Form Structure: Sport Concussion Assessment Tool 5th edition (SCAT-5)

Short Name:
SCAT5
Description:
The SCAT-5 is a standardized tool for evaluating injured athletes for concussion and can be used in athletes aged from 13 years and older. For younger persons, ages 12 and under, please use the Child SCAT-5. SCAT-5 to be done in resting state. Best done 10 or more minutes post exercise. Recommended by CDISC for TBI. © Concussion in Sport Group 2017 https://bjsm.bmj.com/content/bjsports/early/2017/04/26/bjsports-2017-097506SCAT5.full.pdf used in Head Kinematics Estimates, Biomechanical sensors study
Disease:
Traumatic Brain Injury
Organization:
NIH/CIT/BRICS
Required Program Form:
No
Standardization:
Standard
Publication Date:
2020-08-27
Version:
1.0
Date Created:
2020-08-27
Created By:
Number of Data Elements:
141
eForms:
N

Attached Data Elements

# 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.

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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

STEP 1 RED FLAGS (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 TBI - red flags type  Type of brain injury "red flags", as part of Military Acute Concussion Evaluation 2 (MACE 2) Sport Concussion Assessment Tool (SCAT-5) TBIRedFlagTyp Optional CDE

STEP 2 OBSERVABLE SIGNS (Appears Up To 2 Times)

# Title Short Description Variable Name Required? Type
1 Sport Concussion Assessment Tool (SCAT-5) - observation type  Type of observation, as part of Sport Concussion Assessment Tool (SCAT-5) SCAT5ObservTyp Recommended CDE
2 Sport Concussion Assessment Tool (SCAT-5) - lying motionless indicator  Indicator of the subject is lying motionless on the playing surface, as part of Sport Concussion Assessment Tool (SCAT-5) SCAT5MotionlessInd Recommended CDE
3 Balance issues indicator  Indicator of the presence of balance issues. BalanceIssueInd Recommended CDE
4 Sport Concussion Assessment Tool (SCAT-3, SCAT-5) - Disorientation/confusion indicator  Indicator that the subject is disoriented and/or confused, or unable to respond appropriately to questions, as part of Sport Concussion Assessment Tool (SCAT-3 and SCAT-5) SCAT3DisorientConfInd Recommended CDE
5 Sport Concussion Assessment Tool (SCAT-3,SCAT-5) - Blank/vacant look indicator  Indicator that the subject has blank and/or vacant look, as part of Sport Concussion Assessment Tool (SCAT-3, SCAT-5) SCAT3BlankVacantLookInd Recommended CDE
6 Sport Concussion Assessment Tool (SCAT-5) - facial injury after head trauma indicator  Indicator that the subject has facial injury after head trauma, as part of Sport Concussion Assessment Tool (SCAT-3, SCAT-5) SCAT5FacialInjuryInd Recommended CDE

STEP 3 MEMORY ASSESSMENT MADDOCKS QUESTIONS (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 Maddocks Score - incident description text  A free text, which is a subject narrative of the incident, describing what happened, as part of the Maddocks Score MaddocksScoreDescrTxt Recommended CDE
2 Maddocks Score - Correct venue indicator  Indicator that the subject remembered the location of the game correctly, as part of the Maddocks Score - Recent Memory Questions MaddocksScoreCorrVenueInd Recommended CDE
3 Maddocks Score - Correct game quarter indicator  Indicator that the subject remembered the quarter correctly, as part of the Maddocks Score - Recent Memory Questions MaddocksScoreCorrQuarterInd Recommended CDE
4 Maddocks Score - Correct name of team to score last indicator  Indicator that the subject remembered the name of the team that kicked the last goal correctly, as part of the Maddocks Score - Recent Memory Questions MaddocksScoreCorrTeamScoreInd Recommended CDE
5 Maddocks Score - Correct name of team played last week indicator  Indicator that the subject remembered the name of the team they played last week correctly, as part of the Maddocks Score - Recent Memory Questions MaddocksScoreCorrTeamPlayInd Recommended CDE
6 Maddocks Score - Correct winning team indicator  Indicator that the subject remembered correctly whether their team won last week, as part of the Maddocks Score - Recent Memory Questions MaddocksScoreCorrTeamWonInd Recommended CDE
7 Maddocks Score - Total score  Total score, as part of the Maddocks Score MaddocksScoreTotalScore Recommended CDE

