Form Structure: Alcohol Use Disorders Identification Test - Consumption Questions (AUDIT-C)
This form structure is an organized set of data definitions for a form that has not been copyrighted
Title:
Alcohol Use Disorders Identification Test - Consumption Questions (AUDIT-C)
Short Name:
AUDITC
Description:
AUDIT-C is a 3-item alcohol screen that can help identify person who are hazardous drinkers or have active alcohol use disorders(including alcohol abuse or dependence). AUDIT-C is a modified version of the 10 question AUDIT instrument. Recommended by CDISC for TBI (TAUG TBI) Refferences: https://www.cdisc.org/foundational/qrs
Disease:
Traumatic Brain Injury
Organization:
CNRM/HJF
Required Program Form:
No
Standardization:
Standard NINDS CDE
Labels:
Form Type:
Clinical Assessment
Publication Date:
2016-06-01
Version:
1.2
Date Created:
2016-02-02
Owner:
Number of Data Elements:
17
eForms:
N
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 | 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 |
AUDITC (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Alcohol Use Disorders Identification Test (AUDIT) - Drink contain alcohol frequency score | Score for the frequency with which the subject consumes alcoholic drinks. | AUDITDrnkContainAlcFreqScore | Recommended | CDE |
| 2 | Alcohol Use Disorders Identification Test (AUDIT) - Alcohol drink typical day number score | Score for the number of drinks the subject consumes on a day he or she is drinking. | AUDITAlcDrnkTypclDayNumScore | Recommended | CDE |
| 3 | Alcohol Use Disorders Identification Test (AUDIT) - More than 6 alcohol drink frequency score | Score for the frequency with which the subject consumes six or more alcoholic drinks on a single occasion. | AUDITMoreThan6AlcDrnkFreqScore | Recommended | CDE |
AUDITC Scoring (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Alcohol Use Disorders Identification Test - Consumption Questions (AUDIT-C) - Total Score | The subject's AUDIT-C total score (0-12) | AUDITCTotalScore | Optional | CDE |
Keywords
