Form Structure: Glasgow Outcome Scale Extended (GOS-E)
This form structure is an organized set of data definitions for a copyrighted form
Resource:
FITBIR
Title:
Glasgow Outcome Scale Extended (GOS-E)
Short Name:
GOSE_Standard
Description:
The Glasgow Outcome Scale Extended (GOS-E) is a revision of the Glasgow Outcome Scale (GOS) that 1) rates patient status into one of five categories: Dead, Vegetative State, Severe Disability, Moderate Disability or Good Recovery and 2) divides the upper three ratings into upper and lower categories - lower severe disability, upper severe disability, lower moderate disability, upper moderate disability, lower good recovery, upper good recovery. Recommended by CDISC for TBI (TAUG TBI)
Disease:
Traumatic Brain Injury
Organization:
NIH
Required Program Form:
Yes
Standardization:
Standard NINDS CDE
Labels:
Form Type:
Clinical Assessment
Publication Date:
2014-09-12
Version:
1.3
Date Created:
2014-08-25
Owner:
Number of Data Elements:
32
eForms:
Y
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)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Glasgow Outcome Scale Extended (GOS-E) - Respondent type | Person responding to the Glasgow Outcome Scale Extended (GOSE). | GOSEResponse | Recommended | CDE |
| 2 | Glasgow Outcome Scale Extended (GOS-E) - Consciousness indicator | Indicator if the participant is able to obey simple commands or say any words as part of Glasgow Outcome Scale Extended (GOS-E). | GOSEConsciousInd | Recommended | CDE |
| 3 | Glasgow Outcome Scale Extended (GOS-E) - Assistance daily need indicator | Indicator if the participant needs another person at home essentially every day for some activities of daily living as part of Glasgow Outcome Scale Extended (GOS-E). | GOSEAsstNeedInd | Recommended | CDE |
| 4 | Glasgow Outcome Scale Extended (GOS-E) - Frequent help need indicator | Indicator if the participant is in need of frequent help of someone to be around at home as part of Glasgow Outcome Scale Extended (GOS-E). | GOSEFreqntHlpNeedInd | Recommended | CDE |
| 5 | Glasgow Outcome Scale Extended (GOS-E) - Assistance at home pre-injury indicator | Indicator if the assistance at home was essential for the patient before the injury, as part of Glasgow Outcome Scale Extended (GOS-E). | GOSEIndpntPreInjryInd | Recommended | CDE |
| 6 | Glasgow Outcome Scale Extended (GOS-E) - Shop without assistance indicator | Indicator if the participant is able to shop without assistance as part of Glasgow Outcome Scale Extended (GOS-E). | GOSEShpWoutAsstInd | Recommended | CDE |
| 7 | Glasgow Outcome Scale Extended (GOS-E) - Shop without assistance pre-injury indicator | Indicator if the participant was able to shop without assistance before injury as part of Glasgow Outcome Scale Extended (GOS-E). | GOSEShpWoutAsstPreInjryInd | Recommended | CDE |
| 8 | Glasgow Outcome Scale Extended (GOS-E) - Travel without assistance indicator | Indicator if the participant is able to travel locally without help as part of Glasgow Outcome Scale Extended (GOS-E) | GOSETrvlWoutAsstInd | Recommended | CDE |
| 9 | Glasgow Outcome Scale Extended (GOS-E) - Travel without assistance pre-injury indicator | Indicator if the participant was able to travel locally without help before injury as part of Glasgow Outcome Scale Extended (GOS-E). | GOSETrvlWoutAsstPreInjryInd | Recommended | CDE |
| 10 | Glasgow Outcome Scale Extended (GOS-E) - Current work normal capacity indicator | Indicator if the participant is currently able to work at the same capacity before injury as part of Glasgow Outcome Scale Extended (GOS-E). | GOSECrrntWrkInd | Recommended | CDE |
| 11 | Glasgow Outcome Scale Extended (GOS-E) - Work restriction from injury type | Work restriction type experienced by the participant as a result of injury as part of Glasgow Outcome Scale Extended (GOS-E). | GOSEWrkRestrictTyp | Recommended | CDE |
| 12 | Glasgow Outcome Scale Extended (GOS-E) - Work restriction pre-injury change level indicator | Indicator if the participant was either working or seeking employment before the injury or was doing neither, as part of Glasgow Outcome Scale Extended (GOS-E). | GOSELvlRestrictInd | Recommended | CDE |
| 13 | Glasgow Outcome Scale Extended (GOS-E) - Social leisure outside resume activity indicator | Indicator if the participant is able to resume regular social and leisure activities outside home as part of Glasgow Outcome Scale Extended (GOS-E). | GOSESocLeisOutInd | Recommended | CDE |
| 14 | Glasgow Outcome Scale Extended (GOS-E) - Extent restriction social leisure activity frequency | Frequency of the extent of restriction the participant faces on social and leisure activities as part of Glasgow Outcome Scale Extended (GOS-E). | GOSEExtntRestrctSocFreq | Recommended | CDE |
| 15 | Glasgow Outcome Scale Extended (GOS-E) - Participation social leisure activity pre-injury indicator | Indicator if the participant was engaged in regular social and leisure activities outside home before the injury, as part of Glasgow Outcome Scale Extended (GOS-E). | GOSEExtntRestrctSocPreInjrInd | Recommended | CDE |
| 16 | Glasgow Outcome Scale Extended (GOS-E) - Relationship disruption indicator | Indicator if the participant faces any rifts in family relationships or friendships caused by psychological problems as part of Glasgow Outcome Scale Extended (GOS-E). | GOSEFrindshpInd | Recommended | CDE |
| 17 | Glasgow Outcome Scale Extended (GOS-E) - Extent relationship strain frequency | Frequency of the extent of the rifts in relationships, including family and friendships, due to psychological problems as part of Glasgow Outcome Scale Extended (GOS-E). | GOSEExtntFriendshpStrnFreq | Recommended | CDE |
| 18 | Glasgow Outcome Scale Extended (GOS-E) - Family and friendship problems pre-injury indicator | Indicator if the participant experienced problems with family or friends before the injury, as part of Glasgow Outcome Scale Extended (GOS-E). | GOSELvlStrnPreInjryInd | Recommended | CDE |
| 19 | Glasgow Outcome Scale Extended (GOS-E) - Current other problem indicator | Indicator if the participant faces any other current problems currently due to injury as part of Glasgow Outcome Scale Extended (GOS-E). | GOSECrrntProbInd | Recommended | CDE |
| 20 | Glasgow Outcome Scale Extended (GOS-E) - Similar problems pre-injury indicator | Indicator if the similar problems were present before injury and have these become markedly worse as part of Glasgow Outcome Scale Extended (GOS-E). | GOSESimlrProbPreInjryInd | Recommended | CDE |
| 21 | Glasgow Outcome Scale Extended (GOS - E) - Most important factor in outcome type | The most important factor in outcome as part of Glasgow Outcome Scale Extended (GOS-E). | GOSEMstImptFctrTyp | Recommended | CDE |
| 22 | Glasgow Outcome Scale Extended (GOS-E) - Score | Glasgow Outcome Scale Extended (1-8) | GlasgowOutcomeScalExtScore | Recommended | CDE |
Additional Info (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Epileptic fit post injury indicator | Indicator if the participant has had epileptic fits since the injury | EpilepsyFitsInd | Recommended | CDE |
| 2 | Epileptic fit risk indicator | Indicator if the participant has been told he/she is at risk of developing epilepsy | EpilepsyRiskInd | Recommended | CDE |
Keywords
