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

 General Details

Title:
FITBIR Injury History Form
Short Name:
InjHx_FITBIR
Description:
Injury history for FITBIR. Includes general injury history information, history of TBI, LOC and PTA information, TBI cause, etc. Collecting injury history was recommended by CDISC for TBI. References: 1. National Institute of Neurological Disorders and Stroke (NINDS) CDE project, Traumatic Brain Injury (TBI) CDEs (v2), https://www.commondataelements.ninds.nih.gov/TBI.aspx#tab=Data_Standards
Disease:
Traumatic Brain Injury
Organization:
FITBIR
Required Program Form:
No
Standardization:
Standard NINDS CDE
Labels:
Form Type:
Clinical Assessment
Publication Date:
2017-09-29
Version:
1.1
Date Created:
2016-03-31
Owner:
Number of Data Elements:
253
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

Injury General Info (Appears Up To 27 Times)

# Title Short Description Variable Name Required? Type
1 Traumatic event number  The number of traumatic event , which happened during the subject's life, as reported by the subject TraumaticEventNum Recommended CDE
2 Injury elapsed time  The elapsed time (in minutes) from the time of injury InjElapsedTime Recommended CDE
3 Injury date time  Date (and time, if applicable and known) of injury InjDateTime Recommended CDE
4 Injury date time estimation type  The type as related to the point in time estimated as injury date and time InjDateTimeEstTyp Recommended CDE
5 Data acquisition location type  Type of location where subject data were taken DataAcquisitionLocationTyp Recommended CDE
6 Data acquisition location type other text  The free-text field related to Data acquisition location type, specifying other text. Type of location where the subject data were taken DataAcquisitionLocationOTH Optional CDE
7 Injury cause type  The type as related to the classification of the external cause of the injury InjCauseTyp Recommended CDE
8 Injury cause other text  The free-text field related to 'Injury cause type' specifying other text. InjCauseTypOTH Optional CDE
9 Body system category  Category or grouping used in the comprehensive assessment of a participant/subject, which includes a subjective history taking component as well as an objective based structured interview and physical examination of all the body systems. BodySysCat Recommended CDE
10 Body system category other text  Free-text related to "Body System category" CDE used in the comprehensive assessment of a participant/subject.. BodySysOTH Recommended CDE
11 Medical history condition SNOMED CT code  Systematized Nomenclature Of Medicine Clinical Terms (SNOMED CT) code for medical condition/disease reported by the participant/subject MedclHistCondSNOMEDCTCode Recommended CDE
12 Medical history condition text  Verbatim text for the medical condition/disease reported by the participant/subject or documented in the medical record as part of medical history MedclHistCondTxt Recommended CDE
13 ICD revision number  Number of the International Classification of Diseases (ICD) used to obtain the code ICDRevNumber Recommended CDE
14 Injury ICD external cause code  Code to classify the external cause of the injury InjICDExtCauseCode Recommended CDE
15 TBI mechanism type  Type of mechanism/forces causing the traumatic brain injury TBIMechTyp Recommended CDE
16 TBI type  Indicator of the type of traumatic brain injury experienced by participant/subject TBITyp Recommended CDE
17 Injury place occurrence type  Classification of the place/setting at which the traumatic brain injury occurred InjPlcOccncTyp Recommended CDE
18 Injury place occurrence other text  The free-text field related to 'Injury place occurrence type' specifying other text. Classification of the place/setting at which the traumatic brain injury occurred InjPlcOccncOTH Optional CDE
19 Head concussion or TBI indicator  Indicator of whether the subject has had a concussion or TBI HeadConcussionOrTBIInd Optional CDE
20 Injury intention type  A type of injury intention, specifying if the injury was intentional or unintentional InjIntention Optional CDE

AIS (Appears Up To 12 Times)

# Title Short Description Variable Name Required? Type
1 Abbreviated injury scale (AIS) - Dictionary version type  A type/version of the Abbreviated Injury Scale (AIS) dictionary used to access the injury AISDictionaryVersionTyp Recommended CDE
2 Abbreviated injury scale (AIS) - Body region category  Category of body region assessed by Abbreviated Injury Scale (AIS) AISBodyRegionChapterCat Recommended CDE
3 Abbreviated injury scale (AIS) - Injury severity score  An injury severity score (AIS code), as part of Abbreviated injury scale (AIS) code AISInjurySeverityScore Recommended CDE
4 Abbreviated injury scale (AIS) - Injury clinical description text  A clinical description of the subject injury(ies) from the medical documentation, as part of Abbreviated Injury Scale (AIS). The injury should preferably be described in the Abbreviated Injury Scale code controlled vocabulary terms. AISInjuryDescriptionTxt Recommended CDE
5 Injury ICD external cause code  Code to classify the external cause of the injury InjICDExtCauseCode Recommended CDE

LOC AOC and PTA (Appears Up To 8 Times)

