Form Structure: FITBIR EEG form
This form structure is an organized set of data definitions for a form that has not been copyrighted
Title:
FITBIR EEG form
Short Name:
EEG_FITBIR
Description:
This is a FITBIR EEG form that contains basic EEG information and metadata. The form is created based on 1) recommendations provided by NINDS and 2) FITBIR community input.
References: Light GA, Williams LE, Minow F, Sprock J, Rissling A, Sharp R, Swerdlow NR, Electroencephalography (EEG) and event-related potentials (ERPs) with human participants. Braff DL.Curr Protoc Neurosci. 2010 Jul;Chapter 6:Unit 6.25.1-24. doi: 10.1002/0471142301.ns0625s52. https://www.ncbi.nlm.nih.gov/pubmed/20578033
Disease:
Traumatic Brain Injury
General (For all diseases)
Organization:
FITBIR
Required Program Form:
No
Standardization:
Standard NINDS CDE
Labels:
Form Type:
Imaging
Publication Date:
2017-04-10
Version:
1.1
Date Created:
2016-11-24
Owner:
Number of Data Elements:
89
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 | 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 |
Technical Information (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | EEG recording anatomic location type | Type of anatomic location (scalp or intracranial) where EEG recording was taking place. | EEGRecordAnatLocTyp | Recommended | CDE |
| 2 | EEG recording system make text | Make of EEG recording system | EEGRecordMakeTxt | Recommended | CDE |
| 3 | EEG recording system model text | Model of EEG recording system | EEGRecordModelTxt | Recommended | CDE |
| 4 | EEG recording system model serial number | EEG recording system model serial number | EEGRecordModelSerNum | Optional | CDE |
| 5 | EEG recording system software name | EEG recording system software name | EEGRecordSoftwareName | Recommended | CDE |
| 6 | EEG recording system software version | EEG recording system software version | EEGRecordSoftwareVer | Optional | CDE |
Electrode Information (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | EEG recording system electrodes used number | Number of sensors/electrodes used in EEG recording | EEGRecordElectrodNum | Recommended | CDE |
| 2 | EEG recording system electrodes used number other text | Number of sensors/electrodes used in EEG recording other than one which is specified in 'EEGRecordElectrodNum' | EEGRecordElectrodNumOTH | Optional | CDE |
| 3 | EEG recording electrode montage type | Type of electrode montage used in EEG recording | EEGRecordElectrodMontTyp | Recommended | CDE |
| 4 | EEG recording electrode montage type other text | Other text specifying 'EEG recording electrode montage type' | EEGRecordElectrodMontTypOTH | Optional | CDE |
| 5 | EEG recording electrode locations file uploaded with the dataset indicator | Indicator if the EEG electrode locations file is uploaded with the dataset | EEGRecordLocFileInd | Recommended | CDE |
| 6 | EEG recording electrode type | Type of electrodes used in EEG recording | EEGRecordElectrodTyp | Recommended | CDE |
| 7 | EEG recording electrode type other text | Free text, related 'EEG recording electrode type' specifying other text | EEGRecordElectrodTypOTH | Optional | CDE |
| 8 | EEG recording conductive material used type | Type of conductive material used in EEG recording | EEGRecordConductMatTyp | Recommended | CDE |
| 9 | EEG recording conductive material used other text | Free text, related to 'EEG recording conductive material used type', specifying other text | EEGRecordConductMatTypOTH | Optional | CDE |
| 10 | EEG recording reference electrode placement type | Type of reference electrode placement used in EEG recording | EEGRecordRefElectrodPlcTyp | Recommended | CDE |
| 11 | EEG recording reference electrode placement type other text | Free text, related 'EEG recording reference electrode placement type' specifying other text | EEGRecordRefElectrodPlcTypOTH | Optional | CDE |
EEG Objectives (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Medical history condition SNOMED CT code | Systematized Nomenclature Of Medicine Clinical Terms (SNOMED CT) code for medical condition/disease reported by the participant/subject | MedclHistCondSNOMEDCTCode | Recommended | CDE |
| 2 | Medical history condition text | Verbatim text for the medical condition/disease reported by the participant/subject or documented in the medical record as part of medical history | MedclHistCondTxt | Recommended | CDE |
EEG Recording Information (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | EEG recording start date and time | Date the electroencephalogram (EEG) recording began | EEGRecordingStrtDate | Recommended | CDE |
