Change History

 Administrative Change History