Form Structure: Neurological Outcome Scale for Traumatic Brain Injury (NOS - TBI)
This form structure is an organized set of data definitions for a form that has not been copyrighted
Title:
Neurological Outcome Scale for Traumatic Brain Injury (NOS - TBI)
Short Name:
NOS_TBI
Description:
The Neurological Outcome Scale for Traumatic Brain Injury (NOS-TBI) is a measure adapted from the National Institutes of Health Stroke Scale (NIHSS), and is intended to capture essential neurological deficits impacting individuals with traumatic brain injury (TBI). Recommended by CDISC for TBI (TAUG TBI)
Disease:
Traumatic Brain Injury
Organization:
NIH
Required Program Form:
No
Standardization:
Standard NINDS CDE
Labels:
Form Type:
Clinical Assessment
Publication Date:
2015-08-11
Version:
1.2
Date Created:
2015-04-02
Owner:
Number of Data Elements:
46
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 |
Neurological Outcome Scale (Repeat Infinitely)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Neurological Outcome Scale for Traumatic Brain Injury (NOS - TBI) - Level of consciousness scale | The scale as related to level of consciousness, as part of Neurological Outcome Scale for Traumatic Brain Injury (NOS-TBI) | NOSTBILOCScl | Recommended | CDE |
| 2 | Neurological Outcome Scale for Traumatic Brain Injury (NOS - TBI) - Level of consciousness current month age response scale | The scale as related to level of consciousness based on questions of current month and age, as part of Neurological Outcome Scale for Traumatic Brain Injury (NOS-TBI) | NOSTBILOCQuestionsScl | Recommended | CDE |
| 3 | Neurological Outcome Scale for Traumatic Brain Injury (NOS - TBI) - Level of consciousness eye open make fist command response scale | The scale as related to loss of consciousness commands to open and close eyes and make a fist, as part of Neurological Outcome Scale for Traumatic Brain Injury (NOS-TBI) | NOSTBILOCCommandsScl | Recommended | CDE |
| 4 | Neurological Outcome Scale for Traumatic Brain Injury (NOS - TBI) - Gaze scale | Scale of gaze as part of Neurological Outcome Scale for Traumatic Brain Injury (NOS-TBI) | NOSTBIGazeScl | Recommended | CDE |
| 5 | Neurological Outcome Scale for Traumatic Brain Injury (NOS - TBI) - Right side visual field scale | Scale of right visual field as part of Neurological Outcome Scale for Traumatic Brain Injury (NOS-TBI) | NOSTBIRightVisualFieldScl | Recommended | CDE |
| 6 | Neurological Outcome Scale for Traumatic Brain Injury (NOS - TBI) - Left side visual field scale | Scale of left visual field as part of Neurological Outcome Scale for Traumatic Brain Injury (NOS-TBI) | NOSTBILeftVisualFieldScl | Recommended | CDE |
| 7 | Neurological Outcome Scale for Traumatic Brain Injury (NOS - TBI) - Pupillary response scale | Scale of pupillary response as part of Neurological Outcome Scale for Traumatic Brain Injury (NOS-TBI) | NOSTBIPupilRespnsScl | Recommended | CDE |
| 8 | Neurological Outcome Scale for Traumatic Brain Injury (NOS - TBI) - Right side hearing scale | Scale of hearing on the right side as part of Neurological Outcome Scale for Traumatic Brain Injury (NOS-TBI) | NOSTBIHearingRightSideScl | Recommended | CDE |
| 9 | Neurological Outcome Scale for Traumatic Brain Injury (NOS - TBI) - Left side hearing scale | Scale of hearing on the left side as part of Neurological Outcome Scale for Traumatic Brain Injury (NOS-TBI) | NOSTBIHearingLeftSideScl | Recommended | CDE |
