Form Structure: Hearing
This form structure is an organized set of data definitions for a form that has not been copyrighted
Title:
Hearing
Short Name:
HearingCDEs
Description:
This CRF Module contains data elements recommended by NINDS to collect to further describe the level of hearing.
Disease:
Traumatic Brain Injury
Organization:
NINDS
Required Program Form:
No
Standardization:
Standard NINDS CDE
Labels:
Form Type:
Clinical Assessment
Publication Date:
2017-03-27
Version:
1.0
Date Created:
2017-01-24
Owner:
Number of Data Elements:
32
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 |
Hearing (Appears Up To 1 Time)
# | Title | Short Description | Variable Name | Required? | Type |
---|---|---|---|---|---|
1 | Air conduction result | The result of air conduction testing, or whether patient can detect all test signals at or below 25 dB | AirCondReslt | Optional | CDE |
2 | Bone conduction result | The result of bone conduction testing, or whether patient can detect all test signals at or below 25 dB | BoneConductReslt | Optional | CDE |
3 | Speech reception threshold result | The result of speech reception threshold testing, or lowest dB level at which patient can correctly repeat 50% of words spoken | SpchReceptnThreshldReslt | Optional | CDE |
4 | Word discrimination result | The result of word discrimination testing (percentage of words correctly repeated) | WordDiscrimReslt | Optional | CDE |
5 | Tympanometry result | The result of the tympanometry test | TympanometryReslt | Optional | CDE |
6 | Otoacoustic emissions result | The result of the otoacoustic emissions test | OtoacoustEmissnsReslt | Optional | CDE |
7 | Brainstem auditory evoked potentials result | The result of the brainstem auditory evoked potentials test | BrainstmAuditEvokPotentlReslt | Optional | CDE |
8 | Central auditory processing testing result | Global result of central auditory processing testing | CntrlAuditProcessTestReslt | Optional | CDE |
9 | Dichotic consonant-vowel test result | Dichotic consonant-vowel test result as a percentage | DichotConsonantVowlTestReslt | Optional | CDE |
10 | Dichotic digits test result | Dichotic digits test result as a percentage | DichotDigitTestReslt | Optional | CDE |
11 | Staggered spondee word test result | Staggered spondee word test result as a percentage | StaggrdSpondeeWordTestReslt | Optional | CDE |
12 | Dichotic sentence identification test result | Dichotic sentence identification test result as a percentage | DichotSentnceIdentTestReslt | Optional | CDE |
13 | Masking-level differences result | The result of the masking-level differences test | MaskLevelDiffsReslt | Optional | CDE |
14 | Binaural fusion test result | Binaural fusion test result threshold in msec | BinaurlFusionTestReslt | Optional | CDE |
15 | Frequency pattern test result | Frequency pattern test result as a percentage | FreqPatternTestReslt | Optional | CDE |
16 | Duration pattern test result | Duration pattern test result as a percentage | DuratnPatternTestReslt | Optional | CDE |
17 | Minimum masking level result | The result of minimum masking level testing, the level of sound that masks a patient's tinnitus | MinimumMaskLevelRestul | Optional | CDE |
Keywords