STEP 4 EXAMINATION GLASGOW COMA SCALE (GCS) ADULT (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 Assessment performed date  The date of assessment of the examination being performed. AssessmentPerformedDate Recommended CDE
2 Glasgow Coma Scale (GCS) - eye response scale  Glasgow Coma Scale (GCS) - Best eye response (E). The GCS is a standardized instrument for assessing the level of consciousness. It evaluates three aspects of responsiveness: eye opening, motor response, verbal response. GCSEyeRespnsScale Recommended CDE
3 Glasgow Coma Scale (GCS) - motor response scale  Glasgow Coma Scale (GCS) - Best motor response (M). The GCS is a standardized instrument for assessing the level of consciousness. It evaluates three aspects of responsiveness: eye opening, motor response, verbal response. GCSMotorRespnsScale Recommended CDE
4 Glasgow Coma Scale (GCS) - verbal response scale  Score that describes the participant's verbal response according to the Glasgow Coma Scale (GCS) GCSVerbalRspnsScale Recommended CDE
5 Glasgow Coma Scale (GCS) - total score  Glasgow Coma Scale (GCS) - Total Score. The GCS is a standardized instrument for assessing the level of consciousness. GCSTotalScore Recommended CDE

CERVICAL SPINE ASSESSMENT (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 Sport Concussion Assessment Tool (SCAT-5) - cervical spine assessment neck pain indicator  Indicator if the subject neck is pain free at rest, as part of Sport Concussion Assessment Tool (SCAT-5) - cervical spine assessment SCAT5CervSpineNeckPainInd Recommended CDE
2 Sport Concussion Assessment Tool (SCAT-5) - cervical spine assessment pain free movement indicator  Indicator if the subject neck is pain free at rest, as part of Sport Concussion Assessment Tool (SCAT-5) - cervical spine assessment SCAT5CervSpinePainFreeAMovInd Recommended CDE
3 Sport Concussion Assessment Tool (SCAT-5) - cervical spine assessment limb strength and sensation normal indicator  Indicator I if the subject has the limb strength and sensation normal, as part of Sport Concussion Assessment Tool (SCAT-5) - cervical spine assessment SCAT5CervSpineLimbStrengthInd Recommended CDE

OFFICE OF OFF-FIELD STEP 1 ATHLETE BACKGROUND (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 Sport team participation type  The sport or team that the athlete participates in SportTeamParticipationTyp Recommended UDE
2 Sport team participation other text  The free-text related to Sport team participation type specifying the other type of sport or team SportTeamParticipationTypOTH Optional UDE
3 Education year count  Number of years of education completed (age 5 and beyond) EduYrCt Recommended CDE
4 Hand preference type  Hand which the participant/subject uses predominantly, not necessarily the hand he/she writes with exclusively. HandPrefTyp Recommended CDE
5 Concussion prior number  Number of prior concussions ConcussionPriorNum Recommended CDE
6 Concussion event date  Date (and time, if applicable and known) of concussion event ConcussionEventDate Recommended CDE
7 Concussion symptom duration  Number of days that the participant suffered from post-concussive symptoms ConcussionSymptomDurDays Recommended CDE
8 Sport Concussion Assessment Tool (SCAT-3) - Hospitalized or had medical imaging done for a head injury indicator  Indicator if the subject was hospitalized or had medical imaging done for a head injury, as part of Sport Concussion Assessment Tool (SCAT-3) SCAT3HospitaImgHeadInjInd Recommended CDE
9 Headache migraine diagnosis indicator  Indicator of whether the participant/subject has been diagnosed with the type of headache or migraine HeadachMigranDiagnsInd Recommended CDE
10 Sport Concussion Assessment Tool ( SCAT-5) - learning disability, dyslexia diagnosis indicator  Indicator whether the participant/subject was ever given formal diagnosis of any learning disability or dislexia, as part of Sport Concussion Assessment Tool (SCAT-5) SCAT5LearnDisabDiagnosInd Recommended CDE
11 Sport Concussion Assessment Tool ( SCAT-5) - ADD or ADHD diagnosis indicator  Indicator whether the participant/subject was ever given formal diagnosis of ADD/ADHD, as part of Sport Concussion Assessment Tool (SCAT-5) SCAT5ADDADHDDiagnosInd Recommended CDE
12 Sport Concussion Assessment Tool (SCAT-3) - Diagnosed with depression, anxiety or other psychiatric disorder  Indicator if the subject was diagnosed with depression, anxiety or other psychiatric disorder, as part of Sport Concussion Assessment Tool (SCAT-3) SCAT3AnxDeprPsychDxInd Recommended CDE
13 Medication prior or concomitant ongoing indicator  Indicator of or description that the prior/concomitant medication usage is ongoing. MedctPrConcomOngoingInd Recommended CDE
14 Medication prior or concomitant name  Name of the prior/concomitant agent or drug administered. MedctnPriorConcomName Recommended CDE