| 10 | Neurological Outcome Scale for Traumatic Brain Injury (NOS - TBI) - Right side facial paresis scale | Scale of facial paresis on the right side as part of Neurological Outcome Scale for Traumatic Brain Injury (NOS-TBI) | NOSTBIFacialParesisRightScl | Recommended | CDE |
| 11 | Neurological Outcome Scale for Traumatic Brain Injury (NOS - TBI) - Left side facial paresis scale | Scale of facial paresis on the left side as part of Neurological Outcome Scale for Traumatic Brain Injury (NOS-TBI) | NOSTBIFacialParesisLeftScl | Recommended | CDE |
| 12 | Neurological Outcome Scale for Traumatic Brain Injury (NOS - TBI) - Right arm motor function scale | Scale of motor function for right arm as part of Neurological Outcome Scale for Traumatic Brain Injury (NOS-TBI) | NOSTBIMotorFunctRightArmScl | Recommended | CDE |
| 13 | Neurological Outcome Scale for Traumatic Brain Injury (NOS - TBI) - Right arm motor function untestable reason | Reason right arm motor function is untestable as part of Neurological Outcome Scale for Traumatic Brain Injury (NOS-TBI) | NOSTBIMotorFuncRArmUntestblRsn | Recommended | CDE |
| 14 | Neurological Outcome Scale for Traumatic Brain Injury (NOS - TBI) - Left arm motor function scale | Scale of motor function for left arm as part of Neurological Outcome Scale for Traumatic Brain Injury (NOS-TBI) | NOSTBIMotorFunctLeftArmScl | Recommended | CDE |
| 15 | Neurological Outcome Scale for Traumatic Brain Injury (NOS - TBI) - Left arm motor function untestable reason | Reason left arm motor function is untestable as part of Neurological Outcome Scale for Traumatic Brain Injury (NOS-TBI) | NOSTBIMotorFuncLArmUntestblRsn | Recommended | CDE |
| 16 | Neurological Outcome Scale for Traumatic Brain Injury (NOS - TBI) - Right leg motor function scale | Scale of motor function for right leg as part of Neurological Outcome Scale for Traumatic Brain Injury (NOS-TBI) | NOSTBIMotorFunctRightLegScl | Recommended | CDE |
| 17 | Neurological Outcome Scale for Traumatic Brain Injury (NOS - TBI) - Right leg motor function untestable reason | Reason right leg motor function is untestable as part of Neurological Outcome Scale for Traumatic Brain Injury (NOS-TBI) | NOSTBIRightLegUntestblRsn | Recommended | CDE |
| 18 | Neurological Outcome Scale for Traumatic Brain Injury (NOS - TBI) - Left leg motor function scale | Scale of motor function for left leg as part of Neurological Outcome Scale for Traumatic Brain Injury (NOS-TBI) | NOSTBIMotorFunctLeftLegScl | Recommended | CDE |
| 19 | Neurological Outcome Scale for Traumatic Brain Injury (NOS - TBI) - Left leg motor function untestable reason | Reason left leg motor function is untestable as part of Neurological Outcome Scale for Traumatic Brain Injury (NOS-TBI) | NOSTBILeftLegUntestblRsn | Recommended | CDE |
| 20 | Neurological Outcome Scale for Traumatic Brain Injury (NOS - TBI) - Right upper extremity sensory scale | Scale of right arm sensory loss as part of Neurological Outcome Scale for Traumatic Brain Injury (NOS-TBI) | NOSTBISensoryRightArmScl | Recommended | CDE |
| 21 | Neurological Outcome Scale for Traumatic Brain Injury (NOS - TBI) - Left upper extremity sensory scale | Scale of left arm sensory loss as part of Neurological Outcome Scale for Traumatic Brain Injury (NOS-TBI) | NOSTBISensoryLeftArmScl | Recommended | CDE |
