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

 General Details

Title:
Ohio State University TBI Identification Method short form (OSUTBIMS)
Short Name:
OSUTBIMSF
Description:
The Ohio State University (OSU) Traumatic Brain Injury (TBI) Short Form adapted with permission from the Ohio State University TBI Identification Method (Corrigan, J.D., Bogner, J.A. (2007. Initial reliability and validity of the OSU TBI Identification Method. Journal of Head Trauma Rehabilitation. This version will assess history of TBI prior to index TBI. Other timeframes for assessment can be used by changing wording of questions to fit proper timeframe.
Disease:
Traumatic Brain Injury
Organization:
NIH
Required Program Form:
No
Standardization:
Standard NINDS CDE
Labels:
Form Type:
Clinical Assessment
Publication Date:
2019-07-31
Version:
1.0
Date Created:
2016-08-05
Owner:
Number of Data Elements:
41
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
7 Assessment completion status  Status of completion of an assessment, such as a case report from (CRF), instrument, scale, computer assessment, etc. AssessmentCompletionStat Recommended CDE
8 Assessment completion status text  A free text related to "Assessment completion status" specifying completion details. This data element should be used along with AssessmenttCompletionStat to further describe the status of assessment completion AssessmentCompletionStatTxt Recommended CDE

Questionnaire (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 Ohio State TBI Method Short Form (OSUTBIMS) - identification method hospitalization indicator  Number and cause of injuries to head or neck that which subject endured and had to go to a hospital or emergency room as part of Ohio State TBI Method Short Form (OSUTBIMS). OSUTBIMSIdentMethHospInd Recommended CDE
2 Ohio State TBI Method Short Form (OSUTBIMS) - identification method moving vehicle injury indicator  Number and cause of injuries to head or neck that which subject endured from a moving vehicle accident as part of Ohio State TBI Method Short Form (OSUTBIMS). OSUTBIMSIdentMethMovVehInjInd Recommended CDE
3 Ohio State TBI Method Short Form (OSUTBIMS) - identification method object hit injury indicator  Number and cause of injuries to head or neck that which subject endured from being hit by something as part of Ohio State TBI Method Short Form (OSUTBIMS). OSUTBIMSIdentMethObjHitInjInd Recommended CDE
4 Ohio State TBI Method Short Form (OSUTBIMS) - identification method person hit indicator  Number and cause of injuries to head or neck that which subject endured from a fight or from being hit by someone or from being shaken as part of Ohio State TBI Method Short Form (OSUTBIMS). OSUTBIMSIdentMethPersHitInd Recommended CDE
5 Ohio State TBI Method Short Form (OSUTBIMS) - identification method explosion injury indicator  Number of times and cause for subject to come in close contact with an explosion or blast as part of Ohio State TBI Method Short Form (OSUTBIMS). OSUTBIMSIdentMethExplInjInd Recommended CDE
6 Ohio State TBI Method Short Form (OSUTBIMS) - ask question category  Indicator of whether or not subject has lost consciousness and for how long and if not whether subject was dazed or has a gap in their memory from the injury. Also indicates how old the subject was as part of Ohio State TBI Method Short Form (OSUTBIMS). OSUTBIMSAskQuestionCat Recommended CDE

History of LOC (Appears Up To 9 Times)

# Title Short Description Variable Name Required? Type
1 Traumatic event number  The number of traumatic event , which happened during the subject's life, as reported by the subject TraumaticEventNum Recommended CDE
2 Ohio State TBI Method Short Form (OSUTBIMS) - cause reason  The cause of the subject's injury as part of Ohio State TBI Method Short Form (OSUTBIMS). OSUTBIMSCauseRsn Recommended CDE
3 Loss of consciousness indicator  The indicator for whether the participant/subject experienced any period of loss of consciousness (LOC). LOCInd Recommended CDE
4 Ohio State TBI Method Short Form (OSUTBIMS) - loss of consciousness duration range  Range of duration of Loss of consciousness, as part of Ohio State TBI Method Short Form (OSUTBIMS). OSUTBIMSLOCDurRang Recommended CDE
5 Ohio State TBI Method Short Form (OSUTBIMS) - dazed memory gap indicator  Indicator whether the subject was dazed or has a memory gap as part of Ohio State TBI Method Short Form (OSUTBIMS). OSUTBIMSDazeMemryGapInd Recommended CDE
6 Age in years  Value for participant's subject age recorded in years. AgeYrs Recommended CDE