# Title Short Description Variable Name Required? Type
1 Injury elapsed time  The elapsed time (in minutes) from the time of injury InjElapsedTime Recommended CDE
2 Data acquisition location type  Type of location where subject data were taken DataAcquisitionLocationTyp Recommended CDE
3 Data acquisition location type other text  The free-text field related to Data acquisition location type, specifying other text. Type of location where the subject data were taken DataAcquisitionLocationOTH Optional CDE
4 Data collected date and time  Date (and time, if applicable and known) the data were collected. This may be the date/time a particular examination, report, or the procedure performed. DataCollDateTime Recommended CDE
5 Loss of consciousness indicator  The indicator for whether the participant/subject experienced any period of loss of consciousness (LOC). LOCInd Recommended CDE
6 Loss of consciousness duration range  The range of duration of loss of consciousness the participant/subject experienced LOCDurRang Recommended CDE
7 Loss of consciousness duration of time value  Duration of loss of consciousness (in seconds) the participant/subject experienced. LOCDurationVal Recommended CDE
8 Loss of consciousness verification type  The type of verification of the participant/subject's loss of consciousness LOCVerifyTyp Recommended CDE
9 Alteration consciousness indicator  The indicator of whether the participant/subject experienced any period of alteration of consciousness (AOC). AOCInd Recommended CDE
10 Alteration of consciousness duration range  The range of duration of alteration of consciousness the participant/subject experienced AOCDurRang Recommended CDE
11 Alteration of consciousness duration of time value  Duration of alteration of consciousness the participant/subject experienced. AOCDurationVal Recommended CDE
12 Alteration of consciousness verify type  The type of verification of alteration of consciousness of the participant/subject AOCVerifTyp Recommended CDE
13 Lucid interval indicator  The indicator of whether the participant/subject had a lucid interval, a delayed occurrence of loss of consciousness LucidIntrvlInd Recommended CDE
14 Lucid interval duration range  The range of duration of lucid interval the participant/subject experienced LucidIntrvlDurRang Recommended CDE
15 Lucid interval duration of time value  Duration of lucid interval (in minutes) the participant/subject experienced. LucidIntrvlDurationVal Recommended CDE
16 Loss of consciousness (LOC) to lucid interval duration range  The range of duration of time from the loss of consciousness episode to the beginning of lucid interval the participant/subject experienced LOCLucidIntrvlDurRang Recommended CDE
17 Lucid interval verification type  The type of verification of the participant/subject's lucid interval LucidIntrvlVerifyTyp Recommended CDE
18 Post traumatic amnesia indicator  Indicator for whether the participant/subject experienced any period of post-traumatic amnesia - both retrograde and anterograde PstTraumtcAmnsInd Recommended CDE
19 Post traumatic amnesia duration range  The range of duration of post-traumatic amnesia - both retrograde and anterograde- the participant/subject experienced PstTraumAmnsDurRang Recommended CDE
20 Post traumatic amnesia duration of time value  Duration (in minutes) of post-traumatic amnesia- both retrograde and anterograde - the participant/subject experienced. PstTraumAmnsDurationVal Recommended CDE
21 Post traumatic amnesia verification type  The type of verification of the participant/subject's post traumatic amnesia - both retrograde and anterograde PstTraumtcAmnsVerifyTyp Recommended UDE

Type Place Cause Mechanism of Injury Civilian (Appears Up To 12 Times)

