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

 General Details

Title:
NIH Toolbox Sensation Domain Hearing Threshold Test (Audition Supplemental Measures)
Short Name:
NIHTBHearingThresholdTest
Description:
In the NIH Toolbox, the Hearing Threshold Test is used to measure audition. This automated audiometric test measures hearing thresholds at six different frequencies, separately in the left and right ears.This test is part of the NIH Toolbox Sensation Domain Audition Measure. Copyright 2012 Northwestern University and the National Institutes of Health. http://www.nihtoolbox.org/Pages/NIH-Toolbox-Terms-and-Conditions.aspx
Disease:
General (For all diseases) , Traumatic Brain Injury
Organization:
NIH/CIT/DCB
Required Program Form:
No
Standardization:
Standard NINDS CDE
Labels:
Form Type:
Clinical Assessment
Version:
1.0
Date Created:
2016-06-27
Owner:
Number of Data Elements:
43
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

NIH Toolbox Administration (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 NIH Toolbox - Test domain battery type  Type of domain battery for the NIH Toolbox test being administered, as a part of the NIH Toolbox NIHTBTestDomainBatteryTyp Recommended CDE
2 NIH Toolbox - Test domain battery type other  The free-text related to NIHTBTestDomainBatteryTyp specifying other text, as part of the NIH Toolbox NIHTBTestDomainBatteryTypOTH Recommended CDE
3 NIH Toolbox - Test name type  Type of NIH Toolbox test being administered, as part of the NIH Toolbox NIHTBAdminTestNameTyp Recommended CDE
4 NIH Toolbox - Test name type other  The free-text related to NIHTBAdminTestNameTyp specifying other text, as part of the NIH Toolbox NIHTBAdminTestNameTypOTH Recommended CDE
5 NIH Toolbox - Test administration language type  Type of language for test being administrated, as part of the NIH Toolbox NIHTBTestAdminLanguageTyp Recommended CDE
6 NIH Toolbox - Test administration language type other  Free-text related to NIHTBTestAdminLanguageTyp specifying other text, as part of the NIH Toolbox NIHTBTestAdminLanguageTypOTH Recommended CDE
7 NIH Toolbox - Form administered type  Type of NIH Toolbox form being administered, as part of the NIH Toolbox NIHTBFormAdminTyp Recommended CDE
8 NIH Toolbox - Test administration flag indicator  Indicator of a flag for the NIH Toolbox test being administered, as part of the NIH Toolbox NIHTBAdminTestFlagInd Recommended CDE
9 NIH Toolbox - Test administration flag type  Type of flag for the NIH Toolbox test being administered, as part of the NIH Toolbox NIHTBAdminTestFlagTyp Recommended CDE

NIH Toolbox Hearing Threshold Test: Practice (Repeat Infinitely)

# Title Short Description Variable Name Required? Type
1 Trial number (numeric)  The number representing the sequence for any repeated measure test or assessment when it is performed multiple times. TrialNumber Recommended CDE
2 NIH Toolbox Sensation Domain Audition Measure Hearing Threshold Test - Trial type  Type of trial, as part of the NIH Toolbox Sensation Domain Audition Measure Hearing Threshold Test NIHTBHTTTrialType Recommended CDE
3 NIH Toolbox Sensation Domain Audition Measure Hearing Threshold Test - Pediatric response type  Type of response for children, as part of the NIH Toolbox Sensation Domain Audition Measure Hearing Threshold Test NIHTBHTTPedResponsesTyp Recommended CDE
4 NIH Toolbox Sensation Domain Audition Measure Hearing Threshold Test - Practice response type  Type of response for practice test, as part of the NIH Toolbox Sensation Domain Audition Measure Hearing Threshold Test NIHTBHTTPracticeResponsesTyp Recommended CDE

NIH Toolbox Hearing Threshold Test (Appears Up To 2 Times)

