Form Structure: Military Acute Concussion Evaluation (MACE)
This form structure is an organized set of data definitions for a form that has not been copyrighted
Resource:
FITBIR
Title:
Military Acute Concussion Evaluation (MACE)
Short Name:
MACE_FITBIR
Description:
The Military Acute Concussion Evaluation (MACE) is a concussion screening tool for the acute assessment of service members involved in a potentially concussive event.
References:
https://dvbic.dcoe.mil/files/resources/DVBIC_Military-Acute-Concussion-Evaluation_Pocket-Card_Feb2012.pdf
McCrea, M. Standardized Mental Status Testing on the Sideline After
Sport-Related Concussion. J Athl Train. 2001 Sep;36(3):274-279.
Disease:
Traumatic Brain Injury
Organization:
NIH
Required Program Form:
No
Standardization:
Standard NINDS CDE
Labels:
Form Type:
Clinical Assessment
Publication Date:
2015-03-26
Version:
1.1
Date Created:
2015-03-24
Owner:
Number of Data Elements:
115
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 | 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 Administration (Repeat Infinitely)
| # | 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 |
Injury Info (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Military unit | Military unit, also called Unit, a group having a prescribed size and a specific combat or support role within a larger military organization. | MilUnit | Recommended | UDE |
| 2 | Injury date time | Date (and time, if applicable and known) of injury | InjDateTime | Recommended | CDE |
| 3 | Injury elapsed time | The elapsed time (in minutes) from the time of injury | InjElapsedTime | Recommended | CDE |
History (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Military Acute Concussion Evaluation (MACE and MACE2) - Incident description text | Description of incident of what happened to the subject, s part of Military Acute Concussion Evaluation (MACE and MACE2). | MACEIncdntDescrptTxt | Recommended | CDE |
| 2 | Military Acute Concussion Evaluation (MACE and MACE2) - Incident description subject remember text | Description of incident of what the subject remembers, as part of Military Acute Concussion Evaluation (MACE and MACE2). | MACEIncdntDescrptSubjRemmbrTxt | Recommended | CDE |
| 3 | Military Acute Concussion Evaluation (MACE and MACE2) - Incident description daze indicator | Indicator of whether or not the subject was dazed, confused or "saw stars", as part of Military Acute Concussion Evaluation (MACE and MACE2). | MACEIncdntDescrptDazeInd | Recommended | CDE |
| 4 | Military Acute Concussion Evaluation (MACE and MACE2) - Incident description hit head indicator | Indicator of whether or not the subject hit his or her head, s part of Military Acute Concussion Evaluation (MACE and MACE2). | MACEIncdntDescrptHitHeadInd | Recommended | CDE |
| 5 | Military Acute Concussion Evaluation (MACE and MACE2) - Incident description subject remember text | Cause of injury, as part of Military Acute Concussion Evaluation (MACE and MACE2). | MACEIncdntCauseTyp | Recommended | CDE |
| 6 | Military Acute Concussion Evaluation (MACE and MACE2) - Incident cause other text | The free-text field related to MACEIncdntCauseTyp, specifying other text, s part of Military Acute Concussion Evaluation (MACE and MACE2). | MACEIncdntCauseOth | Recommended | CDE |
| 7 | Military Acute Concussion Evaluation (MACE) - Helmet worn indicator | Indicator of whether or not a helmet was worn, as part of Military Acute Concussion Evaluation (MACE). | MACEHelmWornInd | Recommended | CDE |
| 8 | Military Acute Concussion Evaluation (MACE) - Helmet worn name | Name of helmet, as part of Military Acute Concussion Evaluation (MACE). | MACEHelmWornName | Recommended | CDE |
| 9 | Military Acute Concussion Evaluation (MACE) - Unremembered events before indicator | Indicator of whether or not there were events just BEFORE the injury that are not remembered, as part of Military Acute Concussion Evaluation (MACE). | MACEUnremmbrdEvntBfrInd | Recommended | CDE |
