Form Structure: FITBIR Injury History Form
This form structure is an organized set of data definitions for a form that has not been copyrighted
Resource:
FITBIR
Title:
FITBIR Injury History Form
Short Name:
InjHx_FITBIR
Description:
Injury history for FITBIR. Includes general injury history information, history of TBI, LOC and PTA information, TBI cause, etc. Collecting injury history was recommended by CDISC for TBI.
References: 1. National Institute of Neurological Disorders and Stroke (NINDS) CDE project, Traumatic Brain Injury (TBI) CDEs (v2), https://www.commondataelements.ninds.nih.gov/TBI.aspx#tab=Data_Standards
Disease:
Traumatic Brain Injury
Organization:
FITBIR
Required Program Form:
Yes
Standardization:
Standard NINDS CDE
Labels:
Form Type:
Clinical Assessment
Publication Date:
2017-09-29
Version:
1.1
Date Created:
2016-03-31
Owner:
Number of Data Elements:
253
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 |
Injury General Info (Appears Up To 27 Times)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Traumatic event number | The number of traumatic event , which happened during the subject's life, as reported by the subject | TraumaticEventNum | Recommended | CDE |
| 2 | Injury elapsed time | The elapsed time (in minutes) from the time of injury | InjElapsedTime | Recommended | CDE |
| 3 | Injury date time | Date (and time, if applicable and known) of injury | InjDateTime | Recommended | UDE |
| 4 | Injury date time estimation type | The type as related to the point in time estimated as injury date and time | InjDateTimeEstTyp | Recommended | CDE |
| 5 | Data acquisition location type | Type of location where subject data were taken | DataAcquisitionLocationTyp | Recommended | CDE |
| 6 | Data acquisition location type other text | The free-text field related to Data acquisition location type, specifying other text. Type of location where the subject data were taken | DataAcquisitionLocationOTH | Optional | CDE |
| 7 | Injury cause type | The type as related to the classification of the external cause of the injury | InjCauseTyp | Recommended | CDE |
| 8 | Injury cause other text | The free-text field related to 'Injury cause type' specifying other text. | InjCauseTypOTH | Optional | CDE |
| 9 | Body system category | Category or grouping used in the comprehensive assessment of a participant/subject, which includes a subjective history taking component as well as an objective based structured interview and physical examination of all the body systems. | BodySysCat | Recommended | CDE |
| 10 | Body system category other text | Free-text related to Body System category CDE used in the comprehensive assessment of a participant/subject.. | BodySysOTH | Recommended | CDE |
| 11 | 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 |
| 12 | 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 |
| 13 | ICD revision number | Number of the International Classification of Diseases (ICD) used to obtain the code | ICDRevNumber | Recommended | CDE |
| 14 | Injury ICD external cause code | Code to classify the external cause of the injury | InjICDExtCauseCode | Recommended | CDE |
| 15 | TBI mechanism type | Type of mechanism/forces causing the traumatic brain injury | TBIMechTyp | Recommended | CDE |
| 16 | TBI type | Indicator of the type of traumatic brain injury experienced by participant/subject | TBITyp | Recommended | CDE |
| 17 | Injury place occurrence type | Classification of the place/setting at which the traumatic brain injury occurred | InjPlcOccncTyp | Recommended | CDE |
| 18 | Injury place occurrence other text | The free-text field related to 'Injury place occurrence type' specifying other text. Classification of the place/setting at which the traumatic brain injury occurred | InjPlcOccncOTH | Optional | CDE |
| 19 | Head concussion or TBI indicator | Indicator of whether the subject has had a concussion or TBI | HeadConcussionOrTBIInd | Optional | CDE |
| 20 | Injury intention type | A type of injury intention, specifying if the injury was intentional or unintentional | InjIntention | Optional | CDE |
AIS (Appears Up To 12 Times)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Abbreviated injury scale (AIS) - Dictionary version type | A type/version of the Abbreviated Injury Scale (AIS) dictionary used to access the injury | AISDictionaryVersionTyp | Recommended | CDE |
| 2 | Abbreviated injury scale (AIS) - Body region category | Category of body region assessed by Abbreviated Injury Scale (AIS) | AISBodyRegionChapterCat | Recommended | CDE |
| 3 | Abbreviated injury scale (AIS) - Injury severity score | An injury severity score (AIS code), as part of Abbreviated injury scale (AIS) code | AISInjurySeverityScore | Recommended | CDE |
| 4 | Abbreviated injury scale (AIS) - Injury clinical description text | A clinical description of the subject injury(ies) from the medical documentation, as part of Abbreviated Injury Scale (AIS). The injury should preferably be described in the Abbreviated Injury Scale code controlled vocabulary terms. | AISInjuryDescriptionTxt | Recommended | CDE |
| 5 | Injury ICD external cause code | Code to classify the external cause of the injury | InjICDExtCauseCode | Recommended | CDE |
LOC AOC and PTA (Appears Up To 8 Times)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Injury elapsed time | The elapsed time (in minutes) from the time of injury | InjElapsedTime | Recommended | CDE |