OFFICE OF OFF-FIELD STEP 2 SYMPTOM EVALUATION (Appears Up To 2 Times)

# 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 Optional CDE
3 Sport Concussion Assessment Tool (SCAT-3, SCAT-5) - Headache scale  Headache scale, as part of Sport Concussion Assessment Tool (SCAT-3) Scat3Headache Recommended CDE
4 Sport Concussion Assessment Tool (SCAT-3, SCAT-5) - Pressure in head scale  Pressure in head scale, as part of Sport Concussion Assessment Tool (SCAT-3) Scat3Pressureinhead Recommended CDE
5 Sport Concussion Assessment Tool (SCAT-3, SCAT-5) - Neck pain scale  Neck pain scale, as part of Sport Concussion Assessment Tool (SCAT-3) Scat3Neckpain Recommended CDE
6 Sport Concussion Assessment Tool (SCAT-3, SCAT-5) - Nausea, vomiting scale  Nausea vomiting scale, as part of Sport Concussion Assessment Tool (SCAT-3) Scat3Nauseavomiting Recommended CDE
7 Sport Concussion Assessment Tool (SCAT-3, SCAT-5) - Dizziness scale  Dizziness scale, as part of Sport Concussion Assessment Tool (SCAT-3) Scat3Dizziness Recommended CDE
8 Sport Concussion Assessment Tool (SCAT-3, SCAT-5) - Blurred vision scale  Blurred vision scale, as part of Sport Concussion Assessment Tool (SCAT-3) Scat3BlurryVision Recommended CDE
9 Sport Concussion Assessment Tool (SCAT-3, SCAT-5) - Balance problems scale  Balance problems scale, as part of Sport Concussion Assessment Tool (SCAT-3) Scat3BalanceProblem Recommended CDE
10 Sport Concussion Assessment Tool (SCAT-3, SCAT-5) - Sensitivity to light scale  Sensitivity to light scale, as part of Sport Concussion Assessment Tool (SCAT-3) Scat3SenssivityLight Recommended CDE
11 Sport Concussion Assessment Tool (SCAT-3, SCAT-5) - Sensitivity to noise scale  Sensitivity to noise scale, as part of Sport Concussion Assessment Tool (SCAT-3) Scat3SensitivityNoise Recommended CDE
12 Sport Concussion Assessment Tool (SCAT-3, SCAT-5) - Feeling slowed down scale  Feeling slowed down scale, as part of Sport Concussion Assessment Tool (SCAT-3) Scat3FeelSlowDown Recommended CDE
13 Sport Concussion Assessment Tool (SCAT-3, SCAT-5) - Feeling in a fog scale  Feeling in a fog scale, as part of Sport Concussion Assessment Tool (SCAT-3) Scat3FeelFog Recommended CDE
14 Sport Concussion Assessment Tool (SCAT-3, SCAT-5) - Don't feel right scale  Don't feel right scale, as part of Sport Concussion Assessment Tool (SCAT-3) Scat3DontFeelRight Recommended CDE
15 Sport Concussion Assessment Tool (SCAT-3, SCAT-5) - Difficult concentrating scale  Difficult concentrating scale, as part of Sport Concussion Assessment Tool (SCAT-3) Scat3DifficultyConcent Recommended CDE
16 Sport Concussion Assessment Tool (SCAT-3, SCAT-5) - Difficulty remembering scale  Difficulty remembering scale, as part of Sport Concussion Assessment Tool (SCAT-3) Scat3DifficultyRemembering Recommended CDE
17 Sport Concussion Assessment Tool (SCAT-3, SCAT-5) - Fatigue or low energy scale  Fatigue or low energy scale, as part of Sport Concussion Assessment Tool (SCAT-3) Scat3FatgLowEnergy Recommended CDE
18 Sport Concussion Assessment Tool (SCAT-3, SCAT-5) - Confusion scale  Confusion scale, as part of Sport Concussion Assessment Tool (SCAT-3) Scat3Confusion Recommended CDE
