Form Structure: Children's Orientation and Amnesia Test (COAT)
This form structure is an organized set of data definitions for a form that has not been copyrighted
Title:
Children's Orientation and Amnesia Test (COAT)
Short Name:
COAT
Description:
The Children's Orientation and Amnesia Test (COAT) was developed to assess cognition serially during the early stage of recovery from traumatic brain injury in children and adolescents. COAT is composed of 16 items evaluating general orientation, temporal orientation, and memory.
Disease:
Traumatic Brain Injury
Organization:
NIH
Required Program Form:
No
Standardization:
Standard NINDS CDE
Labels:
Form Type:
Clinical Assessment
Publication Date:
2016-07-05
Version:
1.0
Date Created:
2015-03-31
Owner:
Number of Data Elements:
47
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 (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 |
Orientation and Amnesia Test (Repeat Infinitely)
# | Title | Short Description | Variable Name | Required? | Type |
---|---|---|---|---|---|
1 | Children's Orientation and Amnesia Test (COAT) - Live state location score | Scored ability to accurately identify the state of residence, as part of the Children's Orientation and Amnesia Test (COAT). | COATLiveStateScore | Recommended | CDE |
2 | Children's Orientation and Amnesia Test (COAT) - Age score | Scored ability to accurately identify age, as part of the Children's Orientation and Amnesia Test (COAT). | COATAgeScore | Recommended | CDE |
3 | Children's Orientation and Amnesia Test (COAT) - Birth day month age score | Scored ability to accurately identify birth day, month, and age, as part of the Children's Orientation and Amnesia Test (COAT). | COATAgeBirthScore | Recommended | CDE |
4 | Children's Orientation and Amnesia Test (COAT) - Birth day score | Scored ability to accurately identify birth day, as part of the Children's Orientation and Amnesia Test (COAT). | COATBirthDayScore | Recommended | CDE |
5 | Children's Orientation and Amnesia Test (COAT) - Birth month score | Scored ability to accurately identify birth month, as part of the Children's Orientation and Amnesia Test (COAT). | COATBirthMonthScore | Recommended | CDE |
6 | Children's Orientation and Amnesia Test (COAT) - Current location score | Scored ability to accurately identify current location, as part of the Children's Orientation and Amnesia Test (COAT). | COATCurrentLocationScore | Recommended | CDE |
7 | Children's Orientation and Amnesia Test (COAT) - Current time score | Scored ability identify the current time, as part of the Children's Orientation and Amnesia Test (COAT). | COATCurrentTimeScore | Recommended | CDE |
8 | Children's Orientation and Amnesia Test (COAT) - Day month score | Scored ability to identify current day of the month, as part of the Children's Orientation and Amnesia Test (COAT). | COATDayMonthScore | Recommended | CDE |
9 | Children's Orientation and Amnesia Test (COAT) - Day week score | Scored ability to identify current day of the week, as part of the Children's Orientation and Amnesia Test (COAT). | COATDayWeekScore | Recommended | CDE |
10 | Children's Orientation and Amnesia Test (COAT) - Daytime nighttime distinction score | Scored ability to accurately identify if it is daytime or nighttime, as part of the Children's Orientation and Amnesia Test (COAT). | COATTimeOfDayScore | Recommended | CDE |
11 | Children's Orientation and Amnesia Test (COAT) - Father name score | Scored ability to accurately identify father's name, as part of the Children's Orientation and Amnesia Test (COAT). | COATFatherNameScore | Recommended | CDE |
12 | Children's Orientation and Amnesia Test (COAT) - Fingers score | Scored ability to accurately identify two, three, and ten fingers being held up, as part of the Children's Orientation and Amnesia Test (COAT). | COATFingerScore | Recommended | CDE |
13 | Children's Orientation and Amnesia Test (COAT) - First name score | Scored ability to accurately identify first name, as part of the Children's Orientation and Amnesia Test (COAT). | COATFirstNameScore | Recommended | CDE |
14 | Children's Orientation and Amnesia Test (COAT) - Full name score | Scored ability to accurately identify first and last name, as part of the Children's Orientation and Amnesia Test (COAT). | COATFullNameScore | Recommended | CDE |
15 | Children's Orientation and Amnesia Test (COAT) - General orientation total score | Subject's total score for general orientation questions, as part of the Children's Orientation and Amnesia Test (COAT). | COATGeneralOrientTotalScore | Recommended | CDE |
