Form Structure: Post-Concussion Symptom Inventory - Parent (PCSI-P)
This form structure is an organized set of data definitions for a form that has not been copyrighted
Title:
Post-Concussion Symptom Inventory - Parent (PCSI-P)
Short Name:
PCSI_P
Description:
The Post-Concussion Symptom Inventory - Parent (PCSI-P) focuses on symptoms in the cognitive, emotional, sleep, and physical domains. Recommended by CDISC for TBI (TAUG TBI)
Disease:
Traumatic Brain Injury
Required Program Form:
No
Standardization:
Standard NINDS CDE
Labels:
Form Type:
Clinical Assessment
Publication Date:
2015-12-23
Version:
1.2
Date Created:
2015-12-23
Owner:
Number of Data Elements:
66
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 (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 |
Before the Injury/ Pre-Injury (Appears Up To 1 Time)
# | Title | Short Description | Variable Name | Required? | Type |
---|---|---|---|---|---|
1 | Post-Concussion Symptom Inventory - Parent (PCSI-P) - Headache scale | Scale to which the subject complained of headaches, as part of the Post-Concussion Symptom Inventory - Parent (PCSI-P). | PCSIPHeadacheScale | Recommended | CDE |
2 | Post-Concussion Symptom Inventory - Parent (PCSI-P) - Nausea scale | Scale to which the subject complained of nausea, as part of the Post-Concussion Symptom Inventory - Parent (PCSI-P). | PCSIPNauseaScale | Recommended | CDE |
3 | Post-Concussion Symptom Inventory - Parent (PCSI-P) - Vomit scale | Scale to which the subject vomited, as part of the Post-Concussion Symptom Inventory - Parent (PCSI-P). | PCSIPVomitScale | Recommended | CDE |
4 | Post-Concussion Symptom Inventory - Parent (PCSI-P) - Balance problem scale | Scale to which the subject experienced balance problems, as part of the Post-Concussion Symptom Inventory - Parent (PCSI-P). | PCSIPBalanceProbScale | Recommended | CDE |
5 | Post-Concussion Symptom Inventory - Parent (PCSI-P) - Dizziness scale | Scale to which the subject appeared or complained of dizziness, as part of the Post-Concussion Symptom Inventory - Parent (PCSI-P). | PCSIPDizzinessScale | Recommended | CDE |
6 | Post-Concussion Symptom Inventory - Parent (PCSI-P) - Trouble falling asleep scale | Scale to which the subject had trouble falling asleep, as part of the Post-Concussion Symptom Inventory - Parent (PCSI-P). | PCSIPTroubleFallAsleepScale | Recommended | CDE |
7 | Post-Concussion Symptom Inventory - Parent (PCSI-P) - Sleep more than usual scale | Scale to which the subject slept more than usual, as part of the Post-Concussion Symptom Inventory - Parent (PCSI-P). | PCSIPSleepMoreThanUsualScale | Recommended | CDE |
8 | Post-Concussion Symptom Inventory - Parent (PCSI-P) - Sleep less than usual scale | Scale to which the subject slept less than usual, as part of the Post-Concussion Symptom Inventory - Parent (PCSI-P). | PCSIPSleepLessThanUsualScale | Recommended | CDE |
9 | Post-Concussion Symptom Inventory - Parent (PCSI-P) - Drowsy scale | Scale to which the subject appeared drowsy, as part of the Post-Concussion Symptom Inventory - Parent (PCSI-P). | PCSIPDrowsyScale | Recommended | CDE |
10 | Post-Concussion Symptom Inventory - Parent (PCSI-P) - Sensitive to light scale | Scale to which the subject was sensitive to light, as part of the Post-Concussion Symptom Inventory - Parent (PCSI-P). | PCSIPSensitiveToLightScale | Recommended | CDE |
11 | Post-Concussion Symptom Inventory - Parent (PCSI-P) - Sensitive to noise scale | Scale to which the subject was sensitive to noise, as part of the Post-Concussion Symptom Inventory - Parent (PCSI-P). | PCSIPSensitiveToNoiseScale | Recommended | CDE |
