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

 General Details

Title:
Neurobehavioral Symptom Inventory
Short Name:
NSI1
Description:
The severity of each symptom on the NSI is measured using a 5-item scale (0-none to 4-very severe) that asks patients to indicate the extent to which each symptom has disturbed them in the previous 2 weeks. The NSI total score is the sum of severity ratings of the 22 symptoms. Cluster scores (domains: physical, cognitive, affective, and sensory) were derived. The DVBIC recommendation is that the initial NSI administered use the injury as the reference point provided the patient is diagnosed with concussion within 90 days of an injury event. It is recommended that follow-up administrations of the NSI use the prior medical appointment or the past two weeks as the time frame for symptom reporting. REFERENCES. Cicerone KD. Use of the NSI for serial assessment of concussion related health outcomes in the military health system, personal communication, 7 May 2014.
Disease:
Traumatic Brain Injury
Organization:
NINDS
Required Program Form:
No
Standardization:
Standard NINDS CDE
Labels:
Form Type:
Clinical Assessment
Publication Date:
2015-10-19
Version:
1.1
Date Created:
2015-10-19
Owner:
Number of Data Elements:
36
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

Neurobehavioral Symptom Inventory (Repeat Infinitely)

# Title Short Description Variable Name Required? Type
1 Neurobehavioral Symptom Inventory (NSI) - Dizzy score  Score of subject's dizziness, as part of the Neurobehavioral Symptom Inventory (NSI) NSIDizScore Recommended CDE
2 Neurobehavioral Symptom Inventory (NSI) - Balance impairment score  Score of subject's loss of balance, as part of the Neurobehavioral Symptom Inventory (NSI) NSIBalncImprmntScore Recommended CDE
3 Neurobehavioral Symptom Inventory (NSI) - Coordination impairment score  Score of subject's coordination impairment, as part of the Neurobehavioral Symptom Inventory (NSI) NSICoordntnImprmntScore Recommended CDE
4 Neurobehavioral Symptom Inventory (NSI) - Headaches score  Score of subject's headache, as part of the Neurobehavioral Symptom Inventory (NSI) NSIHdcheScore Recommended CDE
5 Neurobehavioral Symptom Inventory (NSI) - Nausea score  Score of subject's nausea, as part of the Neurobehavioral Symptom Inventory (NSI) NSINausScore Recommended CDE
6 Neurobehavioral Symptom Inventory (NSI) - Vision impairment score  Score of subject's vision impairment, as part of the Neurobehavioral Symptom Inventory (NSI) NSIVisnImprmntScore Recommended CDE
7 Neurobehavioral Symptom Inventory (NSI) - Sensitive light score  Score of subject's sensitivity to light, as part of the Neurobehavioral Symptom Inventory (NSI) NSISenstvLgtScore Recommended CDE
8 Neurobehavioral Symptom Inventory (NSI) - Hearing impairment score  Score of subject's hearing impairment, as part of the Neurobehavioral Symptom Inventory (NSI) NSIHearngImprmntScore Recommended CDE
9 Neurobehavioral Symptom Inventory (NSI) - Sensitive noise score  Score of subject's sensitivity to noise, as part of the Neurobehavioral Symptom Inventory (NSI) NSiSenstvNoisScore Recommended CDE
10 Neurobehavioral Symptom Inventory (NSI) - Numbness impairment score  Score of subject's numbness or tingling on parts of the body, as part of the Neurobehavioral Symptom Inventory (NSI) NSINumbnssImprmntScore Recommended CDE
11 Neurobehavioral Symptom Inventory (NSI) - Taste impairment score  Score of subject's taste impairment, as part of the Neurobehavioral Symptom Inventory (NSI) NSITastImprmntScore Recommended CDE
12 Neurobehavioral Symptom Inventory (NSI) - Appetite impairment score  Score of subject's appetite impairment, as part of the Neurobehavioral Symptom Inventory (NSI) NSIApptitImprmntScore Recommended CDE
13 Neurobehavioral Symptom Inventory (NSI) - Concentration impairment score  Score of subject's concentration impairment, as part of the Neurobehavioral Symptom Inventory (NSI) NSIConctrtnImprmntScore Recommended CDE
14 Neurobehavioral Symptom Inventory (NSI) - Memory impairment score  Score of subject's memory impairment, as part of the Neurobehavioral Symptom Inventory (NSI) NSIMmryImprmntScore Recommended CDE
15 Neurobehavioral Symptom Inventory (NSI) - Decision impairment score  Score of subject's indecisiveness, as part of the Neurobehavioral Symptom Inventory (NSI) NSIDecsnImprmntScore Recommended CDE
16 Neurobehavioral Symptom Inventory (NSI) - Slow thinking impairment score  Score of subject's slow thinking impairment, as part of the Neurobehavioral Symptom Inventory (NSI) NSISlwThnkngImprmntScore Recommended CDE
17 Neurobehavioral Symptom Inventory (NSI) - Fatigue impairment score  Score of subject's fatigue, loss of energy and getting tired easily, as part of the Neurobehavioral Symptom Inventory (NSI) NSIFatigImprmntScore Recommended CDE
18 Neurobehavioral Symptom Inventory (NSI) - Sleep impairment score  Score of subject's sleep impairment, as part of the Neurobehavioral Symptom Inventory (NSI) NSISlpImprmntScore Recommended CDE
19 Neurobehavioral Symptom Inventory (NSI) - Anxiety impairment score  Score of subject's anxiety , as part of the Neurobehavioral Symptom Inventory (NSI) NSIAnxtyImprmntScore Recommended CDE
20 Neurobehavioral Symptom Inventory (NSI) - Depression impairment score  Score of subject's depression , as part of the Neurobehavioral Symptom Inventory (NSI) NSIDeprsnImprmntScore Recommended CDE
21 Neurobehavioral Symptom Inventory (NSI) - Irritability impairment score  Score of subject's irritability, as part of the Neurobehavioral Symptom Inventory (NSI) NSIIrrabltyImprmntScore Recommended CDE
22 Neurobehavioral Symptom Inventory (NSI) - Frustration impairment score  Score of subject's frustration tolerance, as part of the Neurobehavioral Symptom Inventory (NSI) NSIFrustrtnImprmntScore Recommended CDE
23 Neurobehavioral Symptom Inventory (NSI) - Total score  Total Score for the Neurobehavioral Symptom Inventory (NSI) (0-88) NSITotalScore Recommended CDE
24 Neurobehavioral Symptom Inventory (NSI) - Form completion date  Date of form completion, as part of the Neurobehavioral Symptom Inventory (NSI) NSIFrmCompltDate Recommended CDE

 Change History

 Administrative Change History