19 Sport Concussion Assessment Tool (SCAT-3, SCAT-5) - Drowsiness scale  Drowsiness scale, as part of Sport Concussion Assessment Tool (SCAT-3) Scat3Drowsiness Recommended CDE
20 Sport Concussion Assessment Tool (SCAT-3, SCAT-5) - More emotional scale  More emotional scale, as part of Sport Concussion Assessment Tool (SCAT-3) Scat3MoreEmotional Recommended CDE
21 Sport Concussion Assessment Tool (SCAT-3, SCAT-5) - Irritability scale  Irritability scale, as part of Sport Concussion Assessment Tool (SCAT-3) Scat3Irritable Recommended CDE
22 Sport Concussion Assessment Tool (SCAT-3, SCAT-5) - Sadness scale  Sadness scale, as part of Sport Concussion Assessment Tool (SCAT-3) Scat3Sadness Recommended CDE
23 Sport Concussion Assessment Tool (SCAT-3, SCAT-5) - Nervous or anxious scale  Nervous or anxious scale, as part of Sport Concussion Assessment Tool (SCAT-3) Scat3NervousAnxious Recommended CDE
24 Sport Concussion Assessment Tool (SCAT-3, SCAT-5) - Trouble falling asleep  SCAT-3 Trouble falling asleep indicator Scat3TroublFallAsleep Recommended CDE
25 Sport Concussion Assessment Tool (SCAT-3, SCAT-5) - Total symptoms  Value for total number of symptoms reported, as part of Sport Concussion Assessment Tool (SCAT-3) Scat3TotalSymptoms Recommended CDE
26 Sport Concussion Assessment Tool (SCAT-3, SCAT-5) - Total symptom score  Value for total symptom score, as part of Sport Concussion Assessment Tool (SCAT-3) Scat3TotSympScore Recommended CDE
27 Sport Concussion Assessment Tool (SCAT-3, SCAT-5) - Symptoms worsen with physical activity indicator  Symptoms get worse with physical activity indicator, as part of Sport Concussion Assessment Tool (SCAT-3) Scat3SympPhysActvty Recommended CDE
28 Sport Concussion Assessment Tool (SCAT-3, SCAT-5) - Symptoms worsen with mental activity indicator  Symptoms get worse with mental activity indicator, as part of Sport Concussion Assessment Tool (SCAT-3) Scat3SympMentActvty Recommended CDE
29 Sport Concussion Assessment Tool (SCAT-3) - Source of data rating type  Type of rating applied for the "How do you feel?" section, as part of Sport Concussion Assessment Tool (SCAT-3) SCAT3DataSourceTyp Optional CDE
30 Sport Concussion Assessment Tool (SCAT-3) - Difference in athlete acting scale  Scale showing how different is the athlete acting compared to his / her usual (before injury) self, as part of Sport Concussion Assessment Tool (SCAT-3) SCAT3DifferAthleteActScore Recommended CDE
31 Sport Concussion Assessment Tool (SCAT-3, SCAT-5) - Feel normal percent text  A free text, related to "Sport Concussion Assessment Tool (SCAT-3, SCAT-5) - Feel normal percent" explaining why the subject does not feel 100% normal, as part of Sport Concussion Assessment Tool (SCAT-3) SCAT5FeelNormalPecentTxt Recommended CDE
32 Sport Concussion Assessment Tool (SCAT-3, SCAT-5) - Feel normal percent  Percent use as a score to evaluate how normal the subject feels, as part of Sport Concussion Assessment Tool (SCAT-3) SCAT5FeelNormalPecent Recommended CDE

