Form Structure: NIH Toolbox Sensation Domain Hearing Threshold Test (Audition Supplemental Measures)
This form structure is an organized set of data definitions for a copyrighted form
Title:
NIH Toolbox Sensation Domain Hearing Threshold Test (Audition Supplemental Measures)
Short Name:
NIHTBHearingThresholdTest
Description:
In the NIH Toolbox, the Hearing Threshold Test is used to measure audition. This automated audiometric test measures hearing thresholds at six different frequencies, separately in the left and right ears.This test is part of the NIH Toolbox Sensation Domain Audition Measure. Copyright 2012 Northwestern University and the National Institutes of Health. http://www.nihtoolbox.org/Pages/NIH-Toolbox-Terms-and-Conditions.aspx
Disease:
General (For all diseases)
Traumatic Brain Injury
Organization:
NIH/CIT/DCB
Required Program Form:
No
Standardization:
Standard NINDS CDE
Labels:
Form Type:
Clinical Assessment
Version:
1.0
Date Created:
2016-06-27
Owner:
Number of Data Elements:
43
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 |
NIH Toolbox Administration (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | NIH Toolbox - Test domain battery type | Type of domain battery for the NIH Toolbox test being administered, as a part of the NIH Toolbox | NIHTBTestDomainBattryTyp | Recommended | CDE |
| 2 | NIH Toolbox - Test domain battery type other | The free-text related to NIHTBTestDomainBatteryTyp specifying other text, as part of the NIH Toolbox | NIHTBTestDomainBatteryTypOTH | Recommended | CDE |
| 3 | NIH Toolbox - Test name type | Type of NIH Toolbox test being administered, as part of the NIH Toolbox | NIHTBAdminTestNameTyp | Recommended | CDE |
| 4 | NIH Toolbox - Test name type other | The free-text related to NIHTBAdminTestNameTyp specifying other text, as part of the NIH Toolbox | NIHTBAdminTestNameTypOTH | Recommended | CDE |
| 5 | NIH Toolbox - Test administration language type | Type of language for test being administrated, as part of the NIH Toolbox | NIHTBTestAdminLanguageTyp | Recommended | CDE |
| 6 | NIH Toolbox - Test administration language type other | Free-text related to NIHTBTestAdminLanguageTyp specifying other text, as part of the NIH Toolbox | NIHTBTestAdminLanguageTypOTH | Recommended | CDE |
| 7 | NIH Toolbox - Form administered type | Type of NIH Toolbox form being administered, as part of the NIH Toolbox | NIHTBFormAdminTyp | Recommended | CDE |
| 8 | NIH Toolbox - Test administration flag indicator | Indicator of a flag for the NIH Toolbox test being administered, as part of the NIH Toolbox | NIHTBAdminTestFlagInd | Recommended | CDE |
| 9 | NIH Toolbox - Test administration flag type | Type of flag for the NIH Toolbox test being administered, as part of the NIH Toolbox | NIHTBAdminTestFlagTyp | Recommended | CDE |
NIH Toolbox Hearing Threshold Test: Practice (Repeat Infinitely)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Trial number (numeric) | The number representing the sequence for any repeated measure test or assessment when it is performed multiple times. | TrialNumber | Recommended | CDE |
| 2 | NIH Toolbox Sensation Domain Audition Measure Hearing Threshold Test - Trial type | Type of trial, as part of the NIH Toolbox Sensation Domain Audition Measure Hearing Threshold Test | NIHTBHTTTrialType | Recommended | CDE |
| 3 | NIH Toolbox Sensation Domain Audition Measure Hearing Threshold Test - Pediatric response type | Type of response for children, as part of the NIH Toolbox Sensation Domain Audition Measure Hearing Threshold Test | NIHTBHTTPedResponsesTyp | Recommended | CDE |
| 4 | NIH Toolbox Sensation Domain Audition Measure Hearing Threshold Test - Practice response type | Type of response for practice test, as part of the NIH Toolbox Sensation Domain Audition Measure Hearing Threshold Test | NIHTBHTTPracticeResponsesTyp | Recommended | CDE |
