Form Structure: King-Devick Concussion Screening Test
This form structure is an organized set of data definitions for a copyrighted form
Title:
King-Devick Concussion Screening Test
Short Name:
KingDevickTest
Description:
The King-Devick Concussion Screening Test is an objective remove-from-play sideline concussion screening test that can be administered by parents and coaches in minutes. The King-Devick Test (K-D Test) is defined by Mosby's Medical Dictionary as a tool for evaluation of saccade, consisting of a series of test cards of numbers. The test cards become progressively more difficult to read due to variability of spacing between the numbers. Both errors in reading and speed of reading are included in deriving a score.
Copyright: King-Devick Test (K-D Test) All rights reserved. Copyrighted. 1983, 2010-2016, Patents-Pending. Mayo and Mayo Clinic are registered trademarks owned by Mayo Foundation for Medical Education and Research. Two Mid America Plaza, Suite 110, Oakbrook Terrace, IL 60181. King-Devick Test is for screening purposes only and any suspicion or indication of head trauma should be evaluated by a licensed professional.
Disease:
General (For all diseases)
Traumatic Brain Injury
Organization:
NIH
Required Program Form:
No
Standardization:
Standard NINDS CDE
Labels:
Form Type:
Clinical Assessment
Publication Date:
2016-09-09
Version:
1.1
Date Created:
2016-05-27
Owner:
Number of Data Elements:
33
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 | 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 |
King-Devick Test General Details (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Sport team participation type | The sport or team that the athlete participates in | SportTeamParticipationTyp | Recommended | UDE |
| 2 | Sport team participation other text | The free-text related to Sport team participation type specifying the other type of sport or team | SportTeamParticipationTypOTH | Recommended | UDE |
| 3 | Indicator whether the subject is wearing glasses/contact while taking the test | Indicator whether the subject is wearing glasses/contact while taking the test | GlassesContactWearInd | Recommended | UDE |
King-Devick Test Baseline Attempt 1 (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | King-Devick Concussion Screening Test (K-D Test) - Baseline attempt three test card assessment total duration | Duration of total time for baseline attempt with three card test assessment, as part of the King-Devick Concussion Screening (K-D Test) | KDTestBaselinThreCardAssTotDur | Recommended | CDE |
| 2 | King-Devick Concussion Screening Test (K-D Test) - Baseline attempt three test card assessment error count | Number of errors the subject makes on their baseline attempt with three card test assessment, as part of the King-Devick Concussion Screening (K-D Test) | KDTestBaselinThreCardAssErrNum | Recommended | CDE |
| 3 | King-Devick Concussion Screening Test (K-D Test) - Test card completed number | The number of completed test cards, as part of the King-Devick Concussion Screening (K-D Test). | KDTestCardCompletedNum | Recommended | CDE |
King-Devick Test Baseline Attempt 2 (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | King-Devick Concussion Screening Test (K-D Test) - Baseline attempt three test card assessment total duration | Duration of total time for baseline attempt with three card test assessment, as part of the King-Devick Concussion Screening (K-D Test) | KDTestBaselinThreCardAssTotDur | Recommended | CDE |
| 2 | King-Devick Concussion Screening Test (K-D Test) - Baseline attempt three test card assessment error count | Number of errors the subject makes on their baseline attempt with three card test assessment, as part of the King-Devick Concussion Screening (K-D Test) | KDTestBaselinThreCardAssErrNum | Recommended | CDE |
| 3 | King-Devick Concussion Screening Test (K-D Test) - Test card completed number | The number of completed test cards, as part of the King-Devick Concussion Screening (K-D Test). | KDTestCardCompletedNum | Recommended | CDE |
King-Devick Test Subject Baseline (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | King-Devick Concussion Screening Test (K-D Test) - Baseline attempt three test card assessment total duration | Duration of total time for baseline attempt with three card test assessment, as part of the King-Devick Concussion Screening (K-D Test) | KDTestBaselinThreCardAssTotDur | Recommended | CDE |
| 2 | King-Devick Concussion Screening Test (K-D Test) - Baseline attempt three test card assessment error count | Number of errors the subject makes on their baseline attempt with three card test assessment, as part of the King-Devick Concussion Screening (K-D Test) | KDTestBaselinThreCardAssErrNum | Recommended | CDE |
| 3 | King-Devick Concussion Screening Test (K-D Test) - Test card completed number | The number of completed test cards, as part of the King-Devick Concussion Screening (K-D Test). | KDTestCardCompletedNum | Recommended | CDE |
| 4 | King-Devick Concussion Screening Test (K-D Test) - Subject's baseline time without error duration | Duration of the subject's fastest baseline total time without errors of the two attempts, as part of the King-Devick Concussion Screening (K-D Test) | KDTestSubjBaselinTimeWtoErrDur | Recommended | CDE |
King-Devick Test After Suspected Head Trauma (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 |
Injury elapsed time (in days)
(Retired) |
The elapsed time in days from the time of injury | InjuryElapsedDaysDur | Recommended | UDE |
| 2 | King-Devick Concussion Screening Test (K-D Test) - Post suspected head trauma three test card assessment total duration | The total time for post suspected head trauma three card test assessment, as part of the King-Devick Concussion Screening (K-D Test) | KDTestPSusHTTCarAssTotDur | Recommended | CDE |
| 3 | King-Devick Concussion Screening Test (K-D Test) - Testing after a suspected head trauma total error number | The number of total errors the subject makes during the King-Devick after a suspected head trauma, as part of the King-Devick Concussion Screening (K-D Test) | KDTestAfterSuspectedHTErrorNum | Recommended | CDE |
| 4 | King-Devick Concussion Screening Test (K-D Test) - Better than baseline time indicator | Indicator if the retest time duration for the suspected head trauma is better than the subject's baseline time without error duration, as a part of the King-Devick Concussion Screening (K-D) Test | KDTestRetstTimBtrThnBslTimInd | Recommended | CDE |
| 5 | King-Devick Concussion Screening Test (K-D Test) - Test card completed number | The number of completed test cards, as part of the King-Devick Concussion Screening (K-D Test). | KDTestCardCompletedNum | Recommended | CDE |
| 6 | King-Devick Concussion Screening Test (K-D Test) - Testing after a suspected head trauma comments text | The text containing comments about testing after a suspected head trauma, as part of the King-Devick Concussion Screening (K-D Test) | KDTestAfterSuspectedHTCommTxt | Recommended | CDE |
King-Devick Test Removed From Play (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | King-Devick Concussion Screening Test (K-D Test) - Removed from play indicator | Indicator whether the subject should be removed from play or not based on subject's performance, as a part of King-Devick Concussion Screening Test | KDTestRemovedFromPlayInd | Optional | CDE |
Keywords
