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

 General Details

Title:
Therapy Intensity Level
Short Name:
TherapyIntensityLevel
Description:
This CRF Module captures a global categorization of therapy intensity over a given period. This may be assessed on a daily basis, or in a summary measured over the entire ICU period.
Disease:
Traumatic Brain Injury
Organization:
NINDS
Required Program Form:
No
Standardization:
Standard NINDS CDE
Labels:
Form Type:
Clinical Assessment
Publication Date:
2016-04-25
Version:
1.1
Date Created:
2014-04-09
Owner:
Number of Data Elements:
21
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 Recommended 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 Recommended 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 Recommended CDE
8 Case control indicator   Indicator of whether subject is in the case or control arm of the study CaseContrlInd Recommended CDE
9 General notes text   General notes GeneralNotesTxt Recommended 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

Therapy Intensity Level Adult (Repeat Infinitely)

# Title Short Description Variable Name Required? Type
1 TBI therapy intensity level procedure indicator  Indicator of whether the procedure or therapy was administered, which is used to assess the therapy intensity level (TIL) for treating the traumatic brain injury TBITherapIntensLvlProcInd Recommended CDE
2 TBI therapy intensity level global assessment code  A summary measure for traumatic brain injury that captures a global categorization of therapy intensity level (TIL) over a given period. TBITherapIntensLvlGlobAsesCod Recommended CDE
3 TBI therapy intensity level procedure type  Type of procedure or therapy used to assess the therapy intensity level (TIL) for treating the traumatic brain injury TBITherapIntensLvlProcType Recommended CDE
4 TBI Adult intensity level of therapy scale score  Adult intensity level of therapy (PILOT) scale (0-38) TBIIntensLvlTherapyScalScr Recommended UDE

Therapy Intensity Level Pediatric (Repeat Infinitely)

# Title Short Description Variable Name Required? Type
1 TBI therapy intensity level procedure indicator for pediatric populations  Indicator of whether the procedure or therapy was administered, which is used to assess the therapy intensity level (TIL) for treating the traumatic brain injury TBITherapIntensLvlProcPedInd Recommended UDE
2 TBI therapy intensity level global assessment code  A summary measure for traumatic brain injury that captures a global categorization of therapy intensity level (TIL) over a given period. TBITherapIntLvlGlobAsesPedCod Recommended UDE
3 TBI therapy intensity level procedure type  Type of procedure or therapy used to assess the therapy intensity level (TIL) for treating the traumatic brain injury TBITherapIntensLvlProcType Recommended CDE
4 Pediatric intensity level of therapy scale score  Pediatric intensity level of therapy (PILOT) scale (0-38) PediatIntensLvlTherapyScalScr Recommended CDE

 Change History

 Administrative Change History