| 10 | Military Acute Concussion Evaluation (MACE) - Unremembered events before time duration | Duration of time of unremembered events from before the trauma, as part of Military Acute Concussion Evaluation (MACE). | MACEUnremmbrdEvntBfrTm | Recommended | CDE |
| 11 | Military Acute Concussion Evaluation (MACE) - Unremembered events before time duration unit of measure | Unit of measure associated with the duration of time of unremembered events from before the trauma, as part of Military Acute Concussion Evaluation (MACE). | MACEUnremmbrdEvntBfrTmUoM | Recommended | CDE |
| 12 | Military Acute Concussion Evaluation (MACE) - Unremembered events after indicator | Indicator of whether or not there were events just AFTER the injury that are not remembered, as part of Military Acute Concussion Evaluation (MACE). | MACEUnremmbrdEvntAftrInd | Recommended | CDE |
| 13 | Military Acute Concussion Evaluation (MACE) - Unremembered events after time duration | Duration of time of unremembered events from after the trauma, as part of Military Acute Concussion Evaluation (MACE). | MACEUnrememEvntAfterTm | Recommended | CDE |
| 14 | Military Acute Concussion Evaluation (MACE) - Unremembered events after time unit of measure | Duration of time of unremembered events from after the trauma, as part of Military Acute Concussion Evaluation (MACE). | MACEUnrememEvntAfterTmUoM | Recommended | CDE |
| 15 | Military Acute Concussion Evaluation (MACE) - Individual loss consciousness indicator | Indicator of whether or not the individual reports loss of consciousness or blacking out, as part of Military Acute Concussion Evaluation (MACE). | MACEIndvdlLossConcsnInd | Recommended | CDE |
| 16 | Military Acute Concussion Evaluation (MACE) - Individual loss consciousness time duration | Duration of incidents where the subject reports losing consciousness or blacking out, as part of Military Acute Concussion Evaluation (MACE). | MACEIndvdlLossConcsnTmDur | Recommended | CDE |
| 17 | Military Acute Concussion Evaluation (MACE) - Individual loss consciousness time unit of measure | Unit of measure associated with the duration of those incidents where the subject reports losing consciousness or blacking out, as part of Military Acute Concussion Evaluation (MACE). | MACEIndvdlLossConcsnTmUoM | Recommended | CDE |
| 18 | Military Acute Concussion Evaluation (MACE) - Anyone loss consciousness indicator | Indicator of whether or not anyone observed a period of loss of consciousness or unresponsiveness, as part of Military Acute Concussion Evaluation (MACE). | MACEAnyoneLossConcsnInd | Recommended | CDE |
| 19 | Military Acute Concussion Evaluation (MACE) - Anyone loss consciousness time duration | Duration of time where anyone observed a period of loss of consciousness or unresponsiveness, as part of Military Acute Concussion Evaluation (MACE). | MACEAnyoneLossConcsnTm | Recommended | CDE |
| 20 | Military Acute Concussion Evaluation (MACE) - Anyone loss consciousness time unit of measure | Unit of measure associated with the duration of time where anyone observed a period of loss of consciousness or unresponsiveness, as part of Military Acute Concussion Evaluation (MACE). | MACEAnyoneLossConcsnTmUoM | Recommended | CDE |
| 21 | Military Acute Concussion Evaluation (MACE) - Symptoms type | Type(s) of symptoms experienced at the time of the incident as part of Military Acute Concussion Evaluation (MACE). | MACESympTyp | Recommended | CDE |
| 22 | Military Acute Concussion Evaluation (MACE and MACE2) - Symptoms other text | The free-text field related to MACESympTyp and MACE2SympTyp specifying other text, as part of Military Acute Concussion Evaluation (MACE and MACE2). | MACESympOth | Recommended | CDE |
Orientation (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Military Acute Concussion Evaluation (MACE and MACE2) - Orientation month score | Orientation month score, as part of Military Acute Concussion Evaluation (MACE and MACE2). | MACEOrientMnthScore | Recommended | CDE |
