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

 General Details

Title:
Hearing
Short Name:
HearingCDEs
Description:
This CRF Module contains data elements recommended by NINDS to collect to further describe the level of hearing.
Disease:
Traumatic Brain Injury
Organization:
NINDS
Required Program Form:
No
Standardization:
Standard NINDS CDE
Labels:
Form Type:
Clinical Assessment
Publication Date:
2017-03-27
Version:
1.0
Date Created:
2017-01-24
Owner:
Number of Data Elements:
32
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 (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 Language form administration ISO code  Code (ISO 639-2) for the language that was used for CRF/instrument/scale/etc. administration LangCRFAdministratISOCode Recommended CDE
2 Language form administration ISO code other text  The free-text field related to 'Language used for CRF/instrument/scale/etc. administration ISO code' specifying other text. LangCRFAdministratISOCodeOTH Recommended CDE
3 Context type  The context to which the questions were answered ContextType Recommended CDE
4 Context type other text  The free-text related to ContextType specifying other text ContextTypeOTH Recommended CDE
5 Data source  Source of the data provided on the case report form DataSource Recommended CDE
6 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

Hearing (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 Air conduction result  The result of air conduction testing, or whether patient can detect all test signals at or below 25 dB AirCondReslt Optional CDE
2 Bone conduction result  The result of bone conduction testing, or whether patient can detect all test signals at or below 25 dB BoneConductReslt Optional CDE
3 Speech reception threshold result  The result of speech reception threshold testing, or lowest dB level at which patient can correctly repeat 50% of words spoken SpchReceptnThreshldReslt Optional CDE
4 Word discrimination result  The result of word discrimination testing (percentage of words correctly repeated) WordDiscrimReslt Optional CDE
5 Tympanometry result  The result of the tympanometry test TympanometryReslt Optional CDE
6 Otoacoustic emissions result  The result of the otoacoustic emissions test OtoacoustEmissnsReslt Optional CDE
7 Brainstem auditory evoked potentials result  The result of the brainstem auditory evoked potentials test BrainstmAuditEvokPotentlReslt Optional CDE
8 Central auditory processing testing result  Global result of central auditory processing testing CntrlAuditProcessTestReslt Optional CDE
9 Dichotic consonant-vowel test result  Dichotic consonant-vowel test result as a percentage DichotConsonantVowlTestReslt Optional CDE
10 Dichotic digits test result  Dichotic digits test result as a percentage DichotDigitTestReslt Optional CDE
11 Staggered spondee word test result  Staggered spondee word test result as a percentage StaggrdSpondeeWordTestReslt Optional CDE
12 Dichotic sentence identification test result  Dichotic sentence identification test result as a percentage DichotSentnceIdentTestReslt Optional CDE
13 Masking-level differences result  The result of the masking-level differences test MaskLevelDiffsReslt Optional CDE
14 Binaural fusion test result  Binaural fusion test result threshold in msec BinaurlFusionTestReslt Optional CDE
15 Frequency pattern test result  Frequency pattern test result as a percentage FreqPatternTestReslt Optional CDE
16 Duration pattern test result  Duration pattern test result as a percentage DuratnPatternTestReslt Optional CDE
17 Minimum masking level result  The result of minimum masking level testing, the level of sound that masks a patient's tinnitus MinimumMaskLevelRestul Optional CDE

 Change History

 Administrative Change History