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

 General Details

Title:
Neurological Outcome Scale for Traumatic Brain Injury (NOS - TBI)
Short Name:
NOS_TBI
Description:
The Neurological Outcome Scale for Traumatic Brain Injury (NOS-TBI) is a measure adapted from the National Institutes of Health Stroke Scale (NIHSS), and is intended to capture essential neurological deficits impacting individuals with traumatic brain injury (TBI). Recommended by CDISC for TBI (TAUG TBI)
Disease:
Traumatic Brain Injury
Organization:
NIH
Required Program Form:
No
Standardization:
Standard NINDS CDE
Labels:
Form Type:
Clinical Assessment
Publication Date:
2015-08-11
Version:
1.2
Date Created:
2015-04-02
Owner:
Number of Data Elements:
46
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 Visit date   Actual interview or visit date VisitDate Recommended CDE
5 Site name   The name of the site for the study SiteName Recommended CDE
6 Days since baseline   The number of days since baseline DaysSinceBaseline Optional CDE
7 Case control indicator   Indicator of whether subject is in the case or control arm of the study CaseContrlInd Optional CDE
8 General notes text   General notes GeneralNotesTxt Optional CDE

Additional Element Groups

Listed below are your additional element groups.

Form Administration (Repeat Infinitely)

# 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

Neurological Outcome Scale (Repeat Infinitely)