# Title Short Description Variable Name Required? Type
1 Injury violent cause type  Type of the violence causing the injury InjVlntCauseTyp Recommended CDE
2 Influence alcohol likelihood type  Indicator for the likelihood the subject was under the influence of alcohol. InfAlcLkhdTyp Recommended CDE
3 Abusive head trauma likelihood type  Indicator to the extent of abusive head trauma is determined to be likely AbsvHdTrmaLkhdTyp Recommended CDE
4 Abusive head trauma reporter type  How the determination of abusive head trauma likelihood was made AbsvHdTrmaRprtrTyp Optional CDE
5 Abusive head trauma reporter other text  The free-text field related to 'Abusive head trauma reporter type' specifying other text. How the determination of abusive head trauma likelihood was made AbsvHdTrmaRprtrOTH Optional CDE
6 Drug or substance current illicit use indicator  Indicator of participant's/subject's use of illegal drugs, prescription or over-the-counter drugs in the past year for purposes other than those for which they are meant to be used, or in large amounts DrgSubstCurrntIllicitUseCat Optional CDE
7 Traffic accident self role type  The participant's/subject's role in The traffic accident that resulted in The injury TrffAccdntSelfRoleTyp Optional CDE
8 Traffic accident self alcohol influence likelihood type  Likelihood of whether the participant/subject was under the influence of alcohol at the time of injury TrffAccdntSefAlcInfLkhdTyp Optional CDE
9 Traffic accident self drug influence likelihood type  Likelihood of whether the participant/subject was under the influence of drugs at the time of injury TrffAccdntSelfDrgIngLkhdTyp Optional CDE
10 Traffic accident other party role type  The other party's role in The traffic accident that resulted in The participant's/subject's injury TrffAccdntOthPrtyRoleTyp Optional CDE
11 Traffic accident other party alcohol influence likelihood type  Likelihood of whether the other involved party was under the influence of alcohol at the time of the participant's/subject's injury TrffAccdntOthPrtyAlcInfLkhdTyp Optional CDE
12 Traffic accident other party drug influence likelihood type  Likelihood of whether the other involved party was under the influence of drugs at the time of the participant's/subject's injury TrffAccdntOthPrtyDrgInfLkhdTyp Optional CDE
13 Airbag deploy indicator  Indicator of an airbag deployed at the time of the participant's/subject's injury AirbagDplyInd Recommended CDE
14 Vehicular protective device type  Type of protective devices used by the participant/subject VehclrPrtctvDevTyp Recommended CDE
15 Vehicular protective device other text  The free-text field related to 'Vehicular protective device type' specifying other text. Type of protective devices used by the participant/subject VehclrPrtctvDevOTH Optional CDE
16 Biological agent exposure likelihood type  Likelihood of whether a biological agent was encountered at the time of the injury. BiolgclAgntExpsrLkhdTyp Optional CDE
17 Chemical agent exposure likelihood type  Likelihood of whether a chemical agent was encountered at the time of the injury. ChemAgntExpsrLkhdTyp Optional CDE
18 Injury description text  A text description of the injury event. InjDescriptionText Optional CDE

Type Place Cause Mechanism of Injury Sport (Appears Up To 16 Times)

# Title Short Description Variable Name Required? Type
1 Injury from sports indicator  TBI Screen: Injured head/neck doing sports TBISportInd Recommended CDE
2 Sport team participation type  The sport or team that the athlete participates in SportTeamParticipationTyp Optional CDE
3 Sport team participation other text  The free-text related to Sport team participation type specifying the other type of sport or team SportTeamParticipationTypOTH Optional CDE
4 Sport league or division type  Sport league/division in which the subject played. SportLeagueOrDivTyp Optional CDE
5 Sport league or division type other text  Free-text related to 'SportLeagueOrDivTyp' specifying other league. SportLeagueOrDivTypOTH Optional CDE
6 Injury description text  A text description of the injury event. InjDescriptionText Optional CDE

Type Place Cause Mechanism of Injury Combat (Appears Up To 16 Times)

# Title Short Description Variable Name Required? Type
1 Military deployment injury indicator  Indicator of whether the injury occurred during deployment MilDplyInjInd Recommended CDE
2 Protective devices use indicator  Indicator of protective devices used by participant/subject (e.g., helmet, car seat, seat belt, etc.) PrtctvDevcUseInd Optional CDE
3 Body armor indicator  Indicator of whether body armor was worn at the time of the injury BodyArmInd Optional CDE
4 Military combat helmet type  Type of combat helmet worn at the time of the injury. MilCmbtHelmtTyp Optional CDE
5 Blast direction type  The location of The blast related to The location of The participant/subject BlastDirTyp Optional CDE
6 Blast enclose space indicator  Indicator of blast occurring in enclosed space BlastEnclSpcInd Optional CDE
7 Blast injury category  Category of blast-related injury BlastInjCat Optional CDE
8 Blast injury device type  Type of device which caused the blast injury BlastInjDevTyp Optional CDE
9 Blast injury device other text  The free-text field related to 'Blast injury device type' specifying other text. Type of device which caused the blast injury BlastInjDevOTH Optional CDE
10 Blast prior exposure number  Number of blasts the participant has been exposed to prior to his or her current injury. BlastPriorExposurNum Recommended CDE
11 Biological agent exposure likelihood type  Likelihood of whether a biological agent was encountered at the time of the injury. BiolgclAgntExpsrLkhdTyp Optional CDE
12 Chemical agent exposure likelihood type  Likelihood of whether a chemical agent was encountered at the time of the injury. ChemAgntExpsrLkhdTyp Optional CDE
13 Drug or substance current illicit use indicator  Indicator of participant's/subject's use of illegal drugs, prescription or over-the-counter drugs in the past year for purposes other than those for which they are meant to be used, or in large amounts DrgSubstCurrntIllicitUseCat Optional CDE
14 Injury description text  A text description of the injury event. InjDescriptionText Optional CDE