| 2 | Military Acute Concussion Evaluation (MACE and MACE2) - Orientation date score | Orientation date score, as part of Military Acute Concussion Evaluation (MACE and MACE2). | MACEOrientDateScore | Recommended | CDE |
| 3 | Military Acute Concussion Evaluation (MACE and MACE2) - Orientation weekday score | Orientation weekday score, as part of Military Acute Concussion Evaluation (MACE and MACE2). | MACEOrientWeekdayScore | Recommended | CDE |
| 4 | Military Acute Concussion Evaluation (MACE and MACE2) - Orientation year score | Orientation year score, as part of Military Acute Concussion Evaluation (MACE and MACE2). | MACEOrientYrScore | Recommended | CDE |
| 5 | Military Acute Concussion Evaluation (MACE and MACE2) - Orientation time score | Orientation time score, as part of Military Acute Concussion Evaluation (MACE and MACE2). | MACEOrientTmScore | Recommended | CDE |
Immediate Memory Trials (Appears Up To 3 Times)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Trial number | The number representing the sequence for any repeated measure test or assessment when it is performed multiple times. | TrialNum | Recommended | CDE |
| 2 | Military Acute Concussion Evaluation (MACE and MACE2) - Immediate memory elbow score | Immediate memory elbow score, as part of Military Acute Concussion Evaluation (MACE and MACE2). | MACEImmdtMemryElbScore | Recommended | CDE |
| 3 | Military Acute Concussion Evaluation (MACE and MACE2) - Immediate memory apple score | Immediate memory apple score, as part of Military Acute Concussion Evaluation (MACE and MACE2). | MACEImmdtMemryApplScore | Recommended | CDE |
| 4 | Military Acute Concussion Evaluation (MACE and MACE2) - Immediate memory carpet score | Immediate memory carpet score, as part of Military Acute Concussion Evaluation (MACE and MACE2). | MACEImmdtMemryCrptScore | Recommended | CDE |
| 5 | Military Acute Concussion Evaluation (MACE and MACE2) - Immediate memory saddle score | Immediate memory saddle score, as part of Military Acute Concussion Evaluation (MACE and MACE2). | MACEImmdtMemrySddlScore | Recommended | CDE |
| 6 | Military Acute Concussion Evaluation (MACE and MACE2) - Immediate memory bubble score | Immediate memory bubble score, as part of Military Acute Concussion Evaluation (MACE and MACE2). | MACEImmdtMemryBubblScore | Recommended | CDE |
| 7 | Military Acute Concussion Evaluation (MACE and MACE2) - Immediate memory trial score | Concentration total score (0-5) from form B, as part of Military Acute Concussion Evaluation (MACE and MACE2). | MACEImmdtMemTrialScore | Recommended | CDE |
Concentration (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Military Acute Concussion Evaluation (MACE and MACE2) - Concentration 493 score | Subject's concentration score for correctly repeating the number 4-9-3 in reverse order, as part of Military Acute Concussion Evaluation (MACE and MACE2). | MACEConc493Score | Recommended | CDE |
| 2 | Military Acute Concussion Evaluation (MACE and MACE2) - Concentration 629 score | Subject's concentration score for correctly repeating the number 6-2-9 in reverse order , as part of Military Acute Concussion Evaluation (MACE and MACE2). | MACEConc629Score | Recommended | CDE |
| 3 | Military Acute Concussion Evaluation (MACE and MACE2) - Concentration 3814 score | Subject's concentration score for correctly repeating the number 3-8-1-4 in reverse order, as part of Military Acute Concussion Evaluation (MACE and MACE2). | MACEConc3814Score | Recommended | CDE |
| 4 | Military Acute Concussion Evaluation (MACE and MACE2) - Concentration 3279 score | Subject's concentration score for correctly repeating the number 3-2-7-9 in reverse order, as part of Military Acute Concussion Evaluation (MACE and MACE2). | MACEConc3279Score | Recommended | CDE |
| 5 | Military Acute Concussion Evaluation (MACE and MACE2) - Concentration 62971 score | Subject's concentration score for correctly repeating the number 6-2-9-7-1 in reverse order, as part of Military Acute Concussion Evaluation (MACE and MACE2). | MACEConc62971Score | Recommended | CDE |
