Form Structure: PTSD Checklist - PCL Scoring
This form structure is an organized set of data definitions for a form that has not been copyrighted
Resource:
FITBIR
Title:
PTSD Checklist - PCL Scoring
Short Name:
PCLScoring
Description:
PCL scoring to provide a presumptive diagnosis according to DSM-IV symptom criteria. Note: DO NOT PUBLISH YET. WORK IN PROGRESS
Disease:
Traumatic Brain Injury
Organization:
NIH
Required Program Form:
No
Standardization:
Standard NINDS CDE
Labels:
Form Type:
Clinical Assessment
Version:
1.0
Date Created:
2016-02-05
Owner:
Number of Data Elements:
18
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 | Recommended | CDE |
| 8 | Case control indicator | Indicator of whether subject is in the case or control arm of the study. | CaseContrlInd | Recommended | CDE |
| 9 | General notes text | General notes | GeneralNotesTxt | Recommended | 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 |
PCL Scoring (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | PTSD Checklist Civilian (PCL - C) - Questions 1 to 5 ratings DSM & Critieria indicator | Indicates whether one or more of questiones 1 to 5 are endorsed with rating of 3 or higher | PCLCQ1toQ5RatngBInd | Recommended | CDE |
| 2 | PTSD Checklist Civilian (PCL - C) - Questions 6 to 12 ratings DSM indicator | Indicates whether three or more of the questions 6 to 12 are endorsed with a rating of 3 or higher | PCLCQ6toQ12RatngCInd | Recommended | CDE |
| 3 | PTSD Checklist Civilian (PCL - C) - Questions 13 to 17 ratings DSM indicator | Indicates whether two or more of the questions 13 to 17 are endorsed with a rating of 3 or higher | PCLCQ13toQ17RatingDInd | Recommended | CDE |
Keywords