| 2 | Data acquisition location type | Type of location where subject data were taken | DataAcquisitionLocationTyp | Recommended | CDE |
| 3 | Data acquisition location type other text | The free-text field related to Data acquisition location type, specifying other text. Type of location where the subject data were taken | DataAcquisitionLocationOTH | Optional | CDE |
| 4 | Data collected date and time | Data collected date and time | DataCollDateTime | Recommended | CDE |
| 5 | Loss of consciousness indicator | The indicator for whether the participant/subject experienced any period of loss of consciousness (LOC). | LOCInd | Recommended | CDE |
| 6 | Loss of consciousness duration range | The range of duration of loss of consciousness the participant/subject experienced | LOCDurRang | Recommended | CDE |
| 7 | Loss of consciousness duration of time value | Duration of loss of consciousness (in seconds) the participant/subject experienced. | LOCDurationVal | Recommended | CDE |
| 8 | Loss of consciousness verification type | The type of verification of the participant/subject's loss of consciousness | LOCVerifyTyp | Recommended | CDE |
| 9 | Alteration consciousness indicator | The indicator of whether the participant/subject experienced any period of alteration of consciousness (AOC). | AOCInd | Recommended | CDE |
| 10 | Alteration of consciousness duration range | The range of duration of alteration of consciousness the participant/subject experienced | AOCDurRang | Recommended | CDE |
| 11 | Alteration of consciousness duration of time value | Duration of alteration of consciousness the participant/subject experienced. | AOCDurationVal | Recommended | CDE |
| 12 | Alteration of consciousness verify type | The type of verification of alteration of consciousness of the participant/subject | AOCVerifTyp | Recommended | CDE |
| 13 | Lucid interval indicator | The indicator of whether the participant/subject had a lucid interval, a delayed occurrence of loss of consciousness | LucidIntrvlInd | Recommended | CDE |
| 14 | Lucid interval duration range | The range of duration of lucid interval the participant/subject experienced | LucidIntrvlDurRang | Recommended | CDE |
| 15 | Lucid interval duration of time value | Duration of lucid interval (in minutes) the participant/subject experienced. | LucidIntrvlDurationVal | Recommended | CDE |
| 16 | Loss of consciousness (LOC) to lucid interval duration range | The range of duration of time from the loss of consciousness episode to the beginning of lucid interval the participant/subject experienced | LOCLucidIntrvlDurRang | Recommended | CDE |
| 17 | Lucid interval verification type | The type of verification of the participant/subject's lucid interval | LucidIntrvlVerifyTyp | Recommended | CDE |
| 18 | Post traumatic amnesia indicator | Indicator for whether the participant/subject experienced any period of post-traumatic amnesia - both retrograde and anterograde | PstTraumtcAmnsInd | Recommended | CDE |
| 19 | Post traumatic amnesia duration range | The range of duration of post-traumatic amnesia the participant/subject experienced | PstTraumAmnsDurRang | Recommended | CDE |
| 20 | Post traumatic amnesia duration of time value | Duration (in minutes) of post-traumatic amnesia- both retrograde and anterograde - the participant/subject experienced. | PstTraumAmnsDurationVal | Recommended | CDE |
| 21 | Post traumatic amnesia verification type | The type of verification of the participant/subject's post traumatic amnesia - both retrograde and anterograde | PstTraumtcAmnsVerifyTyp | Recommended | UDE |
Type Place Cause Mechanism of Injury Civilian (Appears Up To 12 Times)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Injury violent cause type | Type of the violence causing the injury | InjVlntCauseTyp | Recommended | CDE |
| 2 | Influence alcohol likelihood type | Indicator for the likelihood the subject was under the influence of alcohol. | InfAlcLkhdTyp | Recommended | CDE |
| 3 | Abusive head trauma likelihood type | Indicator to the extent of abusive head trauma is determined to be likely | AbsvHdTrmaLkhdTyp | Recommended | CDE |
| 4 | Abusive head trauma reporter type | How the determination of abusive head trauma likelihood was made | AbsvHdTrmaRprtrTyp | Optional | CDE |
| 5 | Abusive head trauma reporter other text | The free-text field related to 'Abusive head trauma reporter type' specifying other text. How the determination of abusive head trauma likelihood was made | AbsvHdTrmaRprtrOTH | Optional | CDE |
| 6 | Drug or substance current illicit use indicator | Indicator of participant's/subject's use of illegal drugs, prescription or over-the-counter drugs in the past year for purposes other than those for which they are meant to be used, or in large amounts | DrgSubstCurrntIllicitUseCat | Optional | CDE |
| 7 | Traffic accident self role type | The participant's/subject's role in The traffic accident that resulted in The injury | TrffAccdntSelfRoleTyp | Optional | CDE |
| 8 | Traffic accident self alcohol influence likelihood type | Likelihood of whether the participant/subject was under the influence of alcohol at the time of injury | TrffAccdntSefAlcInfLkhdTyp | Optional | CDE |
| 9 | Traffic accident self drug influence likelihood type | Likelihood of whether the participant/subject was under the influence of drugs at the time of injury | TrffAccdntSelfDrgIngLkhdTyp | Optional | CDE |