| 6 | Military Acute Concussion Evaluation (MACE and MACE2) - Concentration 15285 score | Subject's concentration score for correctly repeating the number 1-5-2-8-5 in reverse order , as part of Military Acute Concussion Evaluation (MACE and MACE2). | MACEConc15285Score | Recommended | CDE |
| 7 | Military Acute Concussion Evaluation (MACE and MACE2) - Concentration 718462 score | Subject's concentration score for correctly repeating the number 7-1-8-4-6-2 in reverse order, as part of Military Acute Concussion Evaluation (MACE and MACE2). | MACEConc718462Score | Recommended | CDE |
| 8 | Military Acute Concussion Evaluation (MACE and MACE2) - Concentration 539148 score | Subject's concentration score for correctly repeating the number 5-3-9-1-4-8 in reverse order, as part of Military Acute Concussion Evaluation (MACE and MACE2). | MACEConc539148Score | Recommended | CDE |
| 9 | Military Acute Concussion Evaluation (MACE and MACE2) - Concentration months score | Subject's concentration score for correctly reciting the months in reverse order, as part of Military Acute Concussion Evaluation (MACE and MACE2). | MACEConcMnthScore | Recommended | CDE |
Delayed Recall (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Military Acute Concussion Evaluation (MACE and MACE2) - Delayed recall elbow score | Delayed recall elbow score, as part of Military Acute Concussion Evaluation (MACE and MACE2). | MACEDlydRcllElbowScore | Recommended | CDE |
| 2 | Military Acute Concussion Evaluation (MACE and MACE2) - Delayed recall apple score | Delayed recall apple score, as part of Military Acute Concussion Evaluation (MACE and MACE2). | MACEDlydRcllApplScore | Recommended | CDE |
| 3 | Military Acute Concussion Evaluation (MACE and MACE2) - Delayed recall carpet score | Delayed recall carpet score, as part of Military Acute Concussion Evaluation (MACE and MACE2). | MACEDlydRcllCarptScore | Recommended | CDE |
| 4 | Military Acute Concussion Evaluation (MACE and MACE2) - Delayed recall saddle score | Delayed recall saddle score, as part of Military Acute Concussion Evaluation (MACE and MACE2). | MACEDlydRcllSaddlScore | Recommended | CDE |
| 5 | Military Acute Concussion Evaluation (MACE and MACE2) - Delayed recall bubble score | Delayed recall bubble score, as part of Military Acute Concussion Evaluation (MACE and MACE2). | MACEDlydRcllBubblScore | Recommended | CDE |
Scores (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Military Acute Concussion Evaluation (MACE and MACE2) - Orientation score | Orientation total score (0-5), as part of Military Acute Concussion Evaluation (MACE and MACE2). | MACEOrientScore | Recommended | CDE |
| 2 | Military Acute Concussion Evaluation (MACE and MACE2) - Immediate memory score | Immediate memory total score (0-15),as part of Military Acute Concussion Evaluation (MACE and MACE2). | MACEImmdtMemScore | Recommended | CDE |
| 3 | Military Acute Concussion Evaluation (MACE and MACE2) - Concentration score | Concentration total score (0-5), as part of Military Acute Concussion Evaluation (MACE and MACE2). | MACEConcScore | Recommended | CDE |
| 4 | Military Acute Concussion Evaluation (MACE and MACE2) - Delayed recall score | Delayed recall total score (0-5), as part of Military Acute Concussion Evaluation (MACE and MACE2). | MACEDlydRcllScore | Recommended | CDE |
| 5 | Military Acute Concussion Evaluation (MACE) - Total score | The total score for the MACE (0-30), as part of Military Acute Concussion Evaluation (MACE). | MACETotScore | Recommended | CDE |
| 6 | General notes text | General notes | GeneralNotesTxt | Recommended | CDE |
Diagnosis (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Military Acute Concussion Evaluation (MACE) - Neurological screening result | As the clinical condition permits, check: Eyes-pupillary response and tracking; Verbal-speech fluency and word finding; Motor-pronator drift, gait/coordination. Record of any abnormalities, as part of Military Acute Concussion Evaluation (MACE). | MACENrlgclScrnngReslt | Recommended | CDE |