NIH Toolbox Hearing Threshold Test (Appears Up To 2 Times)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Trial number (numeric) | The number representing the sequence for any repeated measure test or assessment when it is performed multiple times. | TrialNumber | Recommended | CDE |
| 2 | NIH Toolbox Sensation Domain Audition Measure Hearing Threshold Test - Ear type | Type of ear being tested, as part of the NIH Toolbox Sensation Domain Audition Measure Hearing Threshold Test | NIHTBHTTEarTyp | Recommended | CDE |
| 3 | NIH Toolbox Sensation Domain Audition Measure Hearing Threshold Test - Threshold level | Level of threshold being tested, as part of the NIH Toolbox Sensation Domain Audition Measure Hearing Threshold Test | NIHTBHTTThresholdLvl | Recommended | CDE |
| 4 | NIH Toolbox Sensation Domain Audition Measure Hearing Threshold Test - Trial type | Type of trial, as part of the NIH Toolbox Sensation Domain Audition Measure Hearing Threshold Test | NIHTBHTTTrialType | Recommended | CDE |
| 5 | NIH Toolbox Sensation Domain Audition Measure Hearing Threshold Test - Pediatric response type | Type of response for children, as part of the NIH Toolbox Sensation Domain Audition Measure Hearing Threshold Test | NIHTBHTTPedResponsesTyp | Recommended | CDE |
| 6 | NIH Toolbox Sensation Domain Audition Measure Hearing Threshold Test - Response type | Type of response, as part of the NIH Toolbox Sensation Domain Audition Measure Hearing Threshold Test | NIHTBHTTResponsesTyp | Recommended | CDE |
| 7 | NIH Toolbox Sensation Domain Audition Measure Hearing Threshold Test - Responses number | Number of responses, as part of the NIH Toolbox Sensation Domain Audition Measure Hearing Threshold Test | NIHTBHTTResponsesNum | Recommended | CDE |
| 8 | NIH Toolbox Sensation Domain Audition Measure Hearing Threshold Test - Catch trial number | Number of catch trials, as part of the NIH Toolbox Sensation Domain Audition Measure Hearing Threshold Test | NIHTBHTTCatchTrialNum | Recommended | CDE |
| 9 | NIH Toolbox Sensation Domain Audition Measure Hearing Threshold Test - False alarms number | Number of false alarms, as part of the NIH Toolbox Sensation Domain Audition Measure Hearing Threshold Test | NIHTBHTTFalseAlarmNum | Recommended | CDE |
| 10 | NIH Toolbox Sensation Domain Audition Measure Hearing Threshold Test - False alarm rate | Rate of false alarms, as part of the NIH Toolbox Sensation Domain Audition Measure Hearing Threshold Test | NIHTBHTTFalseAlarmRt | Recommended | CDE |
| 11 | NIH Toolbox Sensation Domain Audition Measure Hearing Threshold Test - Pure tone average score | Score for pure tone average, as part of the NIH Toolbox Sensation Domain Audition Measure Hearing Threshold Test | NIHTBHTTPureToneAverageScore | Recommended | CDE |
NIH Toolbox Hearing Threshold Test Scoring (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | NIH Toolbox Sensation Domain Audition Measure Hearing Threshold Test - Dominant computed score | Computed score for the dominant ear, as part of the NIH Toolbox Sensation Domain Audition Measure Hearing Threshold Test | NIHTBHTTDominantEarCompScore | Recommended | CDE |
| 2 | NIH Toolbox Sensation Domain Audition Measure Hearing Threshold Test - Nondominant computed score | Computed score for the nondominant ear, as part of the NIH Toolbox Sensation Domain Audition Measure Hearing Threshold Test | NIHTBHTTNonDomintEarCompScore | Recommended | CDE |
| 3 | NIH Toolbox Sensation Domain Audition Measure Hearing Threshold Test - Hearing loss classification type | Type of hearing loss classification, as part of the NIH Toolbox Sensation Domain Audition Measure Hearing Threshold Test | NIHTBHTTHearLossClassTyp | Recommended | CDE |
| 4 | NIH Toolbox - Standard error | Standard error (a statistical measure of variance that represents the margin of error for the Tscore), as part of the NIH Toolbox Web, Cat and iPad Cognition measures such as: Picture Vocabulary Test and Oral Reading Recognition Test. | NIHTBStandardError | Optional | CDE |
Keywords
