Form Structure: Ohio State University TBI Identification Method short form (OSUTBIMS)
This form structure is an organized set of data definitions for a form that has not been copyrighted
Title:
Ohio State University TBI Identification Method short form (OSUTBIMS)
Short Name:
OSUTBIMSF
Description:
The Ohio State University (OSU) Traumatic Brain Injury (TBI) Short Form adapted with permission from the Ohio State University TBI Identification Method (Corrigan, J.D., Bogner, J.A.
(2007. Initial reliability and validity of the OSU TBI Identification Method. Journal of Head Trauma Rehabilitation. This version will assess history of TBI prior to index
TBI. Other timeframes for assessment can be used by changing wording of questions to fit proper
timeframe.
Disease:
Traumatic Brain Injury
Organization:
NIH
Required Program Form:
No
Standardization:
Standard NINDS CDE
Labels:
Form Type:
Clinical Assessment
Publication Date:
2019-07-31
Version:
1.0
Date Created:
2016-08-05
Owner:
Number of Data Elements:
41
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 |
7 | Assessment completion status | Status of completion of an assessment, such as a case report from (CRF), instrument, scale, computer assessment, etc. | AssessmentCompletionStat | Recommended | CDE |
8 | Assessment completion status text | A free text related to "Assessment completion status" specifying completion details. This data element should be used along with AssessmenttCompletionStat to further describe the status of assessment completion | AssessmentCompletionStatTxt | Recommended | CDE |
Questionnaire (Appears Up To 1 Time)
# | Title | Short Description | Variable Name | Required? | Type |
---|---|---|---|---|---|
1 | Ohio State TBI Method Short Form (OSUTBIMS) - identification method hospitalization indicator | Number and cause of injuries to head or neck that which subject endured and had to go to a hospital or emergency room as part of Ohio State TBI Method Short Form (OSUTBIMS). | OSUTBIMSIdentMethHospInd | Recommended | CDE |
2 | Ohio State TBI Method Short Form (OSUTBIMS) - identification method moving vehicle injury indicator | Number and cause of injuries to head or neck that which subject endured from a moving vehicle accident as part of Ohio State TBI Method Short Form (OSUTBIMS). | OSUTBIMSIdentMethMovVehInjInd | Recommended | CDE |
3 | Ohio State TBI Method Short Form (OSUTBIMS) - identification method object hit injury indicator | Number and cause of injuries to head or neck that which subject endured from being hit by something as part of Ohio State TBI Method Short Form (OSUTBIMS). | OSUTBIMSIdentMethObjHitInjInd | Recommended | CDE |
4 | Ohio State TBI Method Short Form (OSUTBIMS) - identification method person hit indicator | Number and cause of injuries to head or neck that which subject endured from a fight or from being hit by someone or from being shaken as part of Ohio State TBI Method Short Form (OSUTBIMS). | OSUTBIMSIdentMethPersHitInd | Recommended | CDE |
5 | Ohio State TBI Method Short Form (OSUTBIMS) - identification method explosion injury indicator | Number of times and cause for subject to come in close contact with an explosion or blast as part of Ohio State TBI Method Short Form (OSUTBIMS). | OSUTBIMSIdentMethExplInjInd | Recommended | CDE |
6 | Ohio State TBI Method Short Form (OSUTBIMS) - ask question category | Indicator of whether or not subject has lost consciousness and for how long and if not whether subject was dazed or has a gap in their memory from the injury. Also indicates how old the subject was as part of Ohio State TBI Method Short Form (OSUTBIMS). | OSUTBIMSAskQuestionCat | Recommended | CDE |
History of LOC (Appears Up To 9 Times)
# | Title | Short Description | Variable Name | Required? | Type |
---|---|---|---|---|---|
1 | Traumatic event number | The number of traumatic event , which happened during the subject's life, as reported by the subject | TraumaticEventNum | Recommended | CDE |
2 | Ohio State TBI Method Short Form (OSUTBIMS) - cause reason | The cause of the subject's injury as part of Ohio State TBI Method Short Form (OSUTBIMS). | OSUTBIMSCauseRsn | Recommended | CDE |
3 | Loss of consciousness indicator | The indicator for whether the participant/subject experienced any period of loss of consciousness (LOC). | LOCInd | Recommended | CDE |