| 10 | Traffic accident other party role type | The other party's role in The traffic accident that resulted in The participant's/subject's injury | TrffAccdntOthPrtyRoleTyp | Optional | CDE |
| 11 | Traffic accident other party alcohol influence likelihood type | Likelihood of whether the other involved party was under the influence of alcohol at the time of the participant's/subject's injury | TrffAccdntOthPrtyAlcInfLkhdTyp | Optional | CDE |
| 12 | Traffic accident other party drug influence likelihood type | Likelihood of whether the other involved party was under the influence of drugs at the time of the participant's/subject's injury | TrffAccdntOthPrtyDrgInfLkhdTyp | Optional | CDE |
| 13 | Airbag deploy indicator | Indicator of an airbag deployed at the time of the participant's/subject's injury | AirbagDplyInd | Recommended | CDE |
| 14 | Vehicular protective device type | Type of protective devices used by the participant/subject | VehclrPrtctvDevTyp | Recommended | CDE |
| 15 | Vehicular protective device other text | The free-text field related to 'Vehicular protective device type' specifying other text. Type of protective devices used by the participant/subject | VehclrPrtctvDevOTH | Optional | CDE |
| 16 | Biological agent exposure likelihood type | Likelihood of whether a biological agent was encountered at the time of the injury. | BiolgclAgntExpsrLkhdTyp | Optional | CDE |
| 17 | Chemical agent exposure likelihood type | Likelihood of whether a chemical agent was encountered at the time of the injury. | ChemAgntExpsrLkhdTyp | Optional | CDE |
| 18 | Injury description text | A text description of the injury event. | InjDescriptionText | Optional | CDE |
Type Place Cause Mechanism of Injury Sport (Appears Up To 16 Times)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Injury from sports indicator | TBI Screen: Injured head/neck doing sports | TBISportInd | Recommended | CDE |
| 2 | Sport team participation type | The sport or team that the athlete participates in | SportTeamParticipationTyp | Optional | UDE |
| 3 | Sport team participation other text | The free-text related to Sport team participation type specifying the other type of sport or team | SportTeamParticipationTypOTH | Optional | UDE |
| 4 | Sport league or division type | Sport league/division in which the subject played. | SportLeagueOrDivTyp | Optional | CDE |
| 5 | Sport league or division type other text | Free-text related to 'SportLeagueOrDivTyp' specifying other league. | SportLeagueOrDivTypOTH | Optional | CDE |
| 6 | Injury description text | A text description of the injury event. | InjDescriptionText | Optional | CDE |
Type Place Cause Mechanism of Injury Combat (Appears Up To 16 Times)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Military deployment injury indicator | Indicator of whether the injury occurred during deployment | MilDplyInjInd | Recommended | CDE |
| 2 | Protective devices use indicator | Indicator of protective devices used by participant/subject (e.g., helmet, car seat, seat belt, etc.) | PrtctvDevcUseInd | Optional | CDE |
| 3 | Body armor indicator | Indicator of whether body armor was worn at the time of the injury | BodyArmInd | Optional | CDE |
| 4 | Military combat helmet type | Type of combat helmet worn at the time of the injury. | MilCmbtHelmtTyp | Optional | CDE |
| 5 | Blast direction type | The location of The blast related to The location of The participant/subject | BlastDirTyp | Optional | CDE |
| 6 | Blast enclose space indicator | Indicator of blast occurring in enclosed space | BlastEnclSpcInd | Optional | CDE |
| 7 | Blast injury category | Category of blast-related injury | BlastInjCat | Optional | CDE |
| 8 | Blast injury device type | Type of device which caused the blast injury | BlastInjDevTyp | Optional | CDE |
| 9 | Blast injury device other text | The free-text field related to 'Blast injury device type' specifying other text. Type of device which caused the blast injury | BlastInjDevOTH | Optional | CDE |
| 10 | Blast prior exposure number | Number of blasts the participant has been exposed to prior to his or her current injury. | BlastPriorExposurNum | Recommended | CDE |
| 11 | Biological agent exposure likelihood type | Likelihood of whether a biological agent was encountered at the time of the injury. | BiolgclAgntExpsrLkhdTyp | Optional | CDE |
| 12 | Chemical agent exposure likelihood type | Likelihood of whether a chemical agent was encountered at the time of the injury. | ChemAgntExpsrLkhdTyp | Optional | CDE |
| 13 | Drug or substance current illicit use indicator | Indicator of participant's/subject's use of illegal drugs, prescription or over-the-counter drugs in the past year for purposes other than those for which they are meant to be used, or in large amounts | DrgSubstCurrntIllicitUseCat | Optional | CDE |
| 14 | Injury description text | A text description of the injury event. | InjDescriptionText | Optional | CDE |
ED Presentation (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Emergency medical care provider type | Type of provider of initial medical care directly after injury | EmrMedCrProvTyp | Recommended | CDE |
| 2 | Emergency medical care provider training type | Type of training by Emergency medical care provider. | EmrgyMedclCarePrvdrTrainTyp | Optional | CDE |
