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

 General Details

Title:
JFK Coma Recovery Scale- Revised (CRS-R)
Short Name:
JKFCRSR
Description:
The CRS-R consists of twenty-three items comprising six hierarchically-arranged subscales addressing auditory, visual, motor, oromotor/verbal, communication and arousal functions. The lowest item on each subscale represents reflexive activity while the highest items represent cognitively-mediated behaviors. CDISC (TAUG TBI) References: Arch Phys Med Rehabil. 2004 Dec;85(12):2020-9. The JFK Coma Recovery Scale-Revised: measurement characteristics and diagnostic utility. Giacino JT1, Kalmar K, Whyte J. https://www.ncbi.nlm.nih.gov/pubmed/15605342 Copyright 2004 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation. Recommended by CDISC for TBI.
Disease:
General (For all diseases) , Traumatic Brain Injury
Organization:
NINDS
Required Program Form:
No
Standardization:
Standard NINDS CDE
Labels:
Form Type:
Clinical Assessment
Publication Date:
2017-09-28
Version:
1.2
Date Created:
2016-04-07
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

JFK CRS-Revised Visit Detail (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 JFK Coma Recovery Scale - Revised (JFK CRS-R) - Consciousness Diagnosis Criteria Category  Category for Consciousness Diagnosis criteria, as a part of JFK Coma Recovery Scale - Revised (JFK CRS-R) ConscDiganosisCriteriaCat Recommended UDE
2 JFK Coma Recovery Scale Revised (JFK CRS-R) - Etiology text  Text for Etiology related to specific condition, as a part of JFK Coma Recovery Scale - Revised (JFK CRS-R) EtiologyTxt Recommended CDE
3 Symptom onset date and time  Date (and time, if applicable and known) reported for onset of participant's/subject's symptoms SymptmOnsetDateTime Recommended CDE
4 Hospital admission date and time  Date (and time, if applicable and known) the participant/subject was admitted to the hospital HospitlAdmissDateTime Recommended CDE
5 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

JFK Coma Recovery Scale-Revised (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 JFK Coma Recovery Scale Revised (JFK CRS-R) - Auditory function scale score  Score on the auditory function scale, as part of JFK Coma Recovery Scale Revised (JFK CRS-R). JFKCRSRAdtyFuncScaleScore Recommended CDE
2 JFK Coma Recovery Scale Revised (JFK CRS-R) - Visual function scale score  Score on the visual function scale, as part of JFK Coma Recovery Scale Revised (JFK CRS-R). JFKCRSRVislFuncScaleScore Recommended CDE
3 JFK Coma Recovery Scale Revised (JFK CRS-R) - Motor function scale score  Score on the motor function scale, as part of JFK Coma Recovery Scale Revised (JFK CRS-R). JFKCRSRMotrFuncScaleScore Recommended CDE
4 JFK Coma Recovery Scale Revised (JFK CRS-R) - Oromotor verbal function scale score  Score on the oromotor verbal function scale, as part of JFK Coma Recovery Scale Revised (JFK CRS-R). JFKCRSROrmtrVerbFuncScaleScore Recommended CDE
5 JFK Coma Recovery Scale Revised (JFK CRS-R) - Communication scale score  Score on the communication scale, as part of JFK Coma Recovery Scale Revised (JFK CRS-R). JFKCRSRCommScaleScore Recommended CDE
6 JFK Coma Recovery Scale Revised (JFK CRS-R) - Arousal scale score  Score on the arousal scale, as part of JFK Coma Recovery Scale Revised (JFK CRS-R). JFKCRSRArousalScaleScore Recommended CDE
7 JFK Coma Recovery Scale Revised (JFK CRS-R) - Total score  Total Score - Sum of 6 scales (0-23), as part of JFK Coma Recovery Scale Revised (JFK CRS-R). JFKCRSRTotalScore Recommended CDE

Assessment of Contingent Behavior (Supplementary item) (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 JFK Coma Recovery Scale Revised (JFK CRS-R) - Target behavior text  Text for target behavior noted in the assessment of contingent behavior (supplementary item), as a part of JFK Coma Recovery Scale-Revised (JFK CRS-R) JFKCRSRAsmtConTargtBehaviorTxt Recommended CDE
2 JFK Coma Recovery Scale Revised (JFK CRS-R) - Spontaneous occurences of target behavior number  Number of spontanoeus occurences of target behavior in the assessment of contingent behavior (supplementary item), as a part of JFK Coma Recovery Scale-Revised (JFK CRS-R) JFKCRSRAsmtConSpontanOccrncNum Recommended CDE
3 JFK Coma Recovery Scale Revised (JFK CRS-R) - Contingent eliciting stimulus text  Text for eliciting stimulus in the assessment of contingent behavior (supplementary item), as a part of JFK Coma Recovery Scale-Revised (JFK CRS-R) JFKCRSRAsmtConBehElictStimlTxt Recommended CDE
4 JFK Coma Recovery Scale Revised (JFK CRS-R) - Occurences of target behavior within 10 sec of eliciting stimulus  Number of occurences of target behavior within 10 sec of eliciting stimulus in assessment of contingent behavior (supplementary item), as a part of JFK Coma Recovery Scale-Revised (JFK CRS-R) JFKCRSRAsmtConOccrWthn10SecNum Recommended CDE
5 JFK Coma Recovery Scale Revised (JFK CRS-R) - Spontaneous occurences of target behavior time duration  Time duration for the spontaneous occurences of target behavior noted in assessment of contingent behavior (supplementary item), as a part of JFK Coma Recovery Scale-Revised (JFK CRS-R) JFKCRSRAsmtConSpontanOccTimDur Recommended CDE

 Change History

 Administrative Change History