12 | Post-Concussion Symptom Inventory - Parent (PCSI-P) - Irritable scale | Scale to which the subject was irritable, as part of the Post-Concussion Symptom Inventory - Parent (PCSI-P). | PCSIPIrritableScale | Recommended | CDE |
13 | Post-Concussion Symptom Inventory - Parent (PCSI-P) - Sad scale | Scale to which the subject appeared sad, as part of the Post-Concussion Symptom Inventory - Parent (PCSI-P). | PCSIPSadScale | Recommended | CDE |
14 | Post-Concussion Symptom Inventory - Parent (PCSI-P) - Nervous scale | Scale to which the subject acted nervous, as part of the Post-Concussion Symptom Inventory - Parent (PCSI-P). | PCSIPNervousScale | Recommended | CDE |
15 | Post-Concussion Symptom Inventory - Parent (PCSI-P) - More emotional scale | Scale to which the subject acted more emotional, as part of the Post-Concussion Symptom Inventory - Parent (PCSI-P). | PCSIPMoreEmotionalScale | Recommended | CDE |
16 | Post-Concussion Symptom Inventory - Parent (PCSI-P) - Numbness or tingling scale | Scale to which the subject had or complained of numbness or tingling, as part of the Post-Concussion Symptom Inventory - Parent (PCSI-P). | PCSIPNumbnessTinglingScale | Recommended | CDE |
17 | Post-Concussion Symptom Inventory - Parent (PCSI-P) - Slowed down scale | Scale to which the subject acted or appeared slowed down, as part of the Post-Concussion Symptom Inventory - Parent (PCSI-P). | PCSIPSlowedDownScale | Recommended | CDE |
18 | Post-Concussion Symptom Inventory - Parent (PCSI-P) - Mentally foggy scale | Scale to which the subject acted or appeared mentally "foggy", as part of the Post-Concussion Symptom Inventory - Parent (PCSI-P). | PCSIPMentallyFoggyScale | Recommended | CDE |
19 | Post-Concussion Symptom Inventory - Parent (PCSI-P) - Difficult to concentrate scale | Scale to which the subject had difficulty concentrating, as part of the Post-Concussion Symptom Inventory - Parent (PCSI-P). | PCSIPDiffConcentrateScale | Recommended | CDE |
20 | Post-Concussion Symptom Inventory - Parent (PCSI-P) - Difficult to remember scale | Scale to which the subject had difficulty remembering, as part of the Post-Concussion Symptom Inventory - Parent (PCSI-P). | PCSIPDiffRememberScale | Recommended | CDE |
21 | Post-Concussion Symptom Inventory - Parent (PCSI-P) - Visual problems scale | Scale to which the subject had or complained of visual problems (blurry, double vision), as part of the Post-Concussion Symptom Inventory - Parent (PCSI-P). | PCSIPVisualProbScale | Recommended | CDE |
22 | Post-Concussion Symptom Inventory - Parent (PCSI-P) - Tired or fatigued scale | Scale to which the subject appeared more tired or fatigued, as part of the Post-Concussion Symptom Inventory - Parent (PCSI-P). | PCSIPTiredFatiguedScale | Recommended | CDE |
23 | Post-Concussion Symptom Inventory - Parent (PCSI-P) - Dazed or stunned scale | Scale to which the subject appeared dazed or stunned, as part of the Post-Concussion Symptom Inventory - Parent (PCSI-P). | PCSIPDazedStunnedScale | Recommended | CDE |
24 | Post-Concussion Symptom Inventory - Parent (PCSI-P) - Confused scale | Scale to which the subject became confused with directions or tasks, as part of the Post-Concussion Symptom Inventory - Parent (PCSI-P). | PCSIPConfusedScale | Recommended | CDE |
25 | Post - Concussion Symptom Inventory - Parent (PCSI-P) - Clumsy scale | Scale to which the subject appeared to move in a clumsy manner, as part of the Post-Concussion Symptom Inventory - Parent (PCSI-P). | PCSIPClumsyScale | Recommended | CDE |