| 3 | Emergency service type | Branch of service involved at the accident scene | EmrServTyp | Optional | CDE |
| 4 | Emergency service other text | The free-text field related to 'Emergency service type' specifying other text. Branch of service involved at the accident scene | EmrServOTH | Optional | CDE |
| 5 | Injury elapsed time | The elapsed time (in minutes) from the time of injury | InjElapsedTime | Recommended | CDE |
| 6 | Care provision level | The level of care provided to participant by health care facility | CareProvisionLevel | Recommended | CDE |
| 7 | Emergency service response time duration | Duration of time between injury and arrival of emergency services. | EmrServRespTmDur | Optional | CDE |
| 8 | Emergency service time injury scene duration | Duration of time between arrival and departure of emergency services. | EmrServTmInjScnDur | Optional | CDE |
| 9 | TBI therapy intensity level procedure type | Type of procedure or therapy used to assess the therapy intensity level (TIL) for treating the traumatic brain injury | TBITherapIntensLvlProcType | Recommended | CDE |
| 10 | Hypothermia indicator | Indicator of hypothermia. Hypothermia is defined as core temperature 35 degrees Celsius | HypothermInd | Recommended | CDE |
| 11 | Hypotensive episode indicator | Indicator of hypotensive episode. In adults, hypotensive episode is defined as systolic blood pressure & less than ; 90 mmHg. In children, it is defined as systolic blood pressure & less than ; 5th percentile for age | HypotnsnEpiInd | Recommended | CDE |
| 12 | Hypoxic episode indicator | Indicator of hypoxic episode. Hypoxic episode is defined as partial pressure of oxygen in the blood (paO2) less than 8kPa (60mmHg) or oxygen saturation (SaO2) less than 90% | HypxEpiInd | Recommended | CDE |
| 13 | Airway treatment type | Type of treatment or procedures the participant/subject received to support airway/ breathing | AirwyTrtmtTyp | Recommended | CDE |
| 14 | Glasgow Outcome Scale Extended (GOS-E) - Score | Glasgow Outcome Scale Extended (1-8) | GlasgowOutcomeScalExtScore | Recommended | CDE |
| 15 | Pediatric Glasgow Outcome Scale - Extended (GOS-E Peds) - Score | Score for the participant, as a part of the Pediatric Glasgow Outcome Scale - Extended (PGOSE). | PGOSEScore | Recommended | CDE |
| 16 | Imaging magnetic resonance imaging performed indicator | Indicator as to whether or not Magnetic Resonance Imaging (MRI) on the brain has been performed on the participant/subject | ImgMRIPerfInd | Recommended | CDE |
| 17 | Imaging brain assessment result | Result of the global assessment of brain imaging | ImgBrainAssessmtReslt | Recommended | CDE |
| 18 | Subarachnoid hemorrhage indicator | Indicator of macroscopic blood located between the brain surface and the arachnoid membrane. On CT and MR, the blood in this location will follow the contour of the sulci and cisterns. Acute SAH is hyperdense on CT and hyperintense on FLAIR MR imaging. | SAHStatus | Recommended | CDE |
ED Discharge (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Injury elapsed time | The elapsed time (in minutes) from the time of injury | InjElapsedTime | Recommended | CDE |
| 2 | Discharge status | Status of patient at time of discharge from hospital (dead or alive) | DischargeStatus | Recommended | CDE |
| 3 | Emergency room discharge destination reason | Reason for choice of destination upon discharge from emergency room. | EmrgyRmDischrgDestRsn | Recommended | CDE |
| 4 | Emergency room discharge destination reason other text | The free-text field related to 'Emergency room discharge destination reason' specifying other text. Reason for choice of destination upon discharge from emergency room. | EmrgyRmDischrgDestRsnOTH | Optional | CDE |
| 5 | Emergency room discharge destination type | Destination on completion of stabilization/evaluation in emergency room | EmrgyRmDischrgDestTyp | Optional | CDE |
| 6 | Emergency room discharge destination other text | The free-text field related to 'Emergency room discharge destination type' specifying other text. Reason for choice of destination upon discharge from emergency room. | EmrgyRmDischrgDestOTH | Optional | CDE |
| 7 | Glasgow Outcome Scale Extended (GOS-E) - Score | Glasgow Outcome Scale Extended (1-8) | GlasgowOutcomeScalExtScore | Recommended | CDE |
| 8 | Pediatric Glasgow Outcome Scale - Extended (GOS-E Peds) - Score | Score for the participant, as a part of the Pediatric Glasgow Outcome Scale - Extended (PGOSE). | PGOSEScore | Recommended | CDE |
| 9 | General notes text | General notes | GeneralNotesTxt | Optional | CDE |
Hospital Early Presentation (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Injury elapsed time | The elapsed time (in minutes) from the time of injury | InjElapsedTime | Recommended | CDE |
| 2 | Hospital admission date and time | Date (and time, if applicable and known) the participant/subject was admitted to the hospital | HospitlAdmissDateTime | Recommended | CDE |
| 3 | Hospital presentation type | Whether the participant/subject was taken directly from the scene of accident to the study hospital (primary) or was first taken to a non-study hospital, and then transferred to the study hospital (secondary) | HospPresTyp | Recommended | CDE |
| 4 | Hospital location patient first received care type | Area of the hospital the patient first evaluated | HospLocPatFirstReceiveCarTyp | Recommended | CDE |