ED Presentation (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 Emergency medical care provider type  Type of provider of initial medical care directly after injury EmrMedCrProvTyp Recommended CDE
2 Emergency medical care provider training type  Type of training by Emergency medical care provider. EmrgyMedclCarePrvdrTrainTyp Optional CDE
3 Emergency service type  Branch of service involved at the accident scene EmrServTyp Optional CDE
4 Emergency service other text  The free-text field related to 'Emergency service type' specifying other text. Branch of service involved at the accident scene EmrServOTH Optional CDE
5 Injury elapsed time  The elapsed time (in minutes) from the time of injury InjElapsedTime Recommended CDE
6 Care provision level  The level of care provided to participant by health care facility CareProvisionLevel Recommended CDE
7 Emergency service response time duration  Duration of time between injury and arrival of emergency services. EmrServRespTmDur Optional CDE
8 Emergency service time injury scene duration  Duration of time between arrival and departure of emergency services. EmrServTmInjScnDur Optional CDE
9 TBI therapy intensity level procedure type  Type of procedure or therapy used to assess the therapy intensity level (TIL) for treating the traumatic brain injury TBITherapIntensLvlProcType Recommended CDE
10 Hypothermia indicator  Indicator of hypothermia. Hypothermia is defined as core temperature 35 degrees Celsius HypothermInd Recommended CDE
11 Hypotensive episode indicator  Indicator of hypotensive episode. In adults, hypotensive episode is defined as systolic blood pressure & less than ; 90 mmHg. In children, it is defined as systolic blood pressure & less than ; 5th percentile for age HypotnsnEpiInd Recommended CDE
12 Hypoxic episode indicator  Indicator of hypoxic episode. Hypoxic episode is defined as partial pressure of oxygen in the blood (paO2) less than 8kPa (60mmHg) or oxygen saturation (SaO2) less than 90% HypxEpiInd Recommended CDE
13 Airway treatment type  Type of treatment or procedures the participant/subject received to support airway/ breathing AirwyTrtmtTyp Recommended CDE
14 Glasgow Outcome Scale Extended (GOS-E) - Score  Glasgow Outcome Scale Extended (1-8) GlasgowOutcomeScalExtScore Recommended CDE
15 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
16 Imaging magnetic resonance imaging performed indicator  Indicator as to whether or not Magnetic Resonance Imaging (MRI) on the brain has been performed on the participant/subject ImgMRIPerfInd Recommended CDE
17 Imaging brain assessment result  Result of the global assessment of brain imaging ImgBrainAssessmtReslt Recommended CDE
18 Subarachnoid hemorrhage status  Status of macroscopic blood located between the brain surface and the arachnoid membrane. On CT and MR, the blood in this location will follow the contour of the sulci and cisterns. Acute SAH is hyperdense on CT and hyperintense on FLAIR MR imaging. SAHStatus Recommended CDE

ED Discharge (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 Injury elapsed time  The elapsed time (in minutes) from the time of injury InjElapsedTime Recommended CDE
2 Discharge status  Status of patient at time of discharge from hospital (dead or alive) DischargeStatus Recommended CDE
3 Emergency room discharge destination reason  Reason for choice of destination upon discharge from emergency room. EmrgyRmDischrgDestRsn Recommended CDE
4 Emergency room discharge destination reason other text  The free-text field related to 'Emergency room discharge destination reason' specifying other text. Reason for choice of destination upon discharge from emergency room. EmrgyRmDischrgDestRsnOTH Optional CDE
5 Emergency room discharge destination type  Destination on completion of stabilization/evaluation in emergency room EmrgyRmDischrgDestTyp Optional CDE
6 Emergency room discharge destination other text  The free-text field related to 'Emergency room discharge destination type' specifying other text. Reason for choice of destination upon discharge from emergency room. EmrgyRmDischrgDestOTH Optional CDE
7 Glasgow Outcome Scale Extended (GOS-E) - Score  Glasgow Outcome Scale Extended (1-8) GlasgowOutcomeScalExtScore Recommended CDE
8 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
9 General notes text  General notes GeneralNotesTxt Optional CDE