| 2 | Military Acute Concussion Evaluation (MACE) - Diagnosis name | The diagnosis based on the MACE total score, as part of Military Acute Concussion Evaluation (MACE). | MACEDiagnNam | Recommended | CDE |
| 3 | Military Acute Concussion Evaluation (MACE) - Diagnosis other specify | The free-text field related to Military Acute Concussion Evaluation (MACE) - Diagnosis name specifying other text, as part of Military Acute Concussion Evaluation (MACE). | MACEDiagnOth | Recommended | CDE |
Form B Immediate Memory (Appears Up To 3 Times)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Trial number | The number representing the sequence for any repeated measure test or assessment when it is performed multiple times. | TrialNum | Recommended | CDE |
| 2 | Military Acute Concussion Evaluation (MACE) - Immediate memory candle form B score | Immediate memory candle score from form B, as part of Military Acute Concussion Evaluation (MACE). | MACEImmdtMemCandlFormBScore | Recommended | CDE |
| 3 | Military Acute Concussion Evaluation (MACE) - Immediate memory paper form B score | Immediate memory paper score from form B, as part of Military Acute Concussion Evaluation (MACE). | MACEImmdtMemPaprFormBScore | Recommended | CDE |
| 4 | Military Acute Concussion Evaluation (MACE) - Immediate memory sugar form B score | Immediate memory sugar score from form B, as part of Military Acute Concussion Evaluation (MACE). | MACEImmdtMemSugrFormBScore | Recommended | CDE |
| 5 | Military Acute Concussion Evaluation (MACE) - Immediate memory sandwich form B score | Immediate memory sandwich score from form B, as part of Military Acute Concussion Evaluation (MACE). | MACEImmdtMemSandwchFormBScore | Recommended | CDE |
| 6 | Military Acute Concussion Evaluation (MACE) - Immediate memory wagon form B score | Immediate memory wagon score from form B, as part of Military Acute Concussion Evaluation (MACE). | MACEImmdtMemWagnFormBScore | Recommended | CDE |
| 7 | Military Acute Concussion Evaluation (MACE and MACE2) - Immediate memory trial score | Concentration total score (0-5) from form B, as part of Military Acute Concussion Evaluation (MACE and MACE2). | MACEImmdtMemTrialScore | Recommended | CDE |
Form B Concentration (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Military Acute Concussion Evaluation (MACE) - Concentration recall 526 form B score | Subject's concentration score for correctly repeating the number 5-2-6 in reverse order, as part of Military Acute Concussion Evaluation (MACE). | MACEConcRcll526FormBScore | Recommended | CDE |
| 2 | Military Acute Concussion Evaluation (MACE) - Concentration recall 415 form B score | Subject's concentration score for correctly repeating the number 4-1-5 in reverse order , as part of Military Acute Concussion Evaluation (MACE). | MACEConcRcll415FormBScore | Recommended | CDE |
| 3 | Military Acute Concussion Evaluation (MACE) - Concentration recall 1795 form B score | Subject's concentration score for correctly repeating the number 1-7-9-5 in reverse order, as part of Military Acute Concussion Evaluation (MACE). | MACEConcRcll1795FormBScore | Recommended | CDE |
| 4 | Military Acute Concussion Evaluation (MACE) - Concentration recall 4968 form B score | Subject's concentration score for correctly repeating the number 4-9-6-8 in reverse order , as part of Military Acute Concussion Evaluation (MACE). | MACEConcRcll4968FormBScore | Recommended | CDE |
| 5 | Military Acute Concussion Evaluation (MACE) - Concentration recall 831964 form B score | Subject's concentration score for correctly repeating the number 8-3-1-9-6-4 in reverse order, as part of Military Acute Concussion Evaluation (MACE). | MACEConcRcll831964FormBScore | Recommended | CDE |
