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

 General Details

Title:
Tests for Auditory Processing Disorders for Children (SCAN-3:C)-Screening
Short Name:
SCAN3CScreening
Description:
SCAN3-C is designed to identify auditory processing disorders in children. Use this table to record and compare scores to pass criteria for Gap Detection, Auditory Figure-Ground +8 dB, and Competing Words–Free Recall. Keith, R. W. (2009). SCAN-3 for Children: Test for Auditory Processing Disorders. Pearson. Copyright 2009, 2000 NCS Pearson, Inc. http://www.pearsonclinical.com/
Disease:
Traumatic Brain Injury
Organization:
FITBIR
Required Program Form:
No
Standardization:
Standard NINDS CDE
Labels:
Form Type:
Clinical Assessment
Version:
1.0
Date Created:
2016-08-25
Owner:
Number of Data Elements:
22
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 (Repeat Infinitely)

# 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

SCAN-3C Pure Tone Results (Appears Up To 6 Times)

# Title Short Description Variable Name Required? Type
1 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
2 SCAN-3:C Tests for Auditory Processing Disorders for Children - Pure tone frequency  Pure tone frequency in Hz used to check both ears' status regarding sensing pure tone with different frequencies, as part of SCAN-3 for children (SCAN-3C) SCAN3CPureToneFreq Recommended CDE
3 SCAN-3:C Tests for Auditory Processing Disorders for Children - Pure tone results status  Status regarding pure tone results, as part of SCAN-3 for children (SCAN-3C) SCAN3CPureToneResultsStat Recommended CDE

SCAN-3C Screening Criteria (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 SCAN-3:C Tests for Auditory Processing Disorders for Children - Gap detection meets criterion indicator  Indicates whether the subject meets pass criterion for Gap Detection, as part of SCAN-3 for children (SCAN-3C) SCAN3CGapDetectionMeetsCritInd Recommended CDE
2 SCAN-3:C Tests for Auditory Processing Disorders for Children - Auditory Figure - Ground +8 meets criterion indicator  Indicates whether the subject meets pass criterion for Auditory Figure-Ground +8, as part of SCAN-3 for children (SCAN-3C) SCAN3CAFG8MeetsCritInd Recommended CDE
3 SCAN-3:C Tests for Auditory Processing Disorders for Children - Competing Words-Free Recall meets criterion indicator  Indicates whether the subject meets pass criterion for Competing Words-Free Recall, as part of SCAN-3 for children (SCAN-3C) SCAN3CCWFRMeetsCritInd Recommended CDE
4 SCAN-3:C Tests for Auditory Processing Disorders for Children - Screening criterion status  Status regarding whether or not the scores pass criteria for Gap Detection, Auditory Figure-Ground plus 8 dB and Competing Words-Free Recall, as part of SCAN-3 for children (SCAN-3C) SCAN3CScreeningCritStat Recommended CDE

 Change History

 Administrative Change History