Hospital Early Presentation (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 Injury elapsed time  The elapsed time (in minutes) from the time of injury InjElapsedTime Recommended CDE
2 Hospital admission date and time  Date (and time, if applicable and known) the participant/subject was admitted to the hospital HospitlAdmissDateTime Recommended CDE
3 Hospital presentation type  Whether the participant/subject was taken directly from the scene of accident to the study hospital (primary) or was first taken to a non-study hospital, and then transferred to the study hospital (secondary) HospPresTyp Recommended CDE
4 Hospital location patient first received care type  Area of the hospital the patient first evaluated HospLocPatFirstReceiveCarTyp Recommended CDE
5 Hospital not admitted but transferred to another acute care hospital indicator  Whether a patient presented to the Emergency Department of the study hospital and was transferred to an outside hospital. HospNotAdmTrnsfAnthAcCrHospInd Recommended CDE
6 Hospital transport type  Type of transportation from injury scene to hospital HospTrnsprtTyp Recommended CDE
7 Hospital transport other text  The free-text field related to 'Hospital transport type' specifying other text. Type of transportation from injury scene to hospital HospTrnsprtOTH Recommended CDE
8 Previous unit  Previous Unit PrevUnit Recommended CDE
9 Hospital unit  Hospital Unit HospitalUnit Recommended CDE
10 Hypothermia indicator  Indicator of hypothermia. Hypothermia is defined as core temperature 35 degrees Celsius HypothermInd Recommended CDE
11 Hypotensive episode indicator  Indicator of hypotensive episode. In adults, hypotensive episode is defined as systolic blood pressure & less than ; 90 mmHg. In children, it is defined as systolic blood pressure & less than ; 5th percentile for age HypotnsnEpiInd Recommended CDE
12 Hypoxic episode indicator  Indicator of hypoxic episode. Hypoxic episode is defined as partial pressure of oxygen in the blood (paO2) less than 8kPa (60mmHg) or oxygen saturation (SaO2) less than 90% HypxEpiInd Recommended CDE
13 Airway treatment type  Type of treatment or procedures the participant/subject received to support airway/ breathing AirwyTrtmtTyp Recommended CDE
14 Glasgow Outcome Scale Extended (GOS-E) - Score  Glasgow Outcome Scale Extended (1-8) GlasgowOutcomeScalExtScore Recommended CDE
15 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
16 Imaging magnetic resonance imaging performed indicator  Indicator as to whether or not Magnetic Resonance Imaging (MRI) on the brain has been performed on the participant/subject ImgMRIPerfInd Recommended CDE
17 Imaging brain assessment result  Result of the global assessment of brain imaging ImgBrainAssessmtReslt Recommended CDE
18 Subarachnoid hemorrhage status  Status of macroscopic blood located between the brain surface and the arachnoid membrane. On CT and MR, the blood in this location will follow the contour of the sulci and cisterns. Acute SAH is hyperdense on CT and hyperintense on FLAIR MR imaging. SAHStatus Recommended CDE
19 Height measurement  Measurement of participant's/subject's height. HgtMeasr Optional CDE
20 Height unit of measure  Unit of measure for the height numerical value for subject/participant HgtUOM Optional CDE
21 Weight measurement  Measurement of participant's/subject's weight WgtMeasr Optional CDE
22 Weight unit of measure  Unit of measure for the weight numerical value WgtUoM Optional CDE

Hospital Late Presentation (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 Injury elapsed time  The elapsed time (in minutes) from the time of injury InjElapsedTime Recommended CDE
2 Hospital admission date and time  Date (and time, if applicable and known) the participant/subject was admitted to the hospital HospitlAdmissDateTime Recommended CDE
3 Injury presentation reason  Reason for presentation at study facility/reason for interface with medical provider. InjPresentRsn Recommended CDE
4 Hospitalization directly after late presentation of injury indicator  Indicator of whether the patient was hospitalized directly after late presentation of injury InjPresLateInitMedCar Recommended CDE
5 Outpatient treatment type after late presentation of injury  Outpatient treatment type if no initial hospitalization after late presentation of injury InjPresLateInitMedTyp Optional CDE
6 Injury presentation professional referral category  Category of professional that referred the participant/subject to seek medical care InjPrsnttnProfssnlRfrrlCat Optional CDE
7 Glasgow Outcome Scale Extended (GOS-E) - Score  Glasgow Outcome Scale Extended (1-8) GlasgowOutcomeScalExtScore Recommended CDE
8 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
9 Imaging magnetic resonance imaging performed indicator  Indicator as to whether or not Magnetic Resonance Imaging (MRI) on the brain has been performed on the participant/subject ImgMRIPerfInd Recommended CDE
10 Imaging brain assessment result  Result of the global assessment of brain imaging ImgBrainAssessmtReslt Recommended CDE
11 Subarachnoid hemorrhage status  Status of macroscopic blood located between the brain surface and the arachnoid membrane. On CT and MR, the blood in this location will follow the contour of the sulci and cisterns. Acute SAH is hyperdense on CT and hyperintense on FLAIR MR imaging. SAHStatus Recommended CDE
12 Height measurement  Measurement of participant's/subject's height. HgtMeasr Optional CDE
13 Height unit of measure  Unit of measure for the height numerical value for subject/participant HgtUOM Optional CDE
14 Weight measurement  Measurement of participant's/subject's weight WgtMeasr Optional CDE
15 Weight unit of measure  Unit of measure for the weight numerical value WgtUoM Optional CDE

