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

 General Details

Title:
Pediatric Glasgow Outcome Scale - Extended (GOS-E Peds)
Short Name:
GOSE_Peds
Description:
The Glasgow Outcome Scale-Extended Pediatric Version (GOS-E Peds) is a modified GOS-E revision, which is developmentally appropriate structured interview that should be used to classify younger patients.
Disease:
Traumatic Brain Injury
Organization:
NIH
Required Program Form:
No
Standardization:
Standard NINDS CDE
Labels:
Form Type:
Clinical Assessment
Publication Date:
2014-10-23
Version:
1.0
Date Created:
2014-08-25
Owner:
Number of Data Elements:
24
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 Completion (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 Pediatric Glasgow Outcome Scale - Extended (GOS-E Peds) - Information obtain type  How was the information obtained GOSEPInfoObtain Recommended CDE
2 Pediatric Glasgow Outcome Scale - Extended (GOS-E Peds) - Consciousness indicator  Consciousness indicator GOSEPConsciousnessInd Recommended CDE
3 Pediatric Glasgow Outcome Scale - Extended (GOS-E Peds) - Assistance home requirement indicator  Assistance for daily living needed indicator GOSEPAsstNeedInd Recommended CDE
4 Pediatric Glasgow Outcome Scale - Extended (GOS-E Peds) - Frequent assistance home need indicator  Frequent help needed indicator GOSEPFreqntHlpNeedInd Recommended CDE
5 Pediatric Glasgow Outcome Scale - Extended (GOS-E Peds) - Shop travel without assistance indicator  Shop and travel without assistance indicator GOSEPShpTrvlWoutAsstInd Recommended CDE
6 Pediatric Glasgow Outcome Scale - Extended (GOS-E Peds) - Current work and school function pre- injury capacity indicator  Current work and school function in pre-injury capacity indicator GOSEPCrrntWrkSchlInd Recommended CDE
7 Pediatric Glasgow Outcome Scale - Extended (GOS-E Peds) - Work school restriction indicator  Work and school restriction indicator GOSEPWrkSchlRestrictInd Recommended CDE
8 Pediatric Glasgow Outcome Scale - Extended (GOS-E Peds) - Reduced work school capacity indicator  Reduced work or school capacity indicator GOSEPWrkSchlReducedCapacInd Recommended CDE
9 Pediatric Glasgow Outcome Scale - Extended (GOS-E Peds) - Current participation social leisure activity pre-injury indicator  Participation in social and leisure activities as before the injury indicator GOSEPSocLeisInd Recommended CDE
10 Pediatric Glasgow Outcome Scale - Extended (GOS-E Peds) - Extent restriction social leisure activity unable participate indicator  Unable to participate in social and leisure activities indicator GOSEPSocLeisUnableParticInd Recommended CDE
11 Pediatric Glasgow Outcome Scale - Extended (GOS-E Peds) - Extent restriction social leisure activity much decrease participation indicator  Participate much less in social and leisure activities indicator GOSEPSocLeisPartMuchLessInd Recommended CDE
12 Pediatric Glasgow Outcome Scale - Extended (GOS-E Peds) - Extent restriction social leisure activity little decrease participation indicator  Participate a bit less in social and leisure activities indicator GOSEPSocLeisPartBitLessInd Recommended CDE
13 Pediatric Glasgow Outcome Scale - Extended (GOS-E Peds) - Family friendship psychological problem indicator  Family and friendship psychological problems indicator GOSEPFamFrindshpInd Recommended CDE
14 Pediatric Glasgow Outcome Scale - Extended (GOS-E Peds) - Extent disruption family friendship type  The extent of disruption or strain in family and friendship due to injury. GOSEPExtntDisrFamFrindshp Recommended CDE
15 Pediatric Glasgow Outcome Scale - Extended (GOS-E Peds) - Return to normal life, other problem indicator  Return to normal life, other problems indicator. GOSEPCrrntOthProbInd Recommended CDE
16 Pediatric Glasgow Outcome Scale - Extended (GOS-E Peds) - Score  Score for the participant, as a part of the Pediatric Glasgow Outcome Scale - Extended (PGOSE). PGOSEScore Recommended CDE

 Change History

 Administrative Change History