Form Structure: Therapy Intensity Level
This form structure is an organized set of data definitions for a form that has not been copyrighted
Resource:
FITBIR
Title:
Therapy Intensity Level
Short Name:
TherapyIntensityLevel
Description:
This CRF Module captures a global categorization of therapy intensity over a given period. This may be assessed on a daily basis, or in a summary measured over the entire ICU period.
Disease:
Traumatic Brain Injury
Organization:
NINDS
Required Program Form:
No
Standardization:
Standard NINDS CDE
Labels:
Form Type:
Clinical Assessment
Publication Date:
2016-04-25
Version:
1.1
Date Created:
2014-04-09
Owner:
Number of Data Elements:
21
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 | Recommended | 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 | Recommended | 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 (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 |
Therapy Intensity Level Adult (Repeat Infinitely)
# | Title | Short Description | Variable Name | Required? | Type |
---|---|---|---|---|---|
1 | TBI therapy intensity level procedure indicator | Indicator of whether the procedure or therapy was administered, which is used to assess the therapy intensity level (TIL) for treating the traumatic brain injury | TBITherapIntensLvlProcInd | Recommended | CDE |
2 | TBI therapy intensity level global assessment code | A summary measure for traumatic brain injury that captures a global categorization of therapy intensity level (TIL) over a given period. | TBITherapIntensLvlGlobAsesCod | Recommended | CDE |
3 | TBI therapy intensity level procedure type | Type of procedure or therapy used to assess the therapy intensity level (TIL) for treating the traumatic brain injury | TBITherapIntensLvlProcType | Recommended | CDE |
4 | TBI Adult intensity level of therapy scale score | Adult intensity level of therapy (PILOT) scale (0-38) | TBIIntensLvlTherapyScalScr | Recommended | UDE |
Therapy Intensity Level Pediatric (Repeat Infinitely)
# | Title | Short Description | Variable Name | Required? | Type |
---|---|---|---|---|---|
1 | TBI therapy intensity level procedure indicator for pediatric populations | Indicator of whether the procedure or therapy was administered, which is used to assess the therapy intensity level (TIL) for treating the traumatic brain injury | TBITherapIntensLvlProcPedInd | Recommended | UDE |
2 | TBI therapy intensity level global assessment code | A summary measure for traumatic brain injury that captures a global categorization of therapy intensity level (TIL) over a given period. | TBITherapIntLvlGlobAsesPedCod | Recommended | UDE |
3 | TBI therapy intensity level procedure type | Type of procedure or therapy used to assess the therapy intensity level (TIL) for treating the traumatic brain injury | TBITherapIntensLvlProcType | Recommended | CDE |
4 | Pediatric intensity level of therapy scale score | Pediatric intensity level of therapy (PILOT) scale (0-38) | PediatIntensLvlTherapyScalScr | Recommended | CDE |
Keywords