Hospital Discharge (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 Injury elapsed time  The elapsed time (in minutes) from the time of injury InjElapsedTime Recommended CDE
2 Hospital discharge date and time  Date (and time, if applicable and known) the participant/subject was discharged from the hospital HospitDischgDateTime Recommended CDE
3 Discharge status  Status of patient at time of discharge from hospital (dead or alive) DischargeStatus Recommended CDE
4 Hospital discharge destination type  Type of destination on completion of stabilization/evaluation in hospital HospDischrgDestTyp Recommended CDE
5 Hospital discharge destination other text  The free-text field related to 'Hospital discharge destination type' specifying other text. Type of destination on completion of stabilization/evaluation in hospital HospDischrgDestOTH Recommended CDE
6 Glasgow Outcome Scale Extended (GOS-E) - Score  Glasgow Outcome Scale Extended (1-8) GlasgowOutcomeScalExtScore Recommended CDE
7 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
8 General notes text  General notes GeneralNotesTxt Optional CDE
9 Do not resuscitate or intubate (DNR or DNI) indicator  Indicates if participant/ subject was made DNR/ DNI (Do not resuscitate/ Do not intubate) during hospitalization DNRDNIInd Recommended CDE
10 Injury elapsed time Do Not Resuscitate (DNR)  Injury elapsed time Do Not Resuscitate (DNR) DNRWrittenInjElapsedTime Optional UDE
11 Do not resuscitate or intubate (DNR or DNI) earliest documentation timepoint type  Timepoint of earliest documentation of DNR/ DNI (Do not resuscitate/ Do not intubate) during hospitalization DNRDNIEarliestDocTimpntTyp Optional CDE
12 Injury elapsed time (Support Withdrawn)  Injury elapsed time (Support Withdrawn) SupportWithdrawnInjElapsedTime Optional CDE

Neurological Assessment Symptoms and Signs (Appears Up To 22 Times)

# Title Short Description Variable Name Required? Type
1 Injury elapsed time  The elapsed time (in minutes) from the time of injury InjElapsedTime Recommended CDE
2 Data acquisition location type  Type of location where subject data were taken DataAcquisitionLocationTyp Optional CDE
3 Data acquisition location type other text  The free-text field related to Data acquisition location type, specifying other text. Type of location where the subject data were taken DataAcquisitionLocationOTH Optional CDE
4 Traumatic Brain Injury symptom indicator  Indicator of whether the participant/subject displayed the specific TBI physical symptom or sign TBISympInd Recommended CDE
5 Traumatic Brain Injury symptom type  The types of Traumatic Brain Injury (TBI) symptoms or signs displayed by The participant/subject TBISympTyp Recommended CDE
6 Traumatic Brain Injury symptom type other text  Free text for "Traumatic Brain Injury symptom type" specifying other text TBISympTypOTH Recommended CDE
7 Orientation person result  Result of how the participant/subject responded to questions about himself/herself, such as name and birth date OrientPersonReslt Optional CDE
8 Orientation place result  Result of how the participant/subject responded to questions about his/her current location OrientPlaceReslt Optional CDE
9 Orientation time result  Result of how the participant/subject responded to questions about today's date (e.g., date, month, year, day of week, time of day, season of year) OrientTimeReslt Optional CDE
10 Traumatic brain injury symptom category  Category of traumatic brain injury symptom/sign displayed by the participant/subject TBISympCat Recommended CDE
11 Traumatic brain injury symptom other text  Specify in the text the type of traumatic Brain Injury symptoms or signs displayed by the participant/subject if not listed above TBISympOthrTxt Recommended CDE
12 Traumatic brain injury symptom rating code  Code that describes overall how different the participant/subject is acting compared to his/her usual self TBISympRatingCode Recommended CDE

Previous TBIs Including Sport Related (Appears Up To 15 Times)

# Title Short Description Variable Name Required? Type
1 Prior traumatic injury indicator  Indicator of prior traumatic injury found either historically, previous emergency department visits, radiographic findings, or signs or symptoms at time of presentation. PriorTraumInjryInd Recommended CDE
2 Traumatic event number  The number of traumatic event , which happened during the subject's life, as reported by the subject TraumaticEventNum Recommended CDE
3 Injury date time  Date (and time, if applicable and known) of injury InjDateTime Recommended CDE
4 Injury date time estimation type  The type as related to the point in time estimated as injury date and time InjDateTimeEstTyp Optional CDE
5 Injury from sports indicator  TBI Screen: Injured head/neck doing sports TBISportInd Recommended CDE
6 History of concussion Indicator  Indicator if the subject had a history of concussion ConcussionHistoryInd Recommended CDE
7 Hospitalization for head/neck injury Indicator  TBI Screen: Hospitalization for head/neck injury Indicator TBIHospitalizedInd Recommended UDE
8 Prior traumatic injury type  General location of traumatic injury, if evidence of prior traumatic injury PriorTraumInjryType Recommended CDE
9 Head injury prior number  Number of prior head injuries, if previous TBI history HeadInjPriorNum Recommended CDE
10 Concussion prior number  Number of prior concussions ConcussionPriorNum Recommended CDE
11 Blast prior exposure number  Number of blasts the participant has been exposed to prior to his or her current injury. BlastPriorExposurNum Recommended CDE
12 Loss of Consciousness (LOC) - TBI LOC youngest age  TBI Screen: Youngest age reported when subject had Loss of Consciousness (LOC) due to TBI TBILocYoungestAge Optional UDE
13 Youngest age of dazed and confused injury  TBI Screen: youngest age of dazed and confused injury TBIDazedYoungestAge Optional UDE
14 Loss of Consciousness (LOC) - Longest period of unconsciousness due to TBI age in years  Enter age in years when the subject had the longest period of unconsciousness (LOC) due to injury TBILocLongestKO Optional UDE
15 Loss of Consciousness (LOC) - due to TBI memory gap indicator  TBI Screen: Indicator if the subject was dazed or had a gap in memory due to TBI TBILocMemoryGapInd Optional UDE
16 Loss of Consciousness (LOC) - over 30 minutes due to TBI lifetime count  TBI Screen: Count of how many injuries had the subject during his/her lifetime where LOC was over 30 minutes TBILocOver30MinCnt Optional UDE
17 Number of times lost consciousness from drug overdose  TBI Screen: number of times lost consciousness from drug overdose TBIOverdoseCnt Optional CDE
18 Longest period of being dazed and confused  TBI Screen: Longest period of being dazed and confused TBIDazedLongestKO Optional UDE
19 Number of times dazed and confused for more than 30 mins  TBI Screen: number of times dazed and confused for more than 30 mins TBIDazedOver30MinCnt Optional UDE