| 6 | Military Acute Concussion Evaluation (MACE) - Concentration recall 724856 form B score | Subject's concentration score for correctly repeating the number 7-2-4-8-5-6 in reverse order , as part of Military Acute Concussion Evaluation (MACE). | MACEConcRcll724856FormBScore | Recommended | CDE |
| 7 | Military Acute Concussion Evaluation (MACE) - Concentration recall 61843 form B score | Subject's concentration score for correctly repeating the number 6-1-8-4-3 in reverse order , as part of Military Acute Concussion Evaluation (MACE). | MACEConcRcll61843FormBScore | Recommended | CDE |
| 8 | Military Acute Concussion Evaluation (MACE) - Concentration recall 48527 form B score | Subject's concentration score for correctly repeating the number 4-8-5-2-7 in reverse order, as part of Military Acute Concussion Evaluation (MACE). | MACEConcRcll48527FormBScore | Recommended | CDE |
Form B Scores (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Military Acute Concussion Evaluation (MACE) - Immediate memory form B score | Immediate memory score from form B, as part of Military Acute Concussion Evaluation (MACE). | MACEImmdtMemFormBScore | Recommended | CDE |
| 2 | Military Acute Concussion Evaluation (MACE) - Concentration recall form B score | Concentration total score (0-5) from form B, as part of Military Acute Concussion Evaluation (MACE). | MACEConcRcllFormBScore | Recommended | CDE |
| 3 | Military Acute Concussion Evaluation (MACE) - Delayed recall form B score | Delayed recall total score (0-5) from form B, as part of Military Acute Concussion Evaluation (MACE). | MACEDlydRcllFormBScore | Recommended | CDE |
| 4 | Military Acute Concussion Evaluation (MACE) - Form B Total score | The total score for the Form B MACE (0-30), as part of Military Acute Concussion Evaluation (MACE). | MACEFormBTotScore | Recommended | CDE |
Form C Immediate Memory (Appears Up To 3 Times)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Trial number | The number representing the sequence for any repeated measure test or assessment when it is performed multiple times. | TrialNum | Recommended | CDE |
| 2 | Military Acute Concussion Evaluation (MACE) - Immediate memory baby form C score | Immediate memory baby score from form C, as part of Military Acute Concussion Evaluation (MACE). | MACEImmdtMemryBabyFormCScore | Recommended | CDE |
| 3 | Military Acute Concussion Evaluation (MACE) - Immediate memory monkey form C score | Immediate memory monkey score from form C, as part of Military Acute Concussion Evaluation (MACE). | MACEImmdtMemryMnkyFormCScore | Recommended | CDE |
| 4 | Military Acute Concussion Evaluation (MACE) - Immediate memory perfume form C score | Immediate memory perfume score from form C, as part of Military Acute Concussion Evaluation (MACE). | MACEImmdtMemryPerfmFormCScore | Recommended | CDE |
| 5 | Military Acute Concussion Evaluation (MACE) - Immediate memory sunset form C score | Immediate memory sunset score from form C, as part of Military Acute Concussion Evaluation (MACE). | MACEImmdtMemrySunsetFormCScore | Recommended | CDE |
| 6 | Military Acute Concussion Evaluation (MACE) - Immediate memory iron form C score | Immediate memory iron score from form C, as part of Military Acute Concussion Evaluation (MACE). | MACEImmdtMemryIronFormCScore | Recommended | CDE |
| 7 | Military Acute Concussion Evaluation (MACE and MACE2) - Immediate memory trial score | Concentration total score (0-5) from form B, as part of Military Acute Concussion Evaluation (MACE and MACE2). | MACEImmdtMemTrialScore | Recommended | CDE |
Form C Concentration (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Military Acute Concussion Evaluation (MACE) - Concentration 142 form C score | Subject's concentration score for correctly repeating the number 1-4-2 in reverse order, as part of Military Acute Concussion Evaluation (MACE). | MACEConc142FormCScore | Recommended | CDE |
| 2 | Military Acute Concussion Evaluation (MACE) - Concentration 658 form C score | Subject's concentration score for correctly repeating the number 6-5-8 in reverse order, as part of Military Acute Concussion Evaluation (MACE). | MACEConc658FormCScore | Recommended | CDE |