OFFICE OFF-FIELD STEP 3 CS ORIENTATION (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 Standardized Assessment of Concussion (SAC) - Orientation current month score  Scored ability to identify the current month, as part of the Standardized Assessment of Concussion (SAC) Orientation subtest SACOrientationCurrMonthScore Recommended CDE
2 Standardized Assessment of Concussion (SAC) - current date score  Scored ability to identify the current date as part of the Standardized Assessment of Concussion (SAC) Orientation subtest SACOrientationCurrDateScore Recommended CDE
3 Standardized Assessment of Concussion (SAC) - current day of the week score  Scored ability to identify the current day of the week as part of the Standardized Assessment of Concussion (SAC) Orientation subtest SACOrientationCurrDayWeekScore Recommended CDE
4 Standardized Assessment of Concussion (SAC) - current year score  Scored ability to identify the current year as part of the Standardized Assessment of Concussion (SAC) Orientation subtest SACOrientationCurrYearScore Recommended CDE
5 Standardized Assessment of Concussion (SAC) - current time score  Scored ability to identify the current time (within 1 hour) as part of the Standardized Assessment of Concussion (SAC) Orientation subtest SACOrientationCurrTimeScore Recommended CDE
6 Standardized Assessment of Concussion (SAC) - Orientation subset score  Total score as part of the Standardized Assessment of Concussion (SAC) orientation subtest SACOrientationSubsetScore Recommended CDE

OFFICE OFF-FIELD STEP 3 CS IMMEDIATE MEMORY (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 Standardized Assessment of Concussion (SAC) - immediate memory list type  Type of list, as part of the Standardized Assessment of Concussion (SAC) SACListTyp Recommended CDE
2 Standardized Assessment of Concussion (SAC) - List sub- type  Sub-type of the list presented as a letter to be used in capturing immediate memory and concentration trials lists (for words and digits backwards), as part of the Standardized Assessment of Concussion (SAC) SACListSubTyp Recommended CDE
3 Trial number (numeric)  The number representing the sequence for any repeated measure test or assessment when it is performed multiple times. TrialNumber Recommended CDE
4 Standardized Assessment of Concussion (SAC) - Immediate memory 5 words subset trial total score  Trial score as part of the Standardized Assessment of Concussion (SAC) immediate memory subtest 5 words list SACImmdMemoryTrialScore Recommended CDE
5 Standardized Assessment of Concussion (SAC) - Immediate memory 5 words subset score  Total score as part of the Standardized Assessment of Concussion (SAC) immediate memory subtest 5 words list SACImmdMemorySubsetScore Recommended CDE
6 Standardized Assessment of Concussion (SAC) - Immediate memory 10 words subset score  Total score as part of the Standardized Assessment of Concussion (SAC) immediate memory subtest 10 words list SACImmdMemorySubset10Score Recommended CDE
7 Standardized Assessment of Concussion (SAC) - Immediate memory 10 words subset trial total score  Trial score as part of the Standardized Assessment of Concussion (SAC) immediate memory subtest 10 words list SACImmdMemorySubset10TrScore Recommended CDE
8 Trial completion date and time  The date and time (if available) when the given trial was completed. Should be used along with TrialNumber to define the trial number TrialCompletionDatTime Recommended CDE

OFFICE OFF-FIELD STEP 3 CS CONC DIGITS BACKWARDS (Appears Up To 8 Times)

# Title Short Description Variable Name Required? Type
1 Standardized Assessment of Concussion (SAC) - List sub- type  Sub-type of the list presented as a letter to be used in capturing immediate memory and concentration trials lists (for words and digits backwards), as part of the Standardized Assessment of Concussion (SAC) SACListSubTyp Recommended CDE
2 Standardized Assessment of Concussion (SAC) - Concentration subtest digits backward set indicator  Indicator of the participant to recite the first set of digits backwards, as part of the Standardized Assessment of Concussion (SAC) concentration subtest digits backward SACConcDigitBackwrdsSetInd Recommended CDE
3 Standardized Assessment of Concussion (SAC) - Concentration subtest digits backward set 1 score  Scored ability of the participant to recite the first set of digits backwards, as part of the Standardized Assessment of Concussion (SAC) concentration subtest digits backward SACConcDigitBackwrdsSet1Score Recommended CDE
4 Standardized Assessment of Concussion (SAC) - Concentration subtest digits backward set 2 score  Scored ability of the participant to recite the second set of digits backwards, as part of the Standardized Assessment of Concussion (SAC) concentration subtest digits backward SACConcDigitBackwrdsSet2Score Recommended CDE
5 Standardized Assessment of Concussion (SAC) - Concentration subtest digits backward set 3 score  Scored ability of the participant to recite the third set of digits backwards, as part of the Standardized Assessment of Concussion (SAC) concentration subtest digits backward SACConcDigitBackwrdsSet3Score Recommended CDE
6 Standardized Assessment of Concussion (SAC) - Concentration subtest digits backward set 4 score  Scored ability of the participant to recite the fourth set of digits backwards, as part of the Standardized Assessment of Concussion (SAC) concentration subtest digits backward SACConcDigitBackwrdsSet4Score Recommended CDE
7 Standardized Assessment of Concussion (SAC) - Concentration digits backwards subset total score  Total score as part of the Standardized Assessment of Concussion (SAC) concentration subtest SACConcentationDigitsTotScore Recommended CDE