| 2 | EEG recording end date and time | Date the electroencephalogram (EEG) recording ended | EEGRecordingEndDate | Recommended | CDE |
| 3 | EEG data original purpose type | The reason(s) for gathering data via electroencephalogram (EEG) method | EEGDataOriginalPurposeTyp | Recommended | CDE |
| 4 | EEG data original purpose other text | The free-text field related to 'EEG data original purpose type' specifying other text. The reason(s) for gathering data via electroencephalogram (EEG) method | EEGDataOriginalPurposeOTH | Optional | CDE |
| 5 | EEG location type | The location of where the electroencephalogram (EEG) took place | EEGLocTyp | Recommended | CDE |
| 6 | EEG location other text | The free-text field related to 'EEG location type' specifying other text. The location of where the electroencephalogram (EEG) took place | EEGLocOTH | Optional | CDE |
| 7 | EEG monitoring type | Type of electroencephalogram (EEG) monitoring | EEGMonitorType | Recommended | CDE |
| 8 | EEG prolonged duration type | The length of time for the prolonged electroencephalogram (EEG) | EEGProlongedDurTyp | Recommended | CDE |
| 9 | EEG prolonged duration other text | The free-text field related to 'EEG prolonged duration type' specifying other text. The length of time for the prolonged electroencephalogram (EEG) | EEGProlongedDurOTH | Optional | CDE |
| 10 | EEG recording time duration | Duration of time of EEG recording (in minutes). | EEGRecordTimeDur | Recommended | CDE |
| 11 | EEG sampling rate | Sampling rate used for EEG recording (in Hz) | EEGSamplingRate | Recommended | CDE |
| 12 | EEG recording low pass filter setting value | Low pass filter setting value (in HZ) used for EEG recording | EEGRecordLowPassFilterVal | Recommended | CDE |
| 13 | EEG recording high pass filter setting value | High pass filter setting value (in HZ) used for EEG recording | EEGRecordHighPassFilterVal | Recommended | CDE |
| 14 | EEG recording digital filter used text | Text describing a digital filter used for EEG recording | EEGRecordDigitFilterTxt | Recommended | CDE |
| 15 | EEG recording electrode impedance value | Value of electrode impedance in EEG recording (in kOhm) | EEGRecordImpedanceVal | Recommended | CDE |
| 16 | EEG recording electrode impedance value not available text | Text explaining why the value of electrode impedance in EEG recording is not available | EEGRecordImpedanceTxt | Optional | CDE |
| 17 | EEG recording complete indicator | Indicator if the EEG recording is complete | EEGRecordCompleteInd | Recommended | CDE |
| 18 | EEG recording incomplete reason text | Text explaining why the EEG recording wasn't complete | EEGRecordIncompleteTxt | Recommended | CDE |
| 19 | EEG video indicator | A test involving simultaneous Electroencephalography (EEG) and video recording. | EEGVideoInd | Optional | CDE |
| 20 | Video file available with EEG recording indicator | Indicator if the video recording file taken during EEG recording is available | EEGVideoFileAvailableInd | Optional | CDE |
Participant Information (Appears Up To 45 Times)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Medication prior or concomitant use indicator | Indicator of whether the participant/subject reported taking any medications during the time period relevant to the study protocol | MedctnPriorConcomUseInd | Recommended | CDE |
| 2 | Medication prior or concomitant name | Name of the prior/concomitant agent or drug administered. | MedctnPriorConcomName | Recommended | CDE |
| 3 | Substance use indicator | Indicate whether or not the subject showed signs of substance abuse (recreational drug or chronic alcohol use) at the time of injury and/or medical evaluation. | SubUseInd | Recommended | CDE |
| 4 | Context type | The context to which the questions were answered | ContextType | Recommended | CDE |
| 5 | Context type other text | The free-text related to ContextType specifying other text | ContextTypeOTH | Optional | CDE |
| 6 | Substance used type | Type of substance (if any) digested/used before taking a given test (e.g. EEG test) | SubstanceTyp | Recommended | CDE |
| 7 | Substance used type other text | Free text, related to 'Substance used type', specifying other text | SubstanceTypOTH | Optional | CDE |
| 8 | EEG behavioral state recorded type | The recorded state(s) of the subject during the Electroencephalography (EEG) | EEGBehavioralStateRecordedTyp | Recommended | CDE |
| 9 | EEG behavioral state recorded other text | The free-text field related to 'EEG behavioral state recorded type' specifying other text. The recorded state(s) of the subject during the electroencephalogram (EEG) | EEGBehavioralStateRecordedOTH | Optional | CDE |
