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

 General Details

Title:
Children's Orientation and Amnesia Test (COAT)
Short Name:
COAT
Description:
The Children's Orientation and Amnesia Test (COAT) was developed to assess cognition serially during the early stage of recovery from traumatic brain injury in children and adolescents. COAT is composed of 16 items evaluating general orientation, temporal orientation, and memory.
Disease:
Traumatic Brain Injury
Organization:
NIH
Required Program Form:
No
Standardization:
Standard NINDS CDE
Labels:
Form Type:
Clinical Assessment
Publication Date:
2016-07-05
Version:
1.0
Date Created:
2015-03-31
Owner:
Number of Data Elements:
47
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 Vital status   Status of participant/subject as alive or dead VitStatus Optional CDE
5 Visit date   Actual interview or visit date VisitDate Recommended CDE
6 Site name   The name of the site for the study SiteName Recommended CDE
7 Days since baseline   The number of days since baseline DaysSinceBaseline Optional CDE
8 Case control indicator   Indicator of whether subject is in the case or control arm of the study CaseContrlInd Optional CDE
9 General notes text   General notes GeneralNotesTxt Optional CDE

Additional Element Groups

Listed below are your additional element groups.

Form Administration (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

Orientation and Amnesia Test (Repeat Infinitely)

# Title Short Description Variable Name Required? Type
1 Children's Orientation and Amnesia Test (COAT) - Live state location score  Scored ability to accurately identify the state of residence, as part of the Children's Orientation and Amnesia Test (COAT). COATLiveStateScore Recommended CDE
2 Children's Orientation and Amnesia Test (COAT) - Age score  Scored ability to accurately identify age, as part of the Children's Orientation and Amnesia Test (COAT). COATAgeScore Recommended CDE
3 Children's Orientation and Amnesia Test (COAT) - Birth day month age score  Scored ability to accurately identify birth day, month, and age, as part of the Children's Orientation and Amnesia Test (COAT). COATAgeBirthScore Recommended CDE
4 Children's Orientation and Amnesia Test (COAT) - Birth day score  Scored ability to accurately identify birth day, as part of the Children's Orientation and Amnesia Test (COAT). COATBirthDayScore Recommended CDE
5 Children's Orientation and Amnesia Test (COAT) - Birth month score  Scored ability to accurately identify birth month, as part of the Children's Orientation and Amnesia Test (COAT). COATBirthMonthScore Recommended CDE
6 Children's Orientation and Amnesia Test (COAT) - Current location score  Scored ability to accurately identify current location, as part of the Children's Orientation and Amnesia Test (COAT). COATCurrentLocationScore Recommended CDE
7 Children's Orientation and Amnesia Test (COAT) - Current time score  Scored ability identify the current time, as part of the Children's Orientation and Amnesia Test (COAT). COATCurrentTimeScore Recommended CDE
8 Children's Orientation and Amnesia Test (COAT) - Day month score  Scored ability to identify current day of the month, as part of the Children's Orientation and Amnesia Test (COAT). COATDayMonthScore Recommended CDE
9 Children's Orientation and Amnesia Test (COAT) - Day week score  Scored ability to identify current day of the week, as part of the Children's Orientation and Amnesia Test (COAT). COATDayWeekScore Recommended CDE
10 Children's Orientation and Amnesia Test (COAT) - Daytime nighttime distinction score  Scored ability to accurately identify if it is daytime or nighttime, as part of the Children's Orientation and Amnesia Test (COAT). COATTimeOfDayScore Recommended CDE
11 Children's Orientation and Amnesia Test (COAT) - Father name score  Scored ability to accurately identify father's name, as part of the Children's Orientation and Amnesia Test (COAT). COATFatherNameScore Recommended CDE
12 Children's Orientation and Amnesia Test (COAT) - Fingers score  Scored ability to accurately identify two, three, and ten fingers being held up, as part of the Children's Orientation and Amnesia Test (COAT). COATFingerScore Recommended CDE
13 Children's Orientation and Amnesia Test (COAT) - First name score  Scored ability to accurately identify first name, as part of the Children's Orientation and Amnesia Test (COAT). COATFirstNameScore Recommended CDE
14 Children's Orientation and Amnesia Test (COAT) - Full name score  Scored ability to accurately identify first and last name, as part of the Children's Orientation and Amnesia Test (COAT). COATFullNameScore Recommended CDE