# Title Short Description Variable Name Required? Type
1 Trial number (numeric)  The number representing the sequence for any repeated measure test or assessment when it is performed multiple times. TrialNumber Recommended CDE
2 NIH Toolbox Sensation Domain Audition Measure Hearing Threshold Test - Ear type  Type of ear being tested, as part of the NIH Toolbox Sensation Domain Audition Measure Hearing Threshold Test NIHTBHTTEarTyp Recommended CDE
3 NIH Toolbox Sensation Domain Audition Measure Hearing Threshold Test - Threshold level  Level of threshold being tested, as part of the NIH Toolbox Sensation Domain Audition Measure Hearing Threshold Test NIHTBHTTThresholdLvl Recommended CDE
4 NIH Toolbox Sensation Domain Audition Measure Hearing Threshold Test - Trial type  Type of trial, as part of the NIH Toolbox Sensation Domain Audition Measure Hearing Threshold Test NIHTBHTTTrialType Recommended CDE
5 NIH Toolbox Sensation Domain Audition Measure Hearing Threshold Test - Pediatric response type  Type of response for children, as part of the NIH Toolbox Sensation Domain Audition Measure Hearing Threshold Test NIHTBHTTPedResponsesTyp Recommended CDE
6 NIH Toolbox Sensation Domain Audition Measure Hearing Threshold Test - Response type  Type of response, as part of the NIH Toolbox Sensation Domain Audition Measure Hearing Threshold Test NIHTBHTTResponsesTyp Recommended CDE
7 NIH Toolbox Sensation Domain Audition Measure Hearing Threshold Test - Responses number  Number of responses, as part of the NIH Toolbox Sensation Domain Audition Measure Hearing Threshold Test NIHTBHTTResponsesNum Recommended CDE
8 NIH Toolbox Sensation Domain Audition Measure Hearing Threshold Test - Catch trial number  Number of catch trials, as part of the NIH Toolbox Sensation Domain Audition Measure Hearing Threshold Test NIHTBHTTCatchTrialNum Recommended CDE
9 NIH Toolbox Sensation Domain Audition Measure Hearing Threshold Test - False alarms number  Number of false alarms, as part of the NIH Toolbox Sensation Domain Audition Measure Hearing Threshold Test NIHTBHTTFalseAlarmNum Recommended CDE
10 NIH Toolbox Sensation Domain Audition Measure Hearing Threshold Test - False alarm rate  Rate of false alarms, as part of the NIH Toolbox Sensation Domain Audition Measure Hearing Threshold Test NIHTBHTTFalseAlarmRt Recommended CDE
11 NIH Toolbox Sensation Domain Audition Measure Hearing Threshold Test - Pure tone average score  Score for pure tone average, as part of the NIH Toolbox Sensation Domain Audition Measure Hearing Threshold Test NIHTBHTTPureToneAverageScore Recommended CDE

NIH Toolbox Hearing Threshold Test Scoring (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 NIH Toolbox Sensation Domain Audition Measure Hearing Threshold Test - Dominant computed score  Computed score for the dominant ear, as part of the NIH Toolbox Sensation Domain Audition Measure Hearing Threshold Test NIHTBHTTDominantEarCompScore Recommended CDE
2 NIH Toolbox Sensation Domain Audition Measure Hearing Threshold Test - Nondominant computed score  Computed score for the nondominant ear, as part of the NIH Toolbox Sensation Domain Audition Measure Hearing Threshold Test NIHTBHTTNonDomintEarCompScore Recommended CDE
3 NIH Toolbox Sensation Domain Audition Measure Hearing Threshold Test - Hearing loss classification type  Type of hearing loss classification, as part of the NIH Toolbox Sensation Domain Audition Measure Hearing Threshold Test NIHTBHTTHearLossClassTyp Recommended CDE
4 NIH Toolbox - Standard error  Standard error (a statistical measure of variance that represents the margin of error for the Tscore), as part of the NIH Toolbox NIHTBStandardError Optional CDE

 Change History

 Administrative Change History