Concussion History Including Sport Related (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 Traumatic event number  The number of traumatic event , which happened during the subject's life, as reported by the subject TraumaticEventNum Recommended CDE
2 Concussion diagnosis status  Indicator, whether the reported concussion was or was not diagnosed by a medical provider ConcussDxStatus Recommended CDE
3 Concussion relatedness type  Whether concussion injury was related to playing sports, civilian accident, military accident, combat experience or something else ConcussionRelatednessTyp Recommended CDE
4 Concussion relatedness type other text  A free text related Concussion relatedness type UDE, specifying other text. Whether concussion injury was related to playing sports, civilian accident, military accident, combat experience or something else ConcussionRelatednessTypOTH Recommended CDE
5 Injury date time  Date (and time, if applicable and known) of injury InjDateTime Recommended CDE
6 Injury date time estimation type  The type as related to the point in time estimated as injury date and time InjDateTimeEstTyp Recommended CDE
7 Loss of Consciousness (LOC) - Age of subject when LOC occurred due to Injury 1  TBI Screen: Age of subject when Loss of Consciousness (LOC) occurred due to Injury 1 TBILocAge1 Recommended UDE
8 Loss of Consciousness (LOC) - Age of subject when LOC occurred due to Injury 2  TBI Screen: Age of subject when Loss of Consciousness (LOC) occurred due to Injury 2 TBILocAge2 Recommended UDE
9 Loss of Consciousness (LOC) - Age of subject when LOC occurred due to Injury 3  TBI Screen: Age of subject when Loss of Consciousness (LOC) occurred due to Injury 3 TBILocAge3 Recommended UDE
10 Loss of Consciousness (LOC) - Age of subject when LOC occurred due to Injury 4  TBI Screen: Age of subject when Loss of Consciousness (LOC) occurred due to Injury 4 TBILocAge4 Recommended UDE
11 Loss of Consciousness (LOC) - Age of subject when LOC occurred due to Injury 5  TBI Screen: Age of subject when Loss of Consciousness (LOC) occurred due to Injury 5 TBILocAge5 Recommended UDE
12 Loss of Consciousness (LOC) - Age of subject when LOC occurred due to Injury 6  TBI Screen: Age of subject when Loss of Consciousness (LOC) occurred due to Injury 6 TBILocAge6 Recommended UDE
13 Loss of Consciousness (LOC) - Age of subject when LOC occurred due to Injury 7  TBI Screen: Age of subject when Loss of Consciousness (LOC) occurred due to Injury 7 TBILocAge7 Recommended UDE
14 Loss of Consciousness (LOC) - Age of subject when LOC occurred due to Injury 8  TBI Screen: Age of subject when Loss of Consciousness (LOC) occurred due to Injury 8 TBILocAge8 Recommended UDE
15 Loss of Consciousness (LOC) - Age of subject when LOC occurred due to Injury 9  TBI Screen: Age of subject when Loss of Consciousness (LOC) occurred due to Injury 9 TBILocAge9 Recommended UDE
16 Loss of Consciousness (LOC) - Age of subject when LOC occurred due to Injury 10  TBI Screen: Age of subject when Loss of Consciousness (LOC) occurred due to Injury 10 TBILocAge10 Recommended UDE
17 Loss of Consciousness (LOC) - Subject was unconscious due to injury 1 time duration  TBI Screen: Duration (in minutes) subject report being unconscious due to injury 1 (LOC) TBILocDuration1 Recommended UDE
18 Loss of Consciousness (LOC) - Subject was unconscious due to injury 2 time duration  TBI Screen: Duration (in minutes) subject report being unconscious due to injury 2 (LOC) TBILocDuration2 Recommended UDE
19 Loss of Consciousness (LOC) - Subject was unconscious due to injury 3 time duration  TBI Screen: Duration (in minutes) subject report being unconscious due to injury 3 (LOC) TBILocDuration3 Recommended UDE
20 Loss of Consciousness (LOC) - Subject was unconscious due to injury 4 time duration  TBI Screen: Duration (in minutes) subject report being unconscious due to injury 4 (LOC) TBILocDuration4 Recommended UDE