If more injuries with LOC (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 Loss of consciousness from TBI count  Count of traumatic brain injuries (TBI) the subject incurred with loss of consciousness LOCTBICt Recommended CDE
2 Ohio State TBI Method Short Form (OSUTBIMS) - longest knock out time  Longest amount of time that the subject was knocked out for as part of Ohio State TBI Method Short Form (OSUTBIMS). OSUTBIMSLongKnockOutTime Recommended CDE
3 Ohio State TBI Method Short Form (OSUTBIMS) - loss of consciousness greater than 30 number  Number of injuries the subject incurred with a loss of consciousness for greater than 30 minutes as part of Ohio State TBI Method Short Form (OSUTBIMS). OSUTBIMSLOCGreaterthan30Num Recommended CDE
4 Ohio State TBI Method Short Form (OSUTBIMS) - first loss of consciousness age number  The youngest age the subject incurred a loss of consciousness due to a traumatic brain injury as part of Ohio State TBI Method Short Form (OSUTBIMS). OSUTBIMSFirstLOCAgeNum Recommended CDE

LOC from overdose chocking (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 Ohio State TBI Method Short Form (OSUTBIMS) - identification method loss of consciousness drug overdose number  Number of times subject has lost consciousness from a drug overdose as part of Ohio State TBI Method Short Form (OSUTBIMS). OSUTBIMSIdentMethLOCDrgOvrNum Recommended CDE
2 Ohio State TBI Method Short Form (OSUTBIMS) - anoxic injury number  Number of anoxic injuries (total number of choked incidents reported in question # 7) as part of Ohio State TBI Method Short Form (OSUTBIMS). OSUTBIMSAnoxicInjNum Recommended CDE

Scoring (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 Loss of consciousness from TBI count  Count of traumatic brain injuries (TBI) the subject incurred with loss of consciousness LOCTBICt Recommended CDE
2 Ohio State TBI Method Short Form (OSUTBIMS) - loss of consciousness greater than 30 number  Number of injuries the subject incurred with a loss of consciousness for greater than 30 minutes as part of Ohio State TBI Method Short Form (OSUTBIMS). OSUTBIMSLOCGreaterthan30Num Recommended CDE
3 Ohio State TBI Method Short Form (OSUTBIMS) - first loss of consciousness age number  The youngest age the subject incurred a loss of consciousness due to a traumatic brain injury as part of Ohio State TBI Method Short Form (OSUTBIMS). OSUTBIMSFirstLOCAgeNum Recommended CDE
4 Ohio State TBI Method Short Form (OSUTBIMS) - loss of consciousness before age 15 result  Result to whether the subject was younger than 15 or older or equal to 15 when he or she first lost consciousness due to her traumatic brain injury as part of Ohio State TBI Method Short Form (OSUTBIMS). OSUTBIMSLOCBeforeAge15Reslt Recommended CDE
5 Ohio State TBI Method Short Form (OSUTBIMS) - worst injury result  Result to whether the subject has: 1 an \"improbable TBI\", 2 a \"possible TBI\", 3 a \"mild TBI\", 4 a \"moderate TBI\", or 5 a \"severe TBI\" as part of Ohio State TBI Method Short Form (OSUTBIMS) OSUTBIMSWorstInjReslt Recommended CDE
6 Ohio State TBI Method Short Form (OSUTBIMS) - anoxic injury number  Number of anoxic injuries (total number of choked incidents reported in question # 7) as part of Ohio State TBI Method Short Form (OSUTBIMS). OSUTBIMSAnoxicInjNum Recommended CDE

 Change History

 Administrative Change History