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

 General Details

Title:
Glasgow Outcome Scale Extended (GOS-E)
Short Name:
GOSE_Standard
Description:
The Glasgow Outcome Scale Extended (GOS-E) is a revision of the Glasgow Outcome Scale (GOS) that 1) rates patient status into one of five categories: Dead, Vegetative State, Severe Disability, Moderate Disability or Good Recovery and 2) divides the upper three ratings into upper and lower categories - lower severe disability, upper severe disability, lower moderate disability, upper moderate disability, lower good recovery, upper good recovery. Recommended by CDISC for TBI (TAUG TBI)
Disease:
Traumatic Brain Injury
Organization:
NIH
Required Program Form:
No
Standardization:
Standard NINDS CDE
Labels:
Form Type:
Clinical Assessment
Publication Date:
2014-09-12
Version:
1.3
Date Created:
2014-08-25
Owner:
Number of Data Elements:
32
eForms:
Y

 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 Glasgow Outcome Scale Extended (GOS-E) - Respondent type  Person responding to the Glasgow Outcome Scale Extended (GOSE). GOSEResponse Recommended CDE
2 Glasgow Outcome Scale Extended (GOS-E) - Consciousness indicator  Indicator if the participant is able to obey simple commands or say any words as part of Glasgow Outcome Scale Extended (GOS-E). GOSEConsciousInd Recommended CDE
3 Glasgow Outcome Scale Extended (GOS-E) - Assistance daily need indicator  Indicator if the participant needs another person at home essentially every day for some activities of daily living as part of Glasgow Outcome Scale Extended (GOS-E). GOSEAsstNeedInd Recommended CDE
4 Glasgow Outcome Scale Extended (GOS-E) - Frequent help need indicator  Indicator if the participant is in need of frequent help of someone to be around at home as part of Glasgow Outcome Scale Extended (GOS-E). GOSEFreqntHlpNeedInd Recommended CDE
5 Glasgow Outcome Scale Extended (GOS-E) - Assistance at home pre-injury indicator  Indicator if the assistance at home was essential for the patient before the injury, as part of Glasgow Outcome Scale Extended (GOS-E). GOSEIndpntPreInjryInd Recommended CDE
6 Glasgow Outcome Scale Extended (GOS-E) - Shop without assistance indicator  Indicator if the participant is able to shop without assistance as part of Glasgow Outcome Scale Extended (GOS-E). GOSEShpWoutAsstInd Recommended CDE
7 Glasgow Outcome Scale Extended (GOS-E) - Shop without assistance pre-injury indicator  Indicator if the participant was able to shop without assistance before injury as part of Glasgow Outcome Scale Extended (GOS-E). GOSEShpWoutAsstPreInjryInd Recommended CDE
8 Glasgow Outcome Scale Extended (GOS-E) - Travel without assistance indicator  Indicator if the participant is able to travel locally without help as part of Glasgow Outcome Scale Extended (GOS-E) GOSETrvlWoutAsstInd Recommended CDE
9 Glasgow Outcome Scale Extended (GOS-E) - Travel without assistance pre-injury indicator  Indicator if the participant was able to travel locally without help before injury as part of Glasgow Outcome Scale Extended (GOS-E). GOSETrvlWoutAsstPreInjryInd Recommended CDE
10 Glasgow Outcome Scale Extended (GOS-E) - Current work normal capacity indicator  Indicator if the participant is currently able to work at the same capacity before injury as part of Glasgow Outcome Scale Extended (GOS-E). GOSECrrntWrkInd Recommended CDE
11 Glasgow Outcome Scale Extended (GOS-E) - Work restriction from injury type  Work restriction type experienced by the participant as a result of injury as part of Glasgow Outcome Scale Extended (GOS-E). GOSEWrkRestrictTyp Recommended CDE
12 Glasgow Outcome Scale Extended (GOS-E) - Work restriction pre-injury change level indicator  Indicator if the participant was either working or seeking employment before the injury or was doing neither, as part of Glasgow Outcome Scale Extended (GOS-E). GOSELvlRestrictInd Recommended CDE
13 Glasgow Outcome Scale Extended (GOS-E) - Social leisure outside resume activity indicator  Indicator if the participant is able to resume regular social and leisure activities outside home as part of Glasgow Outcome Scale Extended (GOS-E). GOSESocLeisOutInd Recommended CDE
14 Glasgow Outcome Scale Extended (GOS-E) - Extent restriction social leisure activity frequency  Frequency of the extent of restriction the participant faces on social and leisure activities as part of Glasgow Outcome Scale Extended (GOS-E). GOSEExtntRestrctSocFreq Recommended CDE
15 Glasgow Outcome Scale Extended (GOS-E) - Participation social leisure activity pre-injury indicator  Indicator if the participant was engaged in regular social and leisure activities outside home before the injury, as part of Glasgow Outcome Scale Extended (GOS-E). GOSEExtntRestrctSocPreInjrInd Recommended CDE
16 Glasgow Outcome Scale Extended (GOS-E) - Relationship disruption indicator  Indicator if the participant faces any rifts in family relationships or friendships caused by psychological problems as part of Glasgow Outcome Scale Extended (GOS-E). GOSEFrindshpInd Recommended CDE
17 Glasgow Outcome Scale Extended (GOS-E) - Extent relationship strain frequency  Frequency of the extent of the rifts in relationships, including family and friendships, due to psychological problems as part of Glasgow Outcome Scale Extended (GOS-E). GOSEExtntFriendshpStrnFreq Recommended CDE
18 Glasgow Outcome Scale Extended (GOS-E) - Family and friendship problems pre-injury indicator  Indicator if the participant experienced problems with family or friends before the injury, as part of Glasgow Outcome Scale Extended (GOS-E). GOSELvlStrnPreInjryInd Recommended CDE
19 Glasgow Outcome Scale Extended (GOS-E) - Current other problem indicator  Indicator if the participant faces any other current problems currently due to injury as part of Glasgow Outcome Scale Extended (GOS-E). GOSECrrntProbInd Recommended CDE
20 Glasgow Outcome Scale Extended (GOS-E) - Similar problems pre-injury indicator  Indicator if the similar problems were present before injury and have these become markedly worse as part of Glasgow Outcome Scale Extended (GOS-E). GOSESimlrProbPreInjryInd Recommended CDE
21 Glasgow Outcome Scale Extended (GOS - E) - Most important factor in outcome type  The most important factor in outcome as part of Glasgow Outcome Scale Extended (GOS-E). GOSEMstImptFctrTyp Recommended CDE
22 Glasgow Outcome Scale Extended (GOS-E) - Score  Glasgow Outcome Scale Extended (1-8) GlasgowOutcomeScalExtScore Recommended CDE

Additional Info (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 Epileptic fit post injury indicator  Indicator if the participant has had epileptic fits since the injury EpilepsyFitsInd Recommended CDE
2 Epileptic fit risk indicator  Indicator if the participant has been told he/she is at risk of developing epilepsy EpilepsyRiskInd Recommended CDE

 Change History

 Administrative Change History