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Form Structure: Glasgow Outcome Score (GOS)

This form structure is an organized set of data definitions for a form that has not been copyrighted
Resource:
FITBIR
Title:
Glasgow Outcome Score (GOS)
Short Name:
GOS_V2
Description:
Glasgow Outcome Score is a one item scale with 5 possible ratings - Dead, Vegetative State, Severe Disability, Moderate Disability, and Good Recovery. References: Jennett, B; Bond, M (Mar 1, 1975). \\"Assessment of outcome after severe brain damage.\\". Lancet. 1 (7905): 480?484. doi:10.1016/s0140-6736(75)92830-5. PMID 46957.
Disease:
Traumatic Brain Injury
Organization:
NINDS
Required Program Form:
No
Standardization:
Standard NINDS CDE
Labels:
Form Type:
Clinical Assessment
Publication Date:
2016-09-12
Version:
1.0
Date Created:
2014-05-28
Owner:
Number of Data Elements:
15
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.

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 Form Administation (Appears 1 Time)

# 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

GOS (Appears 1 Time)

# Title Short Description Variable Name Required? Type
1 Glasgow Outcome Scale (GOS) - score  Glasgow Outcome Scale (1-5) GlasgowOutcomeScalScore Optional CDE
2 Glasgow Outcome date and time  Date and Time of Glasgow Outcome Scale GasgwDateTime Optional CDE
Keywords