Form Structure: Brief Traumatic Brain Injury Screen (BTBIS)
This form structure is an organized set of data definitions for a form that has not been copyrighted
Title:
Brief Traumatic Brain Injury Screen (BTBIS)
Short Name:
BTBIS
Description:
The Brief Traumatic Brain Injury Screen (BTBIS) is a self-report measure to traumatic brain injury (TBI) in service members.
References: Schwab KA, Ivins B, Cramer G, Johnson W, Sluss-Tiller M, Kiley K, Lux W, Warden D.J Screening for traumatic brain injury in troops returning from deployment in Afghanistan and Iraq: initial investigation of the usefulness of a short screening tool for traumatic brain injury.
Head Trauma Rehabil. 2007 Nov-Dec;22(6):377-89.https://www.ncbi.nlm.nih.gov/pubmed/18025970
Disease:
General (For all diseases)
Required Program Form:
No
Standardization:
Standard NINDS CDE
Labels:
Form Type:
Clinical Assessment
Publication Date:
2020-03-02
Version:
1.2
Date Created:
2015-05-14
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 | 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.
Form Administration Group (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 |
Brief Traumatic Brain Injury Screen (BTBIS) (Repeat Infinitely)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Brief Traumatic Brain Injury Screen (BTBIS) - Injury during deployment type | The type of injury sustained during deployment, as part of the Brief Traumatic Brain Injury Screen (BTBIS). | BTBISInjDeployTyp | Recommended | CDE |
| 2 | Brief Traumatic Brain Injury Screen (BTBIS) - Injury during deployment other text | The free-text related to 'BTBISInjDeployTyp' specifying other text | BTBISInjDeployOTH | Recommended | CDE |
| 3 | Brief Traumatic Brain Injury Screen (BTBIS) - Injury result type | The type of result from injury during deployment, as part of the Brief Traumatic Brain Injury Screen (BTBIS). | BTBISInjResultTyp | Recommended | CDE |
| 4 | Brief Traumatic Brain Injury Screen (BTBIS) - Symptom related to injury type | The type of symptom experienced related to head injury or concussion, as part of the Brief Traumatic Brain Injury Screen (BTBIS).. | BTBISSymptomRelateInjTyp | Recommended | CDE |
| 5 | Brief Traumatic Brain Injury Screen (BTBIS) - Symptom related to injury other text | The free-text related to 'BTBISSymptomRelateInjTyp' specifying other text | BTBISSymptomRelateInjOTH | Recommended | CDE |
Keywords