| 5 | Hospital not admitted but transferred to another acute care hospital indicator | Whether a patient presented to the Emergency Department of the study hospital and was transferred to an outside hospital. | HospNotAdmTrnsfAnthAcCrHospInd | Recommended | CDE |
| 6 | Hospital transport type | Type of transportation from injury scene to hospital | HospTrnsprtTyp | Recommended | CDE |
| 7 | Hospital transport other text | The free-text field related to 'Hospital transport type' specifying other text. Type of transportation from injury scene to hospital | HospTrnsprtOTH | Recommended | CDE |
| 8 | Previous unit | Previous Unit | PrevUnit | Recommended | CDE |
| 9 | Hospital unit | Hospital Unit | HospitalUnit | Recommended | CDE |
| 10 | Hypothermia indicator | Indicator of hypothermia. Hypothermia is defined as core temperature 35 degrees Celsius | HypothermInd | Recommended | CDE |
| 11 | Hypotensive episode indicator | Indicator of hypotensive episode. In adults, hypotensive episode is defined as systolic blood pressure & less than ; 90 mmHg. In children, it is defined as systolic blood pressure & less than ; 5th percentile for age | HypotnsnEpiInd | Recommended | CDE |
| 12 | Hypoxic episode indicator | Indicator of hypoxic episode. Hypoxic episode is defined as partial pressure of oxygen in the blood (paO2) less than 8kPa (60mmHg) or oxygen saturation (SaO2) less than 90% | HypxEpiInd | Recommended | CDE |
| 13 | Airway treatment type | Type of treatment or procedures the participant/subject received to support airway/ breathing | AirwyTrtmtTyp | Recommended | CDE |
| 14 | Glasgow Outcome Scale Extended (GOS-E) - Score | Glasgow Outcome Scale Extended (1-8) | GlasgowOutcomeScalExtScore | Recommended | CDE |
| 15 | Pediatric Glasgow Outcome Scale - Extended (GOS-E Peds) - Score | Score for the participant, as a part of the Pediatric Glasgow Outcome Scale - Extended (PGOSE). | PGOSEScore | Recommended | CDE |
| 16 | Imaging magnetic resonance imaging performed indicator | Indicator as to whether or not Magnetic Resonance Imaging (MRI) on the brain has been performed on the participant/subject | ImgMRIPerfInd | Recommended | CDE |
| 17 | Imaging brain assessment result | Result of the global assessment of brain imaging | ImgBrainAssessmtReslt | Recommended | CDE |
| 18 | Subarachnoid hemorrhage indicator | Indicator of macroscopic blood located between the brain surface and the arachnoid membrane. On CT and MR, the blood in this location will follow the contour of the sulci and cisterns. Acute SAH is hyperdense on CT and hyperintense on FLAIR MR imaging. | SAHStatus | Recommended | CDE |
| 19 | Height measurement | Measurement of participant's/subject's height. | HgtMeasr | Optional | CDE |
| 20 | Height unit of measure | Unit of measure for the height numerical value for subject/participant | HgtUOM | Optional | CDE |
| 21 | Weight measurement | Measurement of participant's/subject's weight | WgtMeasr | Optional | CDE |
| 22 | Weight unit of measure | Unit of measure for the weight numerical value | WgtUoM | Optional | CDE |
Hospital Late Presentation (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Injury elapsed time | The elapsed time (in minutes) from the time of injury | InjElapsedTime | Recommended | CDE |
| 2 | Hospital admission date and time | Date (and time, if applicable and known) the participant/subject was admitted to the hospital | HospitlAdmissDateTime | Recommended | CDE |
| 3 | Injury presentation reason | Reason for presentation at study facility/reason for interface with medical provider. | InjPresentRsn | Recommended | CDE |
| 4 | Hospitalization directly after late presentation of injury indicator | Indicator of whether the patient was hospitalized directly after late presentation of injury | InjPresLateInitMedCar | Recommended | CDE |
| 5 | Outpatient treatment type after late presentation of injury | Outpatient treatment type if no initial hospitalization after late presentation of injury | InjPresLateInitMedTyp | Optional | CDE |
| 6 | Injury presentation professional referral category | Category of professional that referred the participant/subject to seek medical care | InjPrsnttnProfssnlRfrrlCat | Optional | CDE |
| 7 | Glasgow Outcome Scale Extended (GOS-E) - Score | Glasgow Outcome Scale Extended (1-8) | GlasgowOutcomeScalExtScore | Recommended | CDE |
| 8 | Pediatric Glasgow Outcome Scale - Extended (GOS-E Peds) - Score | Score for the participant, as a part of the Pediatric Glasgow Outcome Scale - Extended (PGOSE). | PGOSEScore | Recommended | CDE |
| 9 | Imaging magnetic resonance imaging performed indicator | Indicator as to whether or not Magnetic Resonance Imaging (MRI) on the brain has been performed on the participant/subject | ImgMRIPerfInd | Recommended | CDE |
| 10 | Imaging brain assessment result | Result of the global assessment of brain imaging | ImgBrainAssessmtReslt | Recommended | CDE |
| 11 | Subarachnoid hemorrhage indicator | Indicator of macroscopic blood located between the brain surface and the arachnoid membrane. On CT and MR, the blood in this location will follow the contour of the sulci and cisterns. Acute SAH is hyperdense on CT and hyperintense on FLAIR MR imaging. | SAHStatus | Recommended | CDE |
| 12 | Height measurement | Measurement of participant's/subject's height. | HgtMeasr | Optional | CDE |