4 | Ohio State TBI Method Short Form (OSUTBIMS) - loss of consciousness duration range | Range of duration of Loss of consciousness, as part of Ohio State TBI Method Short Form (OSUTBIMS). | OSUTBIMSLOCDurRang | Recommended | CDE |
5 | Ohio State TBI Method Short Form (OSUTBIMS) - dazed memory gap indicator | Indicator whether the subject was dazed or has a memory gap as part of Ohio State TBI Method Short Form (OSUTBIMS). | OSUTBIMSDazeMemryGapInd | Recommended | CDE |
6 | Age in years | Value for participant's subject age recorded in years. | AgeYrs | Recommended | CDE |
If more injuries with LOC (Appears Up To 1 Time)
# | Title | Short Description | Variable Name | Required? | Type |
---|---|---|---|---|---|
1 | Loss of consciousness from TBI count | Count of traumatic brain injuries (TBI) the subject incurred with loss of consciousness | LOCTBICt | Recommended | CDE |
2 | Ohio State TBI Method Short Form (OSUTBIMS) - longest knock out time | Longest amount of time that the subject was knocked out for as part of Ohio State TBI Method Short Form (OSUTBIMS). | OSUTBIMSLongKnockOutTime | Recommended | CDE |
3 | Ohio State TBI Method Short Form (OSUTBIMS) - loss of consciousness greater than 30 number | Number of injuries the subject incurred with a loss of consciousness for greater than 30 minutes as part of Ohio State TBI Method Short Form (OSUTBIMS). | OSUTBIMSLOCGreaterthan30Num | Recommended | CDE |
4 | Ohio State TBI Method Short Form (OSUTBIMS) - first loss of consciousness age number | The youngest age the subject incurred a loss of consciousness due to a traumatic brain injury as part of Ohio State TBI Method Short Form (OSUTBIMS). | OSUTBIMSFirstLOCAgeNum | Recommended | CDE |
LOC from overdose chocking (Appears Up To 1 Time)
# | Title | Short Description | Variable Name | Required? | Type |
---|---|---|---|---|---|
1 | Ohio State TBI Method Short Form (OSUTBIMS) - identification method loss of consciousness drug overdose number | Number of times subject has lost consciousness from a drug overdose as part of Ohio State TBI Method Short Form (OSUTBIMS). | OSUTBIMSIdentMethLOCDrgOvrNum | Recommended | CDE |
2 | Ohio State TBI Method Short Form (OSUTBIMS) - anoxic injury number | Number of anoxic injuries (total number of choked incidents reported in question # 7) as part of Ohio State TBI Method Short Form (OSUTBIMS). | OSUTBIMSAnoxicInjNum | Recommended | CDE |
Scoring (Appears Up To 1 Time)
# | Title | Short Description | Variable Name | Required? | Type |
---|---|---|---|---|---|
1 | Loss of consciousness from TBI count | Count of traumatic brain injuries (TBI) the subject incurred with loss of consciousness | LOCTBICt | Recommended | CDE |
2 | Ohio State TBI Method Short Form (OSUTBIMS) - loss of consciousness greater than 30 number | Number of injuries the subject incurred with a loss of consciousness for greater than 30 minutes as part of Ohio State TBI Method Short Form (OSUTBIMS). | OSUTBIMSLOCGreaterthan30Num | Recommended | CDE |
3 | Ohio State TBI Method Short Form (OSUTBIMS) - first loss of consciousness age number | The youngest age the subject incurred a loss of consciousness due to a traumatic brain injury as part of Ohio State TBI Method Short Form (OSUTBIMS). | OSUTBIMSFirstLOCAgeNum | Recommended | CDE |
4 | Ohio State TBI Method Short Form (OSUTBIMS) - loss of consciousness before age 15 result | Result to whether the subject was younger than 15 or older or equal to 15 when he or she first lost consciousness due to her traumatic brain injury as part of Ohio State TBI Method Short Form (OSUTBIMS). | OSUTBIMSLOCBeforeAge15Reslt | Recommended | CDE |
5 | Ohio State TBI Method Short Form (OSUTBIMS) - worst injury result | Result to whether the subject has: 1 an \"improbable TBI\", 2 a \"possible TBI\", 3 a \"mild TBI\", 4 a \"moderate TBI\", or 5 a \"severe TBI\" as part of Ohio State TBI Method Short Form (OSUTBIMS) | OSUTBIMSWorstInjReslt | Recommended | CDE |
6 | Ohio State TBI Method Short Form (OSUTBIMS) - anoxic injury number | Number of anoxic injuries (total number of choked incidents reported in question # 7) as part of Ohio State TBI Method Short Form (OSUTBIMS). | OSUTBIMSAnoxicInjNum | Recommended | CDE |
Keywords