Form Structure: Neurobehavioral Symptom Inventory
This form structure is an organized set of data definitions for a copyrighted form
Title:
Neurobehavioral Symptom Inventory
Short Name:
NSI1
Description:
The severity of each symptom on the NSI is measured using a 5-item scale (0-none to 4-very severe) that asks patients to indicate the extent to which each symptom has disturbed them in the previous 2 weeks. The NSI total score is the sum of severity ratings of the 22 symptoms. Cluster scores (domains: physical, cognitive, affective, and sensory) were derived. The DVBIC recommendation is that the initial NSI administered use the injury as the reference point provided the patient is diagnosed with concussion within 90 days of an injury event. It is recommended that follow-up administrations of the NSI use the prior medical appointment or the past two weeks as the time frame for symptom reporting. REFERENCES.
Cicerone KD. Use of the NSI for serial assessment of concussion related health outcomes in the military health system, personal communication, 7 May 2014. TBI-related symptoms, Knowledge graph, See also
Disease:
Traumatic Brain Injury
Organization:
NINDS
Required Program Form:
No
Standardization:
Standard NINDS CDE
Labels:
Form Type:
Clinical Assessment
Publication Date:
2015-10-19
Version:
1.2
Date Created:
2015-10-19
Owner:
Number of Data Elements:
36
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 |
Neurobehavioral Symptom Inventory (Repeat Infinitely)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Neurobehavioral Symptom Inventory (NSI) - Dizzy score | Score of subject's dizziness, as part of the Neurobehavioral Symptom Inventory (NSI) | NSIDizScore | Recommended | CDE |
| 2 | Neurobehavioral Symptom Inventory (NSI) - Balance impairment score | Score of subject's loss of balance, as part of the Neurobehavioral Symptom Inventory (NSI) | NSIBalncImprmntScore | Recommended | CDE |
| 3 | Neurobehavioral Symptom Inventory (NSI) - Coordination impairment score | Score of subject's coordination impairment, as part of the Neurobehavioral Symptom Inventory (NSI) | NSICoordntnImprmntScore | Recommended | CDE |
| 4 | Neurobehavioral Symptom Inventory (NSI) - Headaches score | Score of subject's headache, as part of the Neurobehavioral Symptom Inventory (NSI) | NSIHdcheScore | Recommended | CDE |
| 5 | Neurobehavioral Symptom Inventory (NSI) - Nausea score | Score of subject's nausea, as part of the Neurobehavioral Symptom Inventory (NSI) | NSINausScore | Recommended | CDE |
| 6 | Neurobehavioral Symptom Inventory (NSI) - Vision impairment score | Score of subject's vision impairment, as part of the Neurobehavioral Symptom Inventory (NSI) | NSIVisnImprmntScore | Recommended | CDE |
| 7 | Neurobehavioral Symptom Inventory (NSI) - Sensitive light score | Score of subject's sensitivity to light, as part of the Neurobehavioral Symptom Inventory (NSI) | NSISenstvLgtScore | Recommended | CDE |
| 8 | Neurobehavioral Symptom Inventory (NSI) - Hearing impairment score | Score of subject's hearing impairment, as part of the Neurobehavioral Symptom Inventory (NSI) | NSIHearngImprmntScore | Recommended | CDE |
| 9 | Neurobehavioral Symptom Inventory (NSI) - Sensitive noise score | Score of subject's sensitivity to noise, as part of the Neurobehavioral Symptom Inventory (NSI) | NSiSenstvNoisScore | Recommended | CDE |
| 10 | Neurobehavioral Symptom Inventory (NSI) - Numbness impairment score | Score of subject's numbness or tingling on parts of the body, as part of the Neurobehavioral Symptom Inventory (NSI) | NSINumbnssImprmntScore | Recommended | CDE |
| 11 | Neurobehavioral Symptom Inventory (NSI) - Taste impairment score | Score of subject's taste impairment, as part of the Neurobehavioral Symptom Inventory (NSI) | NSITastImprmntScore | Recommended | CDE |
| 12 | Neurobehavioral Symptom Inventory (NSI) - Appetite impairment score | Score of subject's appetite impairment, as part of the Neurobehavioral Symptom Inventory (NSI) | NSIApptitImprmntScore | Recommended | CDE |
| 13 | Neurobehavioral Symptom Inventory (NSI) - Concentration impairment score | Score of subject's concentration impairment, as part of the Neurobehavioral Symptom Inventory (NSI) | NSIConctrtnImprmntScore | Recommended | CDE |
| 14 | Neurobehavioral Symptom Inventory (NSI) - Memory impairment score | Score of subject's memory impairment, as part of the Neurobehavioral Symptom Inventory (NSI) | NSIMmryImprmntScore | Recommended | CDE |
| 15 | Neurobehavioral Symptom Inventory (NSI) - Decision impairment score | Score of subject's indecisiveness, as part of the Neurobehavioral Symptom Inventory (NSI) | NSIDecsnImprmntScore | Recommended | CDE |
| 16 | Neurobehavioral Symptom Inventory (NSI) - Slow thinking impairment score | Score of subject's slow thinking impairment, as part of the Neurobehavioral Symptom Inventory (NSI) | NSISlwThnkngImprmntScore | Recommended | CDE |
| 17 | Neurobehavioral Symptom Inventory (NSI) - Fatigue impairment score | Score of subject's fatigue, loss of energy and getting tired easily, as part of the Neurobehavioral Symptom Inventory (NSI) | NSIFatigImprmntScore | Recommended | CDE |
| 18 | Neurobehavioral Symptom Inventory (NSI) - Sleep impairment score | Score of subject's sleep impairment, as part of the Neurobehavioral Symptom Inventory (NSI) | NSISlpImprmntScore | Recommended | CDE |
| 19 | Neurobehavioral Symptom Inventory (NSI) - Anxiety impairment score | Score of subject's anxiety , as part of the Neurobehavioral Symptom Inventory (NSI) | NSIAnxtyImprmntScore | Recommended | CDE |
| 20 | Neurobehavioral Symptom Inventory (NSI) - Depression impairment score | Score of subject's depression , as part of the Neurobehavioral Symptom Inventory (NSI) | NSIDeprsnImprmntScore | Recommended | CDE |
| 21 | Neurobehavioral Symptom Inventory (NSI) - Irritability impairment score | Score of subject's irritability, as part of the Neurobehavioral Symptom Inventory (NSI) | NSIIrrabltyImprmntScore | Recommended | CDE |
| 22 | Neurobehavioral Symptom Inventory (NSI) - Frustration impairment score | Score of subject's frustration tolerance, as part of the Neurobehavioral Symptom Inventory (NSI) | NSIFrustrtnImprmntScore | Recommended | CDE |
| 23 | Neurobehavioral Symptom Inventory (NSI) - Total score | Total Score for the Neurobehavioral Symptom Inventory (NSI) (0-88) | NSITotalScore | Recommended | CDE |
| 24 | Neurobehavioral Symptom Inventory (NSI) - Form completion date | Date of form completion, as part of the Neurobehavioral Symptom Inventory (NSI) | NSIFrmCompltDate | Recommended | CDE |
Keywords
