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

 General Details

Title:
King-Devick Concussion Screening Test
Short Name:
KingDevickTest
Description:
The King-Devick Concussion Screening Test is an objective remove-from-play sideline concussion screening test that can be administered by parents and coaches in minutes. The King-Devick Test (K-D Test) is defined by Mosby's Medical Dictionary as a tool for evaluation of saccade, consisting of a series of test cards of numbers. The test cards become progressively more difficult to read due to variability of spacing between the numbers. Both errors in reading and speed of reading are included in deriving a score. Copyright: King-Devick Test (K-D Test) All rights reserved. Copyrighted. 1983, 2010-2016, Patents-Pending. Mayo and Mayo Clinic are registered trademarks owned by Mayo Foundation for Medical Education and Research. Two Mid America Plaza, Suite 110, Oakbrook Terrace, IL 60181. King-Devick Test is for screening purposes only and any suspicion or indication of head trauma should be evaluated by a licensed professional.
Disease:
General (For all diseases) , Traumatic Brain Injury
Organization:
NIH
Required Program Form:
No
Standardization:
Standard NINDS CDE
Labels:
Form Type:
Clinical Assessment
Publication Date:
2016-09-09
Version:
1.1
Date Created:
2016-05-27
Owner:
Number of Data Elements:
33
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 Context type  The context to which the questions were answered ContextType Recommended CDE
2 Context type other text  The free-text related to ContextType specifying other text ContextTypeOTH Recommended CDE
3 Data source  Source of the data provided on the case report form DataSource Recommended CDE
4 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

King-Devick Test General Details (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 Sport team participation type  The sport or team that the athlete participates in SportTeamParticipationTyp Recommended CDE
2 Sport team participation other text  The free-text related to Sport team participation type specifying the other type of sport or team SportTeamParticipationTypOTH Recommended CDE
3 Indicator whether the subject is wearing glasses/contact while taking the test  Indicator whether the subject is wearing glasses/contact while taking the test GlassesContactWearInd Recommended UDE

King-Devick Test Baseline Attempt 1 (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 King-Devick Concussion Screening Test (K-D Test) - Baseline attempt three test card assessment total duration  Duration of total time for baseline attempt with three card test assessment, as part of the King-Devick Concussion Screening (K-D Test) KDTestBaselinThreCardAssTotDur Recommended CDE
2 King-Devick Concussion Screening Test (K-D Test) - Baseline attempt three test card assessment error count  Number of errors the subject makes on their baseline attempt with three card test assessment, as part of the King-Devick Concussion Screening (K-D Test) KDTestBaselinThreCardAssErrNum Recommended CDE
3 King-Devick Concussion Screening Test (K-D Test) - Test card completed number  The number of completed test cards, as part of the King-Devick Concussion Screening (K-D Test). KDTestCardCompletedNum Recommended CDE

King-Devick Test Baseline Attempt 2 (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 King-Devick Concussion Screening Test (K-D Test) - Baseline attempt three test card assessment total duration  Duration of total time for baseline attempt with three card test assessment, as part of the King-Devick Concussion Screening (K-D Test) KDTestBaselinThreCardAssTotDur Recommended CDE
2 King-Devick Concussion Screening Test (K-D Test) - Baseline attempt three test card assessment error count  Number of errors the subject makes on their baseline attempt with three card test assessment, as part of the King-Devick Concussion Screening (K-D Test) KDTestBaselinThreCardAssErrNum Recommended CDE
3 King-Devick Concussion Screening Test (K-D Test) - Test card completed number  The number of completed test cards, as part of the King-Devick Concussion Screening (K-D Test). KDTestCardCompletedNum Recommended CDE

King-Devick Test Subject Baseline (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 King-Devick Concussion Screening Test (K-D Test) - Baseline attempt three test card assessment total duration  Duration of total time for baseline attempt with three card test assessment, as part of the King-Devick Concussion Screening (K-D Test) KDTestBaselinThreCardAssTotDur Recommended CDE
2 King-Devick Concussion Screening Test (K-D Test) - Baseline attempt three test card assessment error count  Number of errors the subject makes on their baseline attempt with three card test assessment, as part of the King-Devick Concussion Screening (K-D Test) KDTestBaselinThreCardAssErrNum Recommended CDE
3 King-Devick Concussion Screening Test (K-D Test) - Test card completed number  The number of completed test cards, as part of the King-Devick Concussion Screening (K-D Test). KDTestCardCompletedNum Recommended CDE
4 King-Devick Concussion Screening Test (K-D Test) - Subject's baseline time without error duration  Duration of the subject's fastest baseline total time without errors of the two attempts, as part of the King-Devick Concussion Screening (K-D Test) KDTestSubjBaselinTimeWtoErrDur Recommended CDE

King-Devick Test After Suspected Head Trauma (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 Injury elapsed time (in days) 

(Deprecated)

The elapsed time in days from the time of injury InjuryElapsedDaysDur Recommended UDE
2 King-Devick Concussion Screening Test (K-D Test) - Post suspected head trauma three test card assessment total duration  The total time for post suspected head trauma three card test assessment, as part of the King-Devick Concussion Screening (K-D Test) KDTestPSusHTTCarAssTotDur Recommended CDE
3 King-Devick Concussion Screening Test (K-D Test) - Testing after a suspected head trauma total error number  The number of total errors the subject makes during the King-Devick after a suspected head trauma, as part of the King-Devick Concussion Screening (K-D Test) KDTestAfterSuspectedHTErrorNum Recommended CDE
4 King-Devick Concussion Screening Test (K-D Test) - Better than baseline time indicator  Indicator if the retest time duration for the suspected head trauma is better than the subject's baseline time without error duration, as a part of the King-Devick Concussion Screening (K-D) Test KDTestRetstTimBtrThnBslTimInd Recommended CDE
5 King-Devick Concussion Screening Test (K-D Test) - Test card completed number  The number of completed test cards, as part of the King-Devick Concussion Screening (K-D Test). KDTestCardCompletedNum Recommended CDE
6 King-Devick Concussion Screening Test (K-D Test) - Testing after a suspected head trauma comments text  The text containing comments about testing after a suspected head trauma, as part of the King-Devick Concussion Screening (K-D Test) KDTestAfterSuspectedHTCommTxt Recommended CDE

King-Devick Test Removed From Play (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 King-Devick Concussion Screening Test (K-D Test) - Removed from play indicator  Indicator whether the subject should be removed from play or not based on subject's performance, as a part of King-Devick Concussion Screening Test KDTestRemovedFromPlayInd Optional CDE

 Change History

 Administrative Change History