16 | Children's Orientation and Amnesia Test (COAT) - Interviewer score | Scored ability to accurately remember the Interview's name, as part of the Children's Orientation and Amnesia Test (COAT). | COATInterviewerScore | Recommended | CDE |
17 | Children's Orientation and Amnesia Test (COAT) - Last name score | Scored ability to accurately identify last name, as part of the Children's Orientation and Amnesia Test (COAT). | COATLastNameScore | Recommended | CDE |
18 | Children's Orientation and Amnesia Test (COAT) - Live city location score | Scored ability to accurately identify the city of residence, as part of the Children's Orientation and Amnesia Test (COAT). | COATLiveCityScore | Recommended | CDE |
19 | Children's Orientation and Amnesia Test (COAT) - Live city state location score | Scored ability to accurately identify the city and identify of residence, as part of the Children's Orientation and Amnesia Test (COAT). | COATLiveScore | Recommended | CDE |
20 | Children's Orientation and Amnesia Test (COAT) - Memory total score | Total score for memory questions, as part of the Children's Orientation and Amnesia Test (COAT). | COATMemoryScore | Recommended | CDE |
21 | Children's Orientation and Amnesia Test (COAT) - Month score | Scored ability to identify current month, as part of the Children's Orientation and Amnesia Test (COAT). | COATMonthScore | Recommended | CDE |
22 | Children's Orientation and Amnesia Test (COAT) - Mother name score | Scored ability to accurately identify mother's name, as part of the Children's Orientation and Amnesia Test (COAT). | COATMotherNameScore | Recommended | CDE |
23 | Children's Orientation and Amnesia Test (COAT) - Number sequence memory score | Scored ability to repeat numbers in order, as part of the Children's Orientation and Amnesia Test (COAT). | COATNumberMemoryScore | Recommended | CDE |
24 | Children's Orientation and Amnesia Test (COAT) - Overall Score | Overall score, as part of the Children's Orientation and Amnesia Test (COAT). | COATOverallScore | Recommended | CDE |
25 | Children's Orientation and Amnesia Test (COAT) - Parent name score | Scored ability to accurately identify parent's names, as part of the Children's Orientation and Amnesia Test (COAT). | COATParentNameScore | Recommended | CDE |
26 | Children's Orientation and Amnesia Test (COAT) - School grade score | Scored ability to accurately identify grade in school, as part of the Children's Orientation and Amnesia Test (COAT). | COATGradeScore | Recommended | CDE |
27 | Children's Orientation and Amnesia Test (COAT) - School name grade score | Scored ability to accurately identify school name and grade, as part of the Children's Orientation and Amnesia Test (COAT). | COATSchoolScore | Recommended | CDE |
28 | Children's Orientation and Amnesia Test (COAT) - School name score | Scored ability to accurately identify school name, as part of the Children's Orientation and Amnesia Test (COAT). | COATSchoolNameScore | Recommended | CDE |
29 | Children's Orientation and Amnesia Test (COAT) - Television score | Scored ability to accurately remember a character on a television show they watch, as part of the Children's Orientation and Amnesia Test (COAT). | COATTVScore | Recommended | CDE |
30 | Children's Orientation and Amnesia Test (COAT) - Temporal orientation total score | Subject's total score for temporal orientation questions, as part of the Children's Orientation and Amnesia Test (COAT). | COATTemporalOrientTotalScore | Recommended | CDE |
31 | Children's Orientation and Amnesia Test (COAT) - Ten fingers score | Scored ability to accurately identify ten fingers being held up, as part of the Children's Orientation and Amnesia Test (COAT). | COATTenFingersScore | Recommended | CDE |
32 | Children's Orientation and Amnesia Test (COAT) - Three fingers score | Scored ability to accurately identify three fingers being held up, as part of the Children's Orientation and Amnesia Test (COAT). | COATThreeFingersScore | Recommended | CDE |
33 | Children's Orientation and Amnesia Test (COAT) - Two fingers score | Scored ability to accurately identify two fingers being held up, as part of the Children's Orientation and Amnesia Test (COAT). | COATTwoFingersScore | Recommended | CDE |
34 | Children's Orientation and Amnesia Test (COAT) - Year score | Scored ability to identify current year, as part of the Children's Orientation and Amnesia Test (COAT). | COATYearScore | Recommended | CDE |
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