| 13 | Height unit of measure | Unit of measure for the height numerical value for subject/participant | HgtUOM | Optional | CDE |
| 14 | Weight measurement | Measurement of participant's/subject's weight | WgtMeasr | Optional | CDE |
| 15 | Weight unit of measure | Unit of measure for the weight numerical value | WgtUoM | Optional | CDE |
Hospital Discharge (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Injury elapsed time | The elapsed time (in minutes) from the time of injury | InjElapsedTime | Recommended | CDE |
| 2 | Hospital discharge date and time | Date (and time, if applicable and known) the participant/subject was discharged from the hospital | HospitDischgDateTime | Recommended | CDE |
| 3 | Discharge status | Status of patient at time of discharge from hospital (dead or alive) | DischargeStatus | Recommended | CDE |
| 4 | Hospital discharge destination type | Type of destination on completion of stabilization/evaluation in hospital | HospDischrgDestTyp | Recommended | CDE |
| 5 | Hospital discharge destination other text | The free-text field related to 'Hospital discharge destination type' specifying other text. Type of destination on completion of stabilization/evaluation in hospital | HospDischrgDestOTH | Recommended | CDE |
| 6 | Glasgow Outcome Scale Extended (GOS-E) - Score | Glasgow Outcome Scale Extended (1-8) | GlasgowOutcomeScalExtScore | Recommended | CDE |
| 7 | Pediatric Glasgow Outcome Scale - Extended (GOS-E Peds) - Score | Score for the participant, as a part of the Pediatric Glasgow Outcome Scale - Extended (PGOSE). | PGOSEScore | Recommended | CDE |
| 8 | General notes text | General notes | GeneralNotesTxt | Optional | CDE |
| 9 | Do not resuscitate or intubate (DNR or DNI) indicator | Indicates if participant/ subject was made DNR/ DNI (Do not resuscitate/ Do not intubate) during hospitalization | DNRDNIInd | Recommended | CDE |
| 10 | Injury elapsed time Do Not Resuscitate (DNR) | Injury elapsed time Do Not Resuscitate (DNR) | DNRWrittenInjElapsedTime | Optional | UDE |
| 11 | Do not resuscitate or intubate (DNR or DNI) earliest documentation timepoint type | Timepoint of earliest documentation of DNR/ DNI (Do not resuscitate/ Do not intubate) during hospitalization | DNRDNIEarliestDocTimpntTyp | Optional | CDE |
| 12 | Injury elapsed time (Support Withdrawn) | Injury elapsed time (Support Withdrawn) | SupportWithdrawnInjElapsedTime | Optional | CDE |
Neurological Assessment Symptoms and Signs (Appears Up To 22 Times)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Injury elapsed time | The elapsed time (in minutes) from the time of injury | InjElapsedTime | Recommended | CDE |
| 2 | Data acquisition location type | Type of location where subject data were taken | DataAcquisitionLocationTyp | Optional | CDE |
| 3 | Data acquisition location type other text | The free-text field related to Data acquisition location type, specifying other text. Type of location where the subject data were taken | DataAcquisitionLocationOTH | Optional | CDE |
| 4 | Traumatic Brain Injury symptom indicator | Indicator of whether the participant/subject displayed the specific TBI physical symptom or sign | TBISympInd | Recommended | CDE |
| 5 | Traumatic Brain Injury symptom type | The types of Traumatic Brain Injury (TBI) symptoms or signs displayed by The participant/subject | TBISympTyp | Recommended | CDE |
| 6 | Traumatic Brain Injury symptom type other text | Free text for "Traumatic Brain Injury symptom type" specifying other text | TBISympTypOTH | Recommended | CDE |
| 7 | Orientation person result | Result of how the participant/subject responded to questions about himself/herself, such as name and birth date | OrientPersonReslt | Optional | CDE |
| 8 | Orientation place result | Result of how the participant/subject responded to questions about his/her current location | OrientPlaceReslt | Optional | CDE |
| 9 | Orientation time result | Result of how the participant/subject responded to questions about today's date (e.g., date, month, year, day of week, time of day, season of year) | OrientTimeReslt | Optional | CDE |
| 10 | Traumatic brain injury symptom category | Category of traumatic brain injury symptom/sign displayed by the participant/subject | TBISympCat | Recommended | CDE |
| 11 | Traumatic brain injury symptom other text | Specify in the text the type of traumatic Brain Injury symptoms or signs displayed by the participant/subject if not listed above | TBISympOthrTxt | Recommended | CDE |
| 12 | Traumatic brain injury symptom rating code | Code that describes overall how different the participant/subject is acting compared to his/her usual self | TBISympRatingCode | Recommended | CDE |
Previous TBIs Including Sport Related (Appears Up To 15 Times)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Prior traumatic injury indicator | Indicator of prior traumatic injury found either historically, previous emergency department visits, radiographic findings, or signs or symptoms at time of presentation. | PriorTraumInjryInd | Recommended | CDE |
| 2 | Traumatic event number | The number of traumatic event , which happened during the subject's life, as reported by the subject | TraumaticEventNum | Recommended | CDE |
| 3 | Injury date time | Date (and time, if applicable and known) of injury | InjDateTime | Recommended | UDE |
| 4 | Injury date time estimation type | The type as related to the point in time estimated as injury date and time | InjDateTimeEstTyp | Optional | CDE |
