Form Structure: Alcohol Use Disorders Identification Test: Self-Report Version (AUDIT)
This form structure is an organized set of data definitions for a copyrighted form
Title:
Alcohol Use Disorders Identification Test: Self-Report Version (AUDIT)
Short Name:
AUDIT_FITBIR
Description:
The AUDIT consists of 10 items which are used to assess excessive drinking, signs of dependence and harmful use in the past year. Recommended by CDISC for TBI (TAUG TBI)
Disease:
Traumatic Brain Injury
Organization:
NINDS
Required Program Form:
No
Standardization:
Standard NINDS CDE
Labels:
Form Type:
Clinical Assessment
Publication Date:
2014-11-14
Version:
1.3
Date Created:
2014-10-31
Owner:
Number of Data Elements:
19
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 | Visit date | Actual interview or visit date | VisitDate | Recommended | CDE |
5 | Site name | The name of the site for the study | SiteName | Recommended | CDE |
6 | Days since baseline | The number of days since baseline | DaysSinceBaseline | Optional | CDE |
7 | Case control indicator | Indicator of whether subject is in the case or control arm of the study. | CaseContrlInd | Optional | CDE |
8 | General notes text | General notes | GeneralNotesTxt | Optional | CDE |
Additional Element Groups
Listed below are your additional element groups.
AUDIT (Repeat Infinitely)
# | 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 |
4 | Alcohol Use Disorders Identification Test (AUDIT) - Cannot stop drink alcohol frequency score | Score for the frequency within the last year with which the subject found himself or herself unable to stop drinking once he or she started. | AUDITCantStopDrnkAlcFreqScore | Recommended | CDE |
5 | Alcohol Use Disorders Identification Test (AUDIT) - Fail normal activity drink frequency score | The frequency with which the subject found himself or herself unable to perform normal tasks due to drinking. | AUDITFailNrmlActDrnkFreqScore | Recommended | CDE |
6 | Alcohol Use Disorders Identification Test (AUDIT) - Morning drink after frequency score | The frequency with which the subject found himself or herself in need of an alcoholic drink in the morning due to a heavy drinking session the night before. | AUDITMornDrnkAftDrnkFreqScore | Recommended | CDE |
7 | Alcohol Use Disorders Identification Test (AUDIT) - Guilt remorse after drink frequency score | Score for the frequency within the last year with which the subject found himself or herself with feelings or guilt or remorse after drinking. | AUDITGltRmrseAftrDrnkFreqScore | Recommended | CDE |
8 | Alcohol Use Disorders Identification Test (AUDIT) - Cannot remember night before frequency score | Score for the frequency within the last year with which the subject was unable to remember what happened the previous night due to drinking. | AUDITCantRmbrNghtBefrFreqScore | Recommended | CDE |
9 | Alcohol Use Disorders Identification Test (AUDIT) - Drink injury indicator score | Score for the indicator of whether someone that the subject knows was injured due to his or her drinking. | AUDITDrnkInjIndScore | Recommended | CDE |
10 | Alcohol Use Disorders Identification Test (AUDIT) - Relative friend doctor concern indicator score | Score for the indicator of whether a relative, friend, doctor, or other health care workers has been concerned about the subject's drinking or suggested the subject cut down. | AUDITReltvFrndDrCncrnIndScore | Recommended | CDE |
11 | Alcohol Use Disorders Identification Test (AUDIT) - Total score | The subject/participant's AUDIT total score (0-40) | AUDITTotalScore | Recommended | CDE |
Keywords