26 | Post-Concussion Symptom Inventory - Parent (PCSI-P) - Answer slowly scale | Scale to which the subject answered questions more slowly than usual, as part of the Post-Concussion Symptom Inventory - Parent (PCSI-P). | PCSIPAnswerSlowlyScale | Recommended | CDE |
Within the Last Few Days (Appears Up To 1 Time)
# | Title | Short Description | Variable Name | Required? | Type |
---|---|---|---|---|---|
1 | Post-Concussion Symptom Inventory - Parent (PCSI-P) - Headache scale | Scale to which the subject complained of headaches, as part of the Post-Concussion Symptom Inventory - Parent (PCSI-P). | PCSIPHeadacheScale | Recommended | CDE |
2 | Post-Concussion Symptom Inventory - Parent (PCSI-P) - Nausea scale | Scale to which the subject complained of nausea, as part of the Post-Concussion Symptom Inventory - Parent (PCSI-P). | PCSIPNauseaScale | Recommended | CDE |
3 | Post-Concussion Symptom Inventory - Parent (PCSI-P) - Vomit scale | Scale to which the subject vomited, as part of the Post-Concussion Symptom Inventory - Parent (PCSI-P). | PCSIPVomitScale | Recommended | CDE |
4 | Post-Concussion Symptom Inventory - Parent (PCSI-P) - Balance problem scale | Scale to which the subject experienced balance problems, as part of the Post-Concussion Symptom Inventory - Parent (PCSI-P). | PCSIPBalanceProbScale | Recommended | CDE |
5 | Post-Concussion Symptom Inventory - Parent (PCSI-P) - Dizziness scale | Scale to which the subject appeared or complained of dizziness, as part of the Post-Concussion Symptom Inventory - Parent (PCSI-P). | PCSIPDizzinessScale | Recommended | CDE |
6 | Post-Concussion Symptom Inventory - Parent (PCSI-P) - Trouble falling asleep scale | Scale to which the subject had trouble falling asleep, as part of the Post-Concussion Symptom Inventory - Parent (PCSI-P). | PCSIPTroubleFallAsleepScale | Recommended | CDE |
7 | Post-Concussion Symptom Inventory - Parent (PCSI-P) - Sleep more than usual scale | Scale to which the subject slept more than usual, as part of the Post-Concussion Symptom Inventory - Parent (PCSI-P). | PCSIPSleepMoreThanUsualScale | Recommended | CDE |
8 | Post-Concussion Symptom Inventory - Parent (PCSI-P) - Sleep less than usual scale | Scale to which the subject slept less than usual, as part of the Post-Concussion Symptom Inventory - Parent (PCSI-P). | PCSIPSleepLessThanUsualScale | Recommended | CDE |
9 | Post-Concussion Symptom Inventory - Parent (PCSI-P) - Drowsy scale | Scale to which the subject appeared drowsy, as part of the Post-Concussion Symptom Inventory - Parent (PCSI-P). | PCSIPDrowsyScale | Recommended | CDE |
10 | Post-Concussion Symptom Inventory - Parent (PCSI-P) - Sensitive to light scale | Scale to which the subject was sensitive to light, as part of the Post-Concussion Symptom Inventory - Parent (PCSI-P). | PCSIPSensitiveToLightScale | Recommended | CDE |
11 | Post-Concussion Symptom Inventory - Parent (PCSI-P) - Sensitive to noise scale | Scale to which the subject was sensitive to noise, as part of the Post-Concussion Symptom Inventory - Parent (PCSI-P). | PCSIPSensitiveToNoiseScale | Recommended | CDE |
12 | Post-Concussion Symptom Inventory - Parent (PCSI-P) - Irritable scale | Scale to which the subject was irritable, as part of the Post-Concussion Symptom Inventory - Parent (PCSI-P). | PCSIPIrritableScale | Recommended | CDE |
13 | Post-Concussion Symptom Inventory - Parent (PCSI-P) - Sad scale | Scale to which the subject appeared sad, as part of the Post-Concussion Symptom Inventory - Parent (PCSI-P). | PCSIPSadScale | Recommended | CDE |
14 | Post-Concussion Symptom Inventory - Parent (PCSI-P) - Nervous scale | Scale to which the subject acted nervous, as part of the Post-Concussion Symptom Inventory - Parent (PCSI-P). | PCSIPNervousScale | Recommended | CDE |