| 5 | Injury from sports indicator | TBI Screen: Injured head/neck doing sports | TBISportInd | Recommended | CDE |
| 6 | History of concussion Indicator | Indicator if the subject had a history of concussion | ConcussionHistoryInd | Recommended | CDE |
| 7 | Hospitalization for head/neck injury Indicator | TBI Screen: Hospitalization for head/neck injury Indicator | TBIHospitalizedInd | Recommended | UDE |
| 8 | Prior traumatic injury type | General location of traumatic injury, if evidence of prior traumatic injury | PriorTraumInjryType | Recommended | CDE |
| 9 | Head injury prior number | Number of prior head injuries, if previous TBI history | HeadInjPriorNum | Recommended | CDE |
| 10 | Concussion prior number | Number of prior concussions | ConcussionPriorNum | Recommended | CDE |
| 11 | Blast prior exposure number | Number of blasts the participant has been exposed to prior to his or her current injury. | BlastPriorExposurNum | Recommended | CDE |
| 12 | Loss of Consciousness (LOC) - TBI LOC youngest age | TBI Screen: Youngest age reported when subject had Loss of Consciousness (LOC) due to TBI | TBILocYoungestAge | Optional | UDE |
| 13 | Youngest age of dazed and confused injury | TBI Screen: youngest age of dazed and confused injury | TBIDazedYoungestAge | Optional | UDE |
| 14 | Loss of Consciousness (LOC) - Longest period of unconsciousness due to TBI age in years | Enter age in years when the subject had the longest period of unconsciousness (LOC) due to injury | TBILocLongestKO | Optional | UDE |
| 15 | Loss of Consciousness (LOC) - due to TBI memory gap indicator | TBI Screen: Indicator if the subject was dazed or had a gap in memory due to TBI | TBILocMemoryGapInd | Optional | UDE |
| 16 | Loss of Consciousness (LOC) - over 30 minutes due to TBI lifetime count | TBI Screen: Count of how many injuries had the subject during his/her lifetime where LOC was over 30 minutes | TBILocOver30MinCnt | Optional | UDE |
| 17 | Number of times lost consciousness from drug overdose | TBI Screen: number of times lost consciousness from drug overdose | TBIOverdoseCnt | Optional | CDE |
| 18 | Longest period of being dazed and confused | TBI Screen: Longest period of being dazed and confused | TBIDazedLongestKO | Optional | UDE |
| 19 | Number of times dazed and confused for more than 30 mins | TBI Screen: number of times dazed and confused for more than 30 mins | TBIDazedOver30MinCnt | Optional | UDE |
Concussion History Including Sport Related (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Traumatic event number | The number of traumatic event , which happened during the subject's life, as reported by the subject | TraumaticEventNum | Recommended | CDE |
| 2 | Concussion diagnosis status | Indicator, whether the reported concussion was or was not diagnosed by a medical provider | ConcussDxStatus | Recommended | CDE |
| 3 | Concussion relatedness type | Whether concussion injury was related to playing sports, civilian accident, military accident, combat experience or something else | ConcussionRelatednessTyp | Recommended | CDE |
| 4 | Concussion relatedness type other text | A free text related Concussion relatedness type UDE, specifying other text. Whether concussion injury was related to playing sports, civilian accident, military accident, combat experience or something else | ConcussionRelatednessTypOTH | Recommended | CDE |
| 5 | Injury date time | Date (and time, if applicable and known) of injury | InjDateTime | Recommended | UDE |
| 6 | Injury date time estimation type | The type as related to the point in time estimated as injury date and time | InjDateTimeEstTyp | Recommended | CDE |
| 7 | Loss of Consciousness (LOC) - Age of subject when LOC occurred due to Injury 1 | TBI Screen: Age of subject when Loss of Consciousness (LOC) occurred due to Injury 1 | TBILocAge1 | Recommended | UDE |
| 8 | Loss of Consciousness (LOC) - Age of subject when LOC occurred due to Injury 2 | TBI Screen: Age of subject when Loss of Consciousness (LOC) occurred due to Injury 2 | TBILocAge2 | Recommended | UDE |
| 9 | Loss of Consciousness (LOC) - Age of subject when LOC occurred due to Injury 3 | TBI Screen: Age of subject when Loss of Consciousness (LOC) occurred due to Injury 3 | TBILocAge3 | Recommended | UDE |
| 10 | Loss of Consciousness (LOC) - Age of subject when LOC occurred due to Injury 4 | TBI Screen: Age of subject when Loss of Consciousness (LOC) occurred due to Injury 4 | TBILocAge4 | Recommended | UDE |
| 11 | Loss of Consciousness (LOC) - Age of subject when LOC occurred due to Injury 5 | TBI Screen: Age of subject when Loss of Consciousness (LOC) occurred due to Injury 5 | TBILocAge5 | Recommended | UDE |
| 12 | Loss of Consciousness (LOC) - Age of subject when LOC occurred due to Injury 6 | TBI Screen: Age of subject when Loss of Consciousness (LOC) occurred due to Injury 6 | TBILocAge6 | Recommended | UDE |
| 13 | Loss of Consciousness (LOC) - Age of subject when LOC occurred due to Injury 7 | TBI Screen: Age of subject when Loss of Consciousness (LOC) occurred due to Injury 7 | TBILocAge7 | Recommended | UDE |
| 14 | Loss of Consciousness (LOC) - Age of subject when LOC occurred due to Injury 8 | TBI Screen: Age of subject when Loss of Consciousness (LOC) occurred due to Injury 8 | TBILocAge8 | Recommended | UDE |