15 Children's Orientation and Amnesia Test (COAT) - General orientation total score  Subject's total score for general orientation questions, as part of the Children's Orientation and Amnesia Test (COAT). COATGeneralOrientTotalScore Recommended CDE
16 Children's Orientation and Amnesia Test (COAT) - Interviewer score  Scored ability to accurately remember the Interview's name, as part of the Children's Orientation and Amnesia Test (COAT). COATInterviewerScore Recommended CDE
17 Children's Orientation and Amnesia Test (COAT) - Last name score  Scored ability to accurately identify last name, as part of the Children's Orientation and Amnesia Test (COAT). COATLastNameScore Recommended CDE
18 Children's Orientation and Amnesia Test (COAT) - Live city location score  Scored ability to accurately identify the city of residence, as part of the Children's Orientation and Amnesia Test (COAT). COATLiveCityScore Recommended CDE
19 Children's Orientation and Amnesia Test (COAT) - Live city state location score  Scored ability to accurately identify the city and identify of residence, as part of the Children's Orientation and Amnesia Test (COAT). COATLiveScore Recommended CDE
20 Children's Orientation and Amnesia Test (COAT) - Memory total score  Total score for memory questions, as part of the Children's Orientation and Amnesia Test (COAT). COATMemoryScore Recommended CDE
21 Children's Orientation and Amnesia Test (COAT) - Month score  Scored ability to identify current month, as part of the Children's Orientation and Amnesia Test (COAT). COATMonthScore Recommended CDE
22 Children's Orientation and Amnesia Test (COAT) - Mother name score  Scored ability to accurately identify mother's name, as part of the Children's Orientation and Amnesia Test (COAT). COATMotherNameScore Recommended CDE
23 Children's Orientation and Amnesia Test (COAT) - Number sequence memory score  Scored ability to repeat numbers in order, as part of the Children's Orientation and Amnesia Test (COAT). COATNumberMemoryScore Recommended CDE
24 Children's Orientation and Amnesia Test (COAT) - Overall Score  Overall score, as part of the Children's Orientation and Amnesia Test (COAT). COATOverallScore Recommended CDE
25 Children's Orientation and Amnesia Test (COAT) - Parent name score  Scored ability to accurately identify parent's names, as part of the Children's Orientation and Amnesia Test (COAT). COATParentNameScore Recommended CDE
26 Children's Orientation and Amnesia Test (COAT) - School grade score  Scored ability to accurately identify grade in school, as part of the Children's Orientation and Amnesia Test (COAT). COATGradeScore Recommended CDE
27 Children's Orientation and Amnesia Test (COAT) - School name grade score  Scored ability to accurately identify school name and grade, as part of the Children's Orientation and Amnesia Test (COAT). COATSchoolScore Recommended CDE
28 Children's Orientation and Amnesia Test (COAT) - School name score  Scored ability to accurately identify school name, as part of the Children's Orientation and Amnesia Test (COAT). COATSchoolNameScore Recommended CDE
29 Children's Orientation and Amnesia Test (COAT) - Television score  Scored ability to accurately remember a character on a television show they watch, as part of the Children's Orientation and Amnesia Test (COAT). COATTVScore Recommended CDE
30 Children's Orientation and Amnesia Test (COAT) - Temporal orientation total score  Subject's total score for temporal orientation questions, as part of the Children's Orientation and Amnesia Test (COAT). COATTemporalOrientTotalScore Recommended CDE
31 Children's Orientation and Amnesia Test (COAT) - Ten fingers score  Scored ability to accurately identify ten fingers being held up, as part of the Children's Orientation and Amnesia Test (COAT). COATTenFingersScore Recommended CDE
32 Children's Orientation and Amnesia Test (COAT) - Three fingers score  Scored ability to accurately identify three fingers being held up, as part of the Children's Orientation and Amnesia Test (COAT). COATThreeFingersScore Recommended CDE
33 Children's Orientation and Amnesia Test (COAT) - Two fingers score  Scored ability to accurately identify two fingers being held up, as part of the Children's Orientation and Amnesia Test (COAT). COATTwoFingersScore Recommended CDE
34 Children's Orientation and Amnesia Test (COAT) - Year score  Scored ability to identify current year, as part of the Children's Orientation and Amnesia Test (COAT). COATYearScore Recommended CDE

 Change History

 Administrative Change History