15 | Post-Concussion Symptom Inventory - Parent (PCSI-P) - More emotional scale | Scale to which the subject acted more emotional, as part of the Post-Concussion Symptom Inventory - Parent (PCSI-P). | PCSIPMoreEmotionalScale | Recommended | CDE |
16 | Post-Concussion Symptom Inventory - Parent (PCSI-P) - Numbness or tingling scale | Scale to which the subject had or complained of numbness or tingling, as part of the Post-Concussion Symptom Inventory - Parent (PCSI-P). | PCSIPNumbnessTinglingScale | Recommended | CDE |
17 | Post-Concussion Symptom Inventory - Parent (PCSI-P) - Slowed down scale | Scale to which the subject acted or appeared slowed down, as part of the Post-Concussion Symptom Inventory - Parent (PCSI-P). | PCSIPSlowedDownScale | Recommended | CDE |
18 | Post-Concussion Symptom Inventory - Parent (PCSI-P) - Mentally foggy scale | Scale to which the subject acted or appeared mentally "foggy", as part of the Post-Concussion Symptom Inventory - Parent (PCSI-P). | PCSIPMentallyFoggyScale | Recommended | CDE |
19 | Post-Concussion Symptom Inventory - Parent (PCSI-P) - Difficult to concentrate scale | Scale to which the subject had difficulty concentrating, as part of the Post-Concussion Symptom Inventory - Parent (PCSI-P). | PCSIPDiffConcentrateScale | Recommended | CDE |
20 | Post-Concussion Symptom Inventory - Parent (PCSI-P) - Difficult to remember scale | Scale to which the subject had difficulty remembering, as part of the Post-Concussion Symptom Inventory - Parent (PCSI-P). | PCSIPDiffRememberScale | Recommended | CDE |
21 | Post-Concussion Symptom Inventory - Parent (PCSI-P) - Visual problems scale | Scale to which the subject had or complained of visual problems (blurry, double vision), as part of the Post-Concussion Symptom Inventory - Parent (PCSI-P). | PCSIPVisualProbScale | Recommended | CDE |
22 | Post-Concussion Symptom Inventory - Parent (PCSI-P) - Tired or fatigued scale | Scale to which the subject appeared more tired or fatigued, as part of the Post-Concussion Symptom Inventory - Parent (PCSI-P). | PCSIPTiredFatiguedScale | Recommended | CDE |
23 | Post-Concussion Symptom Inventory - Parent (PCSI-P) - Dazed or stunned scale | Scale to which the subject appeared dazed or stunned, as part of the Post-Concussion Symptom Inventory - Parent (PCSI-P). | PCSIPDazedStunnedScale | Recommended | CDE |
24 | Post-Concussion Symptom Inventory - Parent (PCSI-P) - Confused scale | Scale to which the subject became confused with directions or tasks, as part of the Post-Concussion Symptom Inventory - Parent (PCSI-P). | PCSIPConfusedScale | Recommended | CDE |
25 | Post - Concussion Symptom Inventory - Parent (PCSI-P) - Clumsy scale | Scale to which the subject appeared to move in a clumsy manner, as part of the Post-Concussion Symptom Inventory - Parent (PCSI-P). | PCSIPClumsyScale | Recommended | CDE |
26 | Post-Concussion Symptom Inventory - Parent (PCSI-P) - Answer slowly scale | Scale to which the subject answered questions more slowly than usual, as part of the Post-Concussion Symptom Inventory - Parent (PCSI-P). | PCSIPAnswerSlowlyScale | Recommended | CDE |
Generally Different (Appears Up To 1 Time)
# | Title | Short Description | Variable Name | Required? | Type |
---|---|---|---|---|---|
1 | Post-Concussion Symptom Inventory - Parent (PCSI-P) - Generally different scale | Scale to which the subject generally seemed to be acting differently than before the injury, as part of the Post-Concussion Symptom Inventory - Parent (PCSI-P). | PCSIPGenerallyDifferentScale | Recommended | CDE |
Keywords