| 15 | Loss of Consciousness (LOC) - Age of subject when LOC occurred due to Injury 9 | TBI Screen: Age of subject when Loss of Consciousness (LOC) occurred due to Injury 9 | TBILocAge9 | Recommended | UDE |
| 16 | Loss of Consciousness (LOC) - Age of subject when LOC occurred due to Injury 10 | TBI Screen: Age of subject when Loss of Consciousness (LOC) occurred due to Injury 10 | TBILocAge10 | Recommended | UDE |
| 17 | Loss of Consciousness (LOC) - Subject was unconscious due to injury 1 time duration | TBI Screen: Duration (in minutes) subject report being unconscious due to injury 1 (LOC) | TBILocDuration1 | Recommended | UDE |
| 18 | Loss of Consciousness (LOC) - Subject was unconscious due to injury 2 time duration | TBI Screen: Duration (in minutes) subject report being unconscious due to injury 2 (LOC) | TBILocDuration2 | Recommended | UDE |
| 19 | Loss of Consciousness (LOC) - Subject was unconscious due to injury 3 time duration | TBI Screen: Duration (in minutes) subject report being unconscious due to injury 3 (LOC) | TBILocDuration3 | Recommended | UDE |
| 20 | Loss of Consciousness (LOC) - Subject was unconscious due to injury 4 time duration | TBI Screen: Duration (in minutes) subject report being unconscious due to injury 4 (LOC) | TBILocDuration4 | Recommended | UDE |
| 21 | Loss of Consciousness (LOC) - Subject was unconscious due to injury 5 time duration | TBI Screen: Duration (in minutes) subject report being unconscious due to injury 5 (LOC) | TBILocDuration5 | Recommended | UDE |
| 22 | Loss of Consciousness (LOC) - Subject was unconscious due to injury 6 time duration | TBI Screen: Duration (in minutes) subject report being unconscious due to injury 6 (LOC) | TBILocDuration6 | Recommended | UDE |
| 23 | Loss of Consciousness (LOC) - Subject was unconscious due to injury 7 time duration | TBI Screen: Duration (in minutes) subject report being unconscious due to injury 7 (LOC) | TBILocDuration7 | Recommended | UDE |
| 24 | Loss of Consciousness (LOC) - Subject was unconscious due to injury 8 time duration | TBI Screen: Duration (in minutes) subject report being unconscious due to injury 8 (LOC) | TBILocDuration8 | Recommended | UDE |
| 25 | Loss of Consciousness (LOC) - Subject was unconscious due to injury 9 time duration | TBI Screen: Duration (in minutes) subject report being unconscious due to injury 9 (LOC) | TBILocDuration9 | Recommended | UDE |
| 26 | Loss of Consciousness (LOC) - Subject was unconscious due to injury 10 time duration | TBI Screen: Duration (in minutes) subject report being unconscious due to injury 10 (LOC) | TBILocDuration10 | Recommended | UDE |
| 27 | Age at dazed injury 1 | TBI Screen: Age at dazed injury 1 | TBIDazedAge1 | Recommended | UDE |
| 28 | Age at dazed injury 2 | TBI Screen: age at dazed injury 2 | TBIDazedAge2 | Recommended | UDE |
| 29 | Age at dazed injury 3 | TBI Screen: age at dazed injury 3 | TBIDazedAge3 | Recommended | UDE |
| 30 | Age at dazed injury 4 | TBI Screen: age at dazed injury 4 | TBIDazedAge4 | Recommended | UDE |
| 31 | Age at dazed injury 5 | TBI Screen: age at dazed and confused injury number 5 | TBIDazedAge5 | Recommended | UDE |
| 32 | Age at dazed injury 6 | TBI Screen: Age at dazed injury 6 | TBIDazedAge6 | Recommended | UDE |
| 33 | Age at dazed injury 7 | TBI Screen: age at dazed injury 7 | TBIDazedAge7 | Recommended | UDE |
| 34 | Age at dazed injury 8 | TBI Screen: age at dazed injury 8 | TBIDazedAge8 | Recommended | UDE |
| 35 | Age at dazed injury 9 | TBI Screen: age at dazed injury 9 | TBIDazedAge9 | Recommended | UDE |
| 36 | Age at dazed injury 10 | TBI Screen: age at dazed injury 10 | TBIDazedAge10 | Recommended | UDE |
| 37 | Dazed and confused for how long dazed injury 1 | TBI Screen: dazed and confused for how long dazed injury 1 | TBIDazedDuration1 | Recommended | UDE |
| 38 | Dazed and confused for how long dazed injury 2 | TBI Screen dazed and confused for how long dazed injury 2 | TBIDazedDuration2 | Recommended | UDE |
| 39 | Dazed and confused for how long dazed injury 3 | TBI Screen: dazed and confused for how long dazed injury 3 | TBIDazedDuration3 | Recommended | UDE |
| 40 | Dazed and confused for how long dazed Injury 4 | TBI Screen: dazed and confused for how long dazed Injury 4 | TBIDazedDuration4 | Recommended | UDE |
| 41 | Dazed and confused for how long dazed injury 5 | TBI Screen: dazed and confused for how long dazed injury 5 | TBIDazedDuration5 | Recommended | UDE |
| 42 | Dazed and confused for how long dazed injury 6 | TBI Screen: dazed and confused for how long dazed injury 6 | TBIDazedDuration6 | Recommended | UDE |
| 43 | Dazed and confused for how long dazed injury 7 | TBI Screen: dazed and confused for how long dazed injury 7 | TBIDazedDuration7 | Recommended | UDE |
| 44 | Dazed and confused for how long dazed injury 8 | TBI Screen: dazed and confused for how long dazed injury 8 | TBIDazedDuration8 | Recommended | UDE |
| 45 | Dazed and confused for how long dazed Injury 9 | TBI Screen: dazed and confused for how long dazed Injury 9 | TBIDazedDuration9 | Recommended | UDE |
| 46 | Dazed and confused for how long dazed injury 10 | TBI Screen: dazed and confused for how long dazed injury 10 | TBIDazedDuration10 | Recommended | UDE |
| 47 | Concussion symptom duration | Number of days that the participant suffered from post-concussive symptoms | ConcussionSymptomDurDays | Recommended | CDE |
Keywords
