Form Structure: Pediatric Glasgow Outcome Scale - Extended (GOS-E Peds)
This form structure is an organized set of data definitions for a form that has not been copyrighted
Title:
Pediatric Glasgow Outcome Scale - Extended (GOS-E Peds)
Short Name:
GOSE_Peds
Description:
The Glasgow Outcome Scale-Extended Pediatric Version (GOS-E Peds) is a modified GOS-E revision, which is developmentally appropriate structured interview that should be used to classify younger patients.
Disease:
Traumatic Brain Injury
Organization:
NIH
Required Program Form:
No
Standardization:
Standard NINDS CDE
Labels:
Form Type:
Clinical Assessment
Publication Date:
2014-10-23
Version:
1.0
Date Created:
2014-08-25
Owner:
Number of Data Elements:
24
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 Completion (Appears Up To 1 Time)
Keywords