OFFICE OFF-FIELD STEP 3 CS CONC MONTHS (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 Standardized Assessment of Concussion (SAC) - Concentration subtest months in reverse order score  Scored ability of the participant to recite months of the year backward as part of the Standardized Assessment of Concussion (SAC) concentration subtest month in reverse order SACConcMonthReverseScore Recommended CDE

OFFICE OFF-FIELD STEP 3 CS CONC TOTAL (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 Standardized Assessment of Concussion (SAC) - Concentration subset score  Total score as part of the Standardized Assessment of Concussion (SAC) concentration subtest SACConcentationSubsetScore Recommended CDE

OFFICE OFF-FIELD STEP 4 NEUROLOGICAL (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 Sport Concussion Assessment Tool (SCAT-5) - neurological screen read aloud indicator  Indicator if the subject can read aloud and follow instructions, as part of Sport Concussion Assessment Tool (SCAT-5) - cervical spine assessment SCAT5NSReadAlodInd Recommended CDE
2 Sport Concussion Assessment Tool (SCAT-5) - neurological screen pain free passive movement indicator  Indicator if the subject has a full range of PASSIVE pain free movement, as part of Sport Concussion Assessment Tool (SCAT-5) - cervical spine assessment SCAT5CervSpinePainFreePMovInd Recommended CDE
3 Sport Concussion Assessment Tool (SCAT-5) - neurological screen no double-vision indicator  Indicator if the subject can move eyes without having double-vision, as part of Sport Concussion Assessment Tool (SCAT-5) - cervical spine assessment SCAT5NSDoubleVisionInd Recommended CDE
4 Sport Concussion Assessment Tool (SCAT-5) - neurological screen finger-nose indicator  Indicator if the subject can perform finger to nose movement, as part of Sport Concussion Assessment Tool (SCAT-5) - cervical spine assessment SCAT5NSFingerNoseInd Recommended CDE
5 Sport Concussion Assessment Tool (SCAT-5) - neurological screen tandem gait indicator  Indicator if the subject can perform tandem gait normally, as part of Sport Concussion Assessment Tool (SCAT-5) - cervical spine assessment SCAT5NSTandemGaitInd Recommended CDE

OFFICE OFF-FIELD STEP 4 NEUROLOGICAL BESS (Appears Up To 48 Times)

# Title Short Description Variable Name Required? Type
1 Balance Error Scoring System Modified (BESS Modified) - Foot tested anatomic site  Anatomic site of non-dominant foot tested, as part of Balance Error Scoring System Modified (BESS Modified). BESSFootTestAnatSite Recommended CDE
2 Ground surface type  The type of ground surface. GroundSurfTyp Recommended CDE
3 Footwear use type  The type of footwear used. FootwearUseTyp Recommended CDE
4 Balance Error Scoring System Modified (BESS Modified) - Double leg stance total error count  Total number of errors during double leg stance with feet together on both firm and foam surfaces, as part of Balance Error Scoring System (BESS). BESSDblLegTotalErrorCt Recommended CDE
5 Balance Error Scoring System Modified (BESS Modified) - Single leg stance total error count  Total number of errors during single leg stance with non-dominant foot tested on both firm and foam surfaces, as part of Balance Error Scoring System (BESS). BESSSglLegTotalErrorCt Recommended CDE
6 Balance Error Scoring System Modified (BESS Modified) - Tandem stance total error count  Total number of errors tandem stance on both firm and foam surfaces, as part of Balance Error Scoring System (BESS). BESSTandemStncTotalErrorCt Recommended CDE
7 Balance Error Scoring System (BESS and mBESS) - Both firm foam surface total error count  Total number of errors for both firm and foam surface, as part of Balance Error Scoring System (BESS) and modified BESS. BESSTotalErrorCt Recommended CDE