| 3 | Military Acute Concussion Evaluation (MACE) - Concentration 6831 form C score | Subject's concentration score for correctly repeating the number 6-8-3-1 in reverse order, as part of Military Acute Concussion Evaluation (MACE). | MACEConc6831FormCScore | Recommended | CDE |
| 4 | Military Acute Concussion Evaluation (MACE) - Concentration 3481 form C score | Subject's concentration score for correctly repeating the number 3-4-8-1 in reverse order , as part of Military Acute Concussion Evaluation (MACE). | MACEConc3481FormCScore | Recommended | CDE |
| 5 | Military Acute Concussion Evaluation (MACE) - Concentration 49153 form C score | Subject's concentration score for correctly repeating the number 4-9-1-5-3 in reverse order, as part of Military Acute Concussion Evaluation (MACE). | MACEConc49153FormCScore | Recommended | CDE |
| 6 | Military Acute Concussion Evaluation (MACE) - Concentration 68251 form C score | Subject's concentration score for correctly repeating the number 6-8-2-5-1 in reverse order, as part of Military Acute Concussion Evaluation (MACE). | MACEConc68251FormCScore | Recommended | CDE |
| 7 | Military Acute Concussion Evaluation (MACE) - Concentration 376519 form C score | Subject's concentration score for correctly repeating the number 3-7-6-5-1-9 in reverse order, as part of Military Acute Concussion Evaluation (MACE). | MACEConc376519FormCScore | Recommended | CDE |
| 8 | Military Acute Concussion Evaluation (MACE) - Concentration 926514 form C score | Subject's concentration score for correctly repeating the number 9-2-6-5-1-4 in reverse order , as part of Military Acute Concussion Evaluation (MACE). | MACEConc926514FormCScore | Recommended | CDE |
Form C Delayed Recall (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Military Acute Concussion Evaluation (MACE) - Delayed recall baby form C score | Delayed recall baby score from form C, as part of Military Acute Concussion Evaluation (MACE). | MACEDlydRcllBabyFormCScore | Recommended | CDE |
| 2 | Military Acute Concussion Evaluation (MACE) - Delayed recall monkey form C score | Delayed recall monkey score from form C, as part of Military Acute Concussion Evaluation (MACE). | MACEDlydRcllMonkyFormCScore | Recommended | CDE |
| 3 | Military Acute Concussion Evaluation (MACE) - Delayed recall perfume form C score | Delayed recall perfume score from form C, as part of Military Acute Concussion Evaluation (MACE). | MACEDlydRcllPerfmFormCScore | Recommended | CDE |
| 4 | Military Acute Concussion Evaluation (MACE) - Delayed recall sunset form C score | Delayed recall sunset score from form C, as part of Military Acute Concussion Evaluation (MACE). | MACEDlydRcllSunstFormCScore | Recommended | CDE |
| 5 | Military Acute Concussion Evaluation (MACE) - Delayed recall iron form C score | Delayed recall iron score from form C, as part of Military Acute Concussion Evaluation (MACE). | MACEDlydRcllIronFormCScore | Recommended | CDE |
Form C Scores (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Military Acute Concussion Evaluation (MACE) - Immediate memory form C score | Immediate memory score from form C, as part of Military Acute Concussion Evaluation (MACE). | MACEImmdtMemFormCScore | Recommended | CDE |
| 2 | Military Acute Concussion Evaluation (MACE) - Concentration form C score | Concentration score from form C, as part of Military Acute Concussion Evaluation (MACE). | MACEDConcFormCScore | Recommended | CDE |
| 3 | Military Acute Concussion Evaluation (MACE) - Delayed recall form C score | Delayed recall score from form C, as part of Military Acute Concussion Evaluation (MACE). | MACEDlydRcllFormCScore | Recommended | CDE |
| 4 | Military Acute Concussion Evaluation (MACE) - Form C Total score | The total score for the Form C MACE (0-30), as part of Military Acute Concussion Evaluation (MACE). | MACEFormCTotScore | Recommended | CDE |
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