| 10 | EEG activating/stimuli procedures used indicator | Indicator, if any EEG activating/stimuli procedures were used during EEG recording | EEGActivatingProcedUsedInd | Recommended | CDE |
| 11 | EEG activating procedures used type | Type(s) of procedures used to improve the Electroencephalography (EEG) diagnostic yield by inducing or enhancing epileptogenic paroxysms. | EEGActivatingProcedUsedTyp | Recommended | CDE |
| 12 | EEG activating procedures used other text | The free-text field related to 'EEG activating procedures used type' specifying other text. Type(s) of procedures used to improve the electroencephalogram (EEG) diagnostic yield by inducing or enhancing epileptogenic paroxysms. | EEGActivatingProcedUsedOTH | Optional | CDE |
| 13 | EEG activating/stimuli procedures file available indicator | Indicator, if a file with any EEG activating/stimuli procedures and timing is available | EEGActivatingProcedFileInd | Recommended | CDE |
| 14 | EEG activating/stimuli procedures used text | Free text describing any EEG activating/stimuli procedures were used during EEG recording | EEGActivatingProcedTxt | Recommended | CDE |
EEG Raw Data Files (Appears Up To 45 Times)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | EEG image quality result | The image quality from the electroencephalogram (EEG) | EEGImgQualityReslt | Recommended | CDE |
| 2 | EEG recording plot file | EEG recording plot file. Could be a ZIP file. | EEGRecordPlotFile | Recommended | CDE |
| 3 | EEG recording electrode location file | EEG recording electrode location file | EEGRecordElectrodeLocFile | Recommended | CDE |
| 4 | EEG recording raw data file | EEG recording raw data files | EEGRecordRawDataFile | Recommended | CDE |
| 5 | EEG recording activating procedure and/or stimuli events file | EEG recording activating procedure and/or stimuli events file with timing. Could be a ZIP file. | EEGActivatingProcedFile | Recommended | CDE |
| 6 | EEG recording video file | EEG recording video file | EEGRecordVideoFile | Recommended | CDE |
EEG Raw Data Comments (Appears Up To 45 Times)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | EEG occipital rhythm presence indicator | Indicator if occipital rhythm is present on EEG records | EEGORPresentInd | Recommended | CDE |
| 2 | EEG background activity presence indicator | Indicator if background activity (BA) is present on EEG recording | EEGBAPresentInd | Recommended | CDE |
| 3 | EEG artifacts present indicator | Indicator if any artifacts are present on EEG recording | EEGArtifactsInd | Recommended | CDE |
| 4 | EEG comments text | Free text for EEG comments | EEGCommentsTxt | Recommended | CDE |
| 5 | Brain region of interest type other text | Free text related to "Anatomic location of the region of interest (ROI) in the brain" specifying other text | BrainROITypOTH | Recommended | CDE |
| 6 | Brain region of interest type | Anatomic location of the region of interest (ROI) in the brain | BrainROITyp | Recommended | CDE |
| 7 | EEG activity morphology type | Type of morphology of EEG activity if it is emphasized in the EEG report | EEGActivityMorphTyp | Recommended | CDE |
| 8 | EEG activity morphology transient -single wave type | Type of transient single-wave morphology of EEG activity if it is emphasized in the EEG report | EEGActivityMorphTransSWTyp | Recommended | CDE |
| 9 | EEG activity morphology transient-complex waves type | Type of transient complex waves morphology of EEG activity if it is emphasized in the EEG report | EEGActivityMorphTransComplTyp | Recommended | CDE |
| 10 | EEG activity morphology pattern type | Type of pattern morphology of EEG activity if it is emphasized in the EEG report | EEGActivityMorphPatternTyp | Recommended | CDE |
| 11 | EEG activity magnitude type | Type of magnitude of EEG activity if it is emphasized in the EEG report | EEGActivityMagnitudeTyp | Recommended | CDE |
| 12 | EEG activity recurrence type | Type of recurrence of EEG activity if it is emphasized in the EEG report | EEGActivityRecurrenceTyp | Recommended | CDE |
EEG Processed Data Files (Appears Up To 45 Times)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | EEG recording processed data file | EEG recording processed data files. Could be a ZIP file. | EEGRecordProcessedDataFile | Recommended | CDE |
| 2 | EEG recording sample duration | Duration of time of EEG recording sample (in seconds). If there are several samples stored in 'EEG recording raw data file', an average duration. | EEGRecordSampleDur | Recommended | CDE |
| 3 | EEG comments text | Free text for EEG comments | EEGCommentsTxt | Recommended | CDE |
Keywords