| 22 | Neurological Outcome Scale for Traumatic Brain Injury (NOS - TBI) - Right lower extremity sensory scale | Scale of right leg sensory loss as part of Neurological Outcome Scale for Traumatic Brain Injury (NOS-TBI) | NOSTBISensoryRightLegScl | Recommended | CDE |
| 23 | Neurological Outcome Scale for Traumatic Brain Injury (NOS - TBI) - Left lower extremity sensory scale | Scale of left leg sensory loss as part of Neurological Outcome Scale for Traumatic Brain Injury (NOS-TBI) | NOSTBISensoryLeftLegScl | Recommended | CDE |
| 24 | Neurological Outcome Scale for Traumatic Brain Injury (NOS - TBI) - Best language scale | Scale of language as part of Neurological Outcome Scale for Traumatic Brain Injury (NOS-TBI) | NOSTBIBestLanguageScl | Recommended | CDE |
| 25 | Neurological Outcome Scale for Traumatic Brain Injury (NOS - TBI) - Dysarthria scale | Scale of dysarthria as part of Neurological Outcome Scale for Traumatic Brain Injury (NOS-TBI) | NOSTBIDysarthriaScl | Recommended | CDE |
| 26 | Neurological Outcome Scale for Traumatic Brain Injury (NOS - TBI) - Neglect scale | Scale of neglect as part of Neurological Outcome Scale for Traumatic Brain Injury (NOS-TBI) | NOSTBINeglectScl | Recommended | CDE |
| 27 | Neurological Outcome Scale for Traumatic Brain Injury (NOS - TBI) - Smell scale | Scale of smell as part of Neurological Outcome Scale for Traumatic Brain Injury (NOS-TBI) | NOSTBISmellScl | Recommended | CDE |
| 28 | Neurological Outcome Scale for Traumatic Brain Injury (NOS - TBI) - Smell untestable reason | Reason smell is untestable as part of Neurological Outcome Scale for Traumatic Brain Injury (NOS-TBI) | NOSTBISmellUntestblRsn | Recommended | CDE |
| 29 | Neurological Outcome Scale for Traumatic Brain Injury (NOS - TBI) - Gait ataxia scale (supplemental) | Scale of gait ataxia as part of Neurological Outcome Scale for Traumatic Brain Injury (NOS-TBI). Supplemental. | NOSTBIGaitAtaxiaScl | Recommended | CDE |
| 30 | Neurological Outcome Scale for Traumatic Brain Injury (NOS - TBI) - Gait ataxia untestable reason | Reason gait ataxia is untestable as part of Neurological Outcome Scale for Traumatic Brain Injury (NOS-TBI) | NOSTBIGaitAtaxiaUntestRsn | Recommended | CDE |
| 31 | Neurological Outcome Scale for Traumatic Brain Injury (NOS - TBI) - Limb ataxia scale (supplemental) | Scale of limb ataxia as part of Neurological Outcome Scale for Traumatic Brain Injury (NOS-TBI). Supplemental. | NOSTBILimbAtaxiaScl | Recommended | CDE |
| 32 | Neurological Outcome Scale for Traumatic Brain Injury (NOS - TBI) - Limb ataxia untestable reason | Reason limb ataxia is untestable as part of Neurological Outcome Scale for Traumatic Brain Injury (NOS-TBI) | NOSTBILimbAtaxiaUntestRsn | Recommended | CDE |
| 33 | Neurological Outcome Scale for Traumatic Brain Injury (NOS - TBI) - Score without supplemental items | Score without supplemental items (except those scored as "UN," as part of Neurological Outcome Scale for Traumatic Brain Injury (NOS-TBI) | NOSTBIWithoutSupplemItemsScore | Recommended | CDE |
| 34 | Neurological Outcome Scale for Traumatic Brain Injury (NOS - TBI) - Score of supplemental items | Score of supplemental items (except those scored as "UN"), as part of Neurological Outcome Scale for Traumatic Brain Injury (NOS-TBI) | NOSTBISupplementalItemsScore | Recommended | CDE |
Keywords