21 Loss of Consciousness (LOC) - Subject was unconscious due to injury 5 time duration  TBI Screen: Duration (in minutes) subject report being unconscious due to injury 5 (LOC) TBILocDuration5 Recommended UDE
22 Loss of Consciousness (LOC) - Subject was unconscious due to injury 6 time duration  TBI Screen: Duration (in minutes) subject report being unconscious due to injury 6 (LOC) TBILocDuration6 Recommended UDE
23 Loss of Consciousness (LOC) - Subject was unconscious due to injury 7 time duration  TBI Screen: Duration (in minutes) subject report being unconscious due to injury 7 (LOC) TBILocDuration7 Recommended UDE
24 Loss of Consciousness (LOC) - Subject was unconscious due to injury 8 time duration  TBI Screen: Duration (in minutes) subject report being unconscious due to injury 8 (LOC) TBILocDuration8 Recommended UDE
25 Loss of Consciousness (LOC) - Subject was unconscious due to injury 9 time duration  TBI Screen: Duration (in minutes) subject report being unconscious due to injury 9 (LOC) TBILocDuration9 Recommended UDE
26 Loss of Consciousness (LOC) - Subject was unconscious due to injury 10 time duration  TBI Screen: Duration (in minutes) subject report being unconscious due to injury 10 (LOC) TBILocDuration10 Recommended UDE
27 Age at dazed injury 1  TBI Screen: Age at dazed injury 1 TBIDazedAge1 Recommended UDE
28 Age at dazed injury 2  TBI Screen: age at dazed injury 2 TBIDazedAge2 Recommended UDE
29 Age at dazed injury 3  TBI Screen: age at dazed injury 3 TBIDazedAge3 Recommended UDE
30 Age at dazed injury 4  TBI Screen: age at dazed injury 4 TBIDazedAge4 Recommended UDE
31 Age at dazed injury 5  TBI Screen: age at dazed and confused injury number 5 TBIDazedAge5 Recommended UDE
32 Age at dazed injury 6  TBI Screen: Age at dazed injury 6 TBIDazedAge6 Recommended UDE
33 Age at dazed injury 7  TBI Screen: age at dazed injury 7 TBIDazedAge7 Recommended UDE
34 Age at dazed injury 8  TBI Screen: age at dazed injury 8 TBIDazedAge8 Recommended UDE
35 Age at dazed injury 9  TBI Screen: age at dazed injury 9 TBIDazedAge9 Recommended UDE
36 Age at dazed injury 10  TBI Screen: age at dazed injury 10 TBIDazedAge10 Recommended UDE
37 Dazed and confused for how long dazed injury 1  TBI Screen: dazed and confused for how long dazed injury 1 TBIDazedDuration1 Recommended UDE
38 Dazed and confused for how long dazed injury 2  TBI Screen dazed and confused for how long dazed injury 2 TBIDazedDuration2 Recommended UDE
39 Dazed and confused for how long dazed injury 3  TBI Screen: dazed and confused for how long dazed injury 3 TBIDazedDuration3 Recommended UDE
40 Dazed and confused for how long dazed Injury 4  TBI Screen: dazed and confused for how long dazed Injury 4 TBIDazedDuration4 Recommended UDE
41 Dazed and confused for how long dazed injury 5  TBI Screen: dazed and confused for how long dazed injury 5 TBIDazedDuration5 Recommended UDE
42 Dazed and confused for how long dazed injury 6  TBI Screen: dazed and confused for how long dazed injury 6 TBIDazedDuration6 Recommended UDE
43 Dazed and confused for how long dazed injury 7  TBI Screen: dazed and confused for how long dazed injury 7 TBIDazedDuration7 Recommended UDE
44 Dazed and confused for how long dazed injury 8  TBI Screen: dazed and confused for how long dazed injury 8 TBIDazedDuration8 Recommended UDE
45 Dazed and confused for how long dazed Injury 9  TBI Screen: dazed and confused for how long dazed Injury 9 TBIDazedDuration9 Recommended UDE
46 Dazed and confused for how long dazed injury 10  TBI Screen: dazed and confused for how long dazed injury 10 TBIDazedDuration10 Recommended UDE
47 Concussion symptom duration  Number of days that the participant suffered from post-concussive symptoms ConcussionSymptomDurDays Recommended CDE

 Change History

 Administrative Change History