# Title Short Description Variable Name Required? Type
1 Neurological Outcome Scale for Traumatic Brain Injury (NOS - TBI) - Level of consciousness scale  The scale as related to level of consciousness, as part of Neurological Outcome Scale for Traumatic Brain Injury (NOS-TBI) NOSTBILOCScl Recommended CDE
2 Neurological Outcome Scale for Traumatic Brain Injury (NOS - TBI) - Level of consciousness current month age response scale  The scale as related to level of consciousness based on questions of current month and age, as part of Neurological Outcome Scale for Traumatic Brain Injury (NOS-TBI) NOSTBILOCQuestionsScl Recommended CDE
3 Neurological Outcome Scale for Traumatic Brain Injury (NOS - TBI) - Level of consciousness eye open make fist command response scale  The scale as related to loss of consciousness commands to open and close eyes and make a fist, as part of Neurological Outcome Scale for Traumatic Brain Injury (NOS-TBI) NOSTBILOCCommandsScl Recommended CDE
4 Neurological Outcome Scale for Traumatic Brain Injury (NOS - TBI) - Gaze scale  Scale of gaze as part of Neurological Outcome Scale for Traumatic Brain Injury (NOS-TBI) NOSTBIGazeScl Recommended CDE
5 Neurological Outcome Scale for Traumatic Brain Injury (NOS - TBI) - Right side visual field scale  Scale of right visual field as part of Neurological Outcome Scale for Traumatic Brain Injury (NOS-TBI) NOSTBIRightVisualFieldScl Recommended CDE
6 Neurological Outcome Scale for Traumatic Brain Injury (NOS - TBI) - Left side visual field scale  Scale of left visual field as part of Neurological Outcome Scale for Traumatic Brain Injury (NOS-TBI) NOSTBILeftVisualFieldScl Recommended CDE
7 Neurological Outcome Scale for Traumatic Brain Injury (NOS - TBI) - Pupillary response scale  Scale of pupillary response as part of Neurological Outcome Scale for Traumatic Brain Injury (NOS-TBI) NOSTBIPupilRespnsScl Recommended CDE
8 Neurological Outcome Scale for Traumatic Brain Injury (NOS - TBI) - Right side hearing scale  Scale of hearing on the right side as part of Neurological Outcome Scale for Traumatic Brain Injury (NOS-TBI) NOSTBIHearingRightSideScl Recommended CDE
9 Neurological Outcome Scale for Traumatic Brain Injury (NOS - TBI) - Left side hearing scale  Scale of hearing on the left side as part of Neurological Outcome Scale for Traumatic Brain Injury (NOS-TBI) NOSTBIHearingLeftSideScl Recommended CDE
10 Neurological Outcome Scale for Traumatic Brain Injury (NOS - TBI) - Right side facial paresis scale  Scale of facial paresis on the right side as part of Neurological Outcome Scale for Traumatic Brain Injury (NOS-TBI) NOSTBIFacialParesisRightScl Recommended CDE
11 Neurological Outcome Scale for Traumatic Brain Injury (NOS - TBI) - Left side facial paresis scale  Scale of facial paresis on the left side as part of Neurological Outcome Scale for Traumatic Brain Injury (NOS-TBI) NOSTBIFacialParesisLeftScl Recommended CDE
12 Neurological Outcome Scale for Traumatic Brain Injury (NOS - TBI) - Right arm motor function scale  Scale of motor function for right arm as part of Neurological Outcome Scale for Traumatic Brain Injury (NOS-TBI) NOSTBIMotorFunctRightArmScl Recommended CDE
13 Neurological Outcome Scale for Traumatic Brain Injury (NOS - TBI) - Right arm motor function untestable reason  Reason right arm motor function is untestable as part of Neurological Outcome Scale for Traumatic Brain Injury (NOS-TBI) NOSTBIMotorFuncRArmUntestblRsn Recommended CDE
14 Neurological Outcome Scale for Traumatic Brain Injury (NOS - TBI) - Left arm motor function scale  Scale of motor function for left arm as part of Neurological Outcome Scale for Traumatic Brain Injury (NOS-TBI) NOSTBIMotorFunctLeftArmScl Recommended CDE
15 Neurological Outcome Scale for Traumatic Brain Injury (NOS - TBI) - Left arm motor function untestable reason  Reason left arm motor function is untestable as part of Neurological Outcome Scale for Traumatic Brain Injury (NOS-TBI) NOSTBIMotorFuncLArmUntestblRsn Recommended CDE
16 Neurological Outcome Scale for Traumatic Brain Injury (NOS - TBI) - Right leg motor function scale  Scale of motor function for right leg as part of Neurological Outcome Scale for Traumatic Brain Injury (NOS-TBI) NOSTBIMotorFunctRightLegScl Recommended CDE
17 Neurological Outcome Scale for Traumatic Brain Injury (NOS - TBI) - Right leg motor function untestable reason  Reason right leg motor function is untestable as part of Neurological Outcome Scale for Traumatic Brain Injury (NOS-TBI) NOSTBIRightLegUntestblRsn Recommended CDE
18 Neurological Outcome Scale for Traumatic Brain Injury (NOS - TBI) - Left leg motor function scale  Scale of motor function for left leg as part of Neurological Outcome Scale for Traumatic Brain Injury (NOS-TBI) NOSTBIMotorFunctLeftLegScl Recommended CDE
19 Neurological Outcome Scale for Traumatic Brain Injury (NOS - TBI) - Left leg motor function untestable reason  Reason left leg motor function is untestable as part of Neurological Outcome Scale for Traumatic Brain Injury (NOS-TBI) NOSTBILeftLegUntestblRsn Recommended CDE
20 Neurological Outcome Scale for Traumatic Brain Injury (NOS - TBI) - Right upper extremity sensory scale  Scale of right arm sensory loss as part of Neurological Outcome Scale for Traumatic Brain Injury (NOS-TBI) NOSTBISensoryRightArmScl Recommended CDE
21 Neurological Outcome Scale for Traumatic Brain Injury (NOS - TBI) - Left upper extremity sensory scale  Scale of left arm sensory loss as part of Neurological Outcome Scale for Traumatic Brain Injury (NOS-TBI) NOSTBISensoryLeftArmScl Recommended CDE
22 Neurological Outcome Scale for Traumatic Brain Injury (NOS - TBI) - Right lower extremity sensory scale  Scale of right leg sensory loss as part of Neurological Outcome Scale for Traumatic Brain Injury (NOS-TBI) NOSTBISensoryRightLegScl Recommended CDE
23 Neurological Outcome Scale for Traumatic Brain Injury (NOS - TBI) - Left lower extremity sensory scale  Scale of left leg sensory loss as part of Neurological Outcome Scale for Traumatic Brain Injury (NOS-TBI) NOSTBISensoryLeftLegScl Recommended CDE
24 Neurological Outcome Scale for Traumatic Brain Injury (NOS - TBI) - Best language scale  Scale of language as part of Neurological Outcome Scale for Traumatic Brain Injury (NOS-TBI) NOSTBIBestLanguageScl Recommended CDE
25 Neurological Outcome Scale for Traumatic Brain Injury (NOS - TBI) - Dysarthria scale  Scale of dysarthria as part of Neurological Outcome Scale for Traumatic Brain Injury (NOS-TBI) NOSTBIDysarthriaScl Recommended CDE
26 Neurological Outcome Scale for Traumatic Brain Injury (NOS - TBI) - Neglect scale  Scale of neglect as part of Neurological Outcome Scale for Traumatic Brain Injury (NOS-TBI) NOSTBINeglectScl Recommended CDE
27 Neurological Outcome Scale for Traumatic Brain Injury (NOS - TBI) - Smell scale  Scale of smell as part of Neurological Outcome Scale for Traumatic Brain Injury (NOS-TBI) NOSTBISmellScl Recommended CDE
28 Neurological Outcome Scale for Traumatic Brain Injury (NOS - TBI) - Smell untestable reason  Reason smell is untestable as part of Neurological Outcome Scale for Traumatic Brain Injury (NOS-TBI) NOSTBISmellUntestblRsn Recommended CDE
29 Neurological Outcome Scale for Traumatic Brain Injury (NOS - TBI) - Gait ataxia scale (supplemental)  Scale of gait ataxia as part of Neurological Outcome Scale for Traumatic Brain Injury (NOS-TBI). Supplemental. NOSTBIGaitAtaxiaScl Recommended CDE
30 Neurological Outcome Scale for Traumatic Brain Injury (NOS - TBI) - Gait ataxia untestable reason  Reason gait ataxia is untestable as part of Neurological Outcome Scale for Traumatic Brain Injury (NOS-TBI) NOSTBIGaitAtaxiaUntestRsn Recommended CDE
31 Neurological Outcome Scale for Traumatic Brain Injury (NOS - TBI) - Limb ataxia scale (supplemental)  Scale of limb ataxia as part of Neurological Outcome Scale for Traumatic Brain Injury (NOS-TBI). Supplemental. NOSTBILimbAtaxiaScl Recommended CDE
32 Neurological Outcome Scale for Traumatic Brain Injury (NOS - TBI) - Limb ataxia untestable reason  Reason limb ataxia is untestable as part of Neurological Outcome Scale for Traumatic Brain Injury (NOS-TBI) NOSTBILimbAtaxiaUntestRsn Recommended CDE
33 Neurological Outcome Scale for Traumatic Brain Injury (NOS - TBI) - Score without supplemental items  Score without supplemental items (except those scored as "UN," as part of Neurological Outcome Scale for Traumatic Brain Injury (NOS-TBI) NOSTBIWithoutSupplemItemsScore Recommended CDE
34 Neurological Outcome Scale for Traumatic Brain Injury (NOS - TBI) - Score of supplemental items  Score of supplemental items (except those scored as "UN"), as part of Neurological Outcome Scale for Traumatic Brain Injury (NOS-TBI) NOSTBISupplementalItemsScore Recommended CDE

 Change History

 Administrative Change History