OFFICE OFF-FIELD STEP 5 DELAYED RECALL (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 Standardized Assessment of Concussion (SAC) - immediate memory list type  Type of list, as part of the Standardized Assessment of Concussion (SAC) SACListTyp Recommended CDE
2 Trial completion date and time  The date and time (if available) when the given trial was completed. Should be used along with TrialNumber to define the trial number TrialCompletionDatTime Recommended CDE
3 Standardized Assessment of Concussion (SAC) - Delayed recall 5 words list subset score  Total score as part of the Standardized Assessment of Concussion (SAC) delayed recall 5 words list subtest SACDelayedRecallSubsetScore Recommended CDE
4 Standardized Assessment of Concussion (SAC) - Delayed recall 10 words list subset score  Total score as part of the Standardized Assessment of Concussion (SAC) delayed recall 10 words list subtest SACDelayedRecall10SubsetScore Recommended CDE
5 Standardized Assessment of Concussion (SAC) - Delayed recall words text  A free text, a list of words recalled by the subject during the delayed recall trial and recorded by the examiner, s part of the Standardized Assessment of Concussion (SAC) delayed recall trial SACDelayedRecallwordsTxt Recommended CDE

OFFICE OFF-FIELD STEP 6 DECISION (Appears Up To 3 Times)

# Title Short Description Variable Name Required? Type
1 Assessment date and time  The date of participant's injury AssessDateTime Recommended CDE
2 Sport Concussion Assessment Tool (SCAT-3, SCAT-5) - Total symptoms  Value for total number of symptoms reported, as part of Sport Concussion Assessment Tool (SCAT-3) Scat3TotalSymptoms Recommended CDE
3 Sport Concussion Assessment Tool (SCAT-3, SCAT-5) - Total symptom score  Value for total symptom score, as part of Sport Concussion Assessment Tool (SCAT-3) Scat3TotSympScore Recommended CDE
4 Standardized Assessment of Concussion (SAC) - Orientation subset score  Total score as part of the Standardized Assessment of Concussion (SAC) orientation subtest SACOrientationSubsetScore Recommended CDE
5 Standardized Assessment of Concussion (SAC) - Immediate memory 5 words subset score  Total score as part of the Standardized Assessment of Concussion (SAC) immediate memory subtest 5 words list SACImmdMemorySubsetScore Recommended CDE
6 Standardized Assessment of Concussion (SAC) - Immediate memory 10 words subset score  Total score as part of the Standardized Assessment of Concussion (SAC) immediate memory subtest 10 words list SACImmdMemorySubset10Score Recommended CDE
7 Standardized Assessment of Concussion (SAC) - Concentration subset score  Total score as part of the Standardized Assessment of Concussion (SAC) concentration subtest SACConcentationSubsetScore Recommended CDE
8 Sport Concussion Assessment Tool (SCAT-5) - neurological screen status  Status of neurological screening (abnormal or normal), as part of Sport Concussion Assessment Tool (SCAT-5) - neurological screen SCAT5NSStatus Recommended CDE
9 Balance Error Scoring System (BESS and mBESS) - Both firm foam surface total error count  Total number of errors for both firm and foam surface, as part of Balance Error Scoring System (BESS) and modified BESS. BESSTotalErrorCt Recommended CDE
10 Standardized Assessment of Concussion (SAC) - Delayed recall 5 words list subset score  Total score as part of the Standardized Assessment of Concussion (SAC) delayed recall 5 words list subtest SACDelayedRecallSubsetScore Recommended CDE
11 Standardized Assessment of Concussion (SAC) - Delayed recall 10 words list subset score  Total score as part of the Standardized Assessment of Concussion (SAC) delayed recall 10 words list subtest SACDelayedRecall10SubsetScore Recommended CDE
12 Injury date time  Date (and time, if applicable and known) of injury InjDateTime Recommended UDE
13 Sport Concussion Assessment Tool (SCAT-3) - Difference in athlete acting scale  Scale showing how different is the athlete acting compared to his / her usual (before injury) self, as part of Sport Concussion Assessment Tool (SCAT-3) SCAT3DifferAthleteActScore Recommended CDE
14 Concussion diagnosis status  Indicator, whether the reported concussion was or was not diagnosed by a medical provider ConcussDxStatus Recommended CDE
15 Subject improved indicator  Indicator, if the subject (an athlete) showed the signs of improvement in his /her conditions during re-testing SubjectImproveInd Recommended CDE

CLINICAL NOTES (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 General notes text  General notes GeneralNotesTxt Recommended CDE