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CDE Detailed Report
This report contains detailed information about the selected CDEs.
Note: If at least one CDE was selected from a copyright- or trademark-protected instrument/scale then all of the CDEs from that instrument/scale are included in this report.
Disease: Epilepsy
Sub-Domain: Assessing Comorbidities
CRF: Post-Traumatic Epilepsy Screening Form
Item count: 11 (11 distinct CDEs)
CDE ID
CDE Name
Variable Name
Definition / Description
Question Text
Permissible Value
Description
Data Type
Instructions
References
Population
Classification (e.g., Core)
Version #
Version Date
Aliases for Variable Name
CRF Module / Guideline
© or TM
Sub-Domain
Domain
Previous Title
Size
Input Restrictions
Min Value
Max Value
Measurement Type
LOINC ID
SNOMED
caDSR ID
CDISC ID
C19504
Family member body uncontrolled movement indicator
FamMmberBodyUncntrlldMovmntInd
Indicator for uncontrolled movements of part or all of the body such as twitching, jerking, shaking, or going limp, lasting about 5 minutes or less, that a family member has had or told you that you/they had
Uncontrolled movements of part or all of the body such as twitching, jerking, shaking or going limp, lasting about 5 minutes or less?
Yes;No;Unknown;
Yes;No;Unknown;
Alphanumeric
No instructions available
No references available
Adult;Pediatric
Supplemental
1.0
6/30/2014
Aliases for variable name not defined
Post-Traumatic Epilepsy Screening Form
Assessing Comorbidities
Outcomes and End Points
  
Single Pre-Defined Value Selected
       
C19505
Family member mental state awareness level unexplained change indicator
FamMmbrMentlSteAwrnsLvlChngInd
Indicator for an unexplained change in mental state or level of awareness; or an episode of "spacing out which you/your family member could not control, lasting about 5 minutes or less, that a family member has had or told you that you/they had
An unexplained change in mental state or level of awareness; or an episode of "spacing out" which you/your family member could not control, lasting about 5 minutes or less?
Yes;No;Unknown;
Yes;No;Unknown;
Alphanumeric
No instructions available
No references available
Adult;Pediatric
Supplemental
1.0
6/30/2014
Aliases for variable name not defined
Post-Traumatic Epilepsy Screening Form
Assessing Comorbidities
Outcomes and End Points
  
Single Pre-Defined Value Selected
       
C19506
Family member repeated unusual attack or convulsion other type indicator
FamMemRepUnuslAtkCnvlOthTypInd
Indicator for any other type of repeated unusual attacks or convulsions lasting about 5 minutes or less that a family member has had or told you that you/they had
Any other type of repeated unusual attacks or convulsions lasting about 5 minutes or less?
Yes;No;Unknown;
Yes;No;Unknown;
Alphanumeric
No instructions available
No references available
Adult;Pediatric
Supplemental
1.0
6/30/2014
Aliases for variable name not defined
Post-Traumatic Epilepsy Screening Form
Assessing Comorbidities
Outcomes and End Points
  
Single Pre-Defined Value Selected
       
C19507
Family member seizures or epilepsy indicator
FamMembrSeizureEpilepsyInd
Indicator for someone having told you that you/your family member have seizures or epilepsy
Has anyone ever told you that you/your family member have seizure(s) or epilepsy?
Yes;No;Unknown;
Yes;No;Unknown;
Alphanumeric
No instructions available
No references available
Adult;Pediatric
Supplemental
1.0
6/30/2014
Aliases for variable name not defined
Post-Traumatic Epilepsy Screening Form
Assessing Comorbidities
Outcomes and End Points
  
Single Pre-Defined Value Selected
       
C19508
Source of information queried type
SourceOfInformationQueriedTyp
Type of source of information queried
Which of the following sources of information were queried?
Patient;Caregiver;Medical record;
Patient;Caregiver;Medical record;
Alphanumeric
Check all that apply
No references available
Adult;Pediatric
Supplemental
1.0
6/30/2014
Aliases for variable name not defined
Post-Traumatic Epilepsy Screening Form
Assessing Comorbidities
Outcomes and End Points
  
Multiple Pre-Defined Values Selected
       
C19509
Pre traumatic brain injury seizure or epilepsy indicator
PreTBISeizureEpilepsyInd
Indicator for seizures or epilepsy that the patient had prior to the traumatic brain injury
Has the participant had seizures or epilepsy prior to the traumatic brain injury?
Yes;No;Unknown;
Yes;No;Unknown;
Alphanumeric
No instructions available
No references available
Adult;Pediatric
Supplemental
1.0
6/30/2014
Aliases for variable name not defined
Post-Traumatic Epilepsy Screening Form
Assessing Comorbidities
Outcomes and End Points
  
Single Pre-Defined Value Selected
       
C19510
Post traumatic brain injury diagnosis epilepsy seizure diagnosis indicator
PstTBIDiagEpilpSeizDiagInd
Indicator for the diagnosis of the participant with epilepsy, a seizure disorder, or a single seizure after the date of the traumatic brain injury diagnosis
Hast the participant been diagnosed with epilepsy, a seizure disorder, or a single seizure after the date of the traumatic brain injury diagnosis?
Yes;No;Unknown;
Yes;No;Unknown;
Alphanumeric
No instructions available
No references available
Adult;Pediatric
Supplemental
1.0
6/30/2014
Aliases for variable name not defined
Post-Traumatic Epilepsy Screening Form
Assessing Comorbidities
Outcomes and End Points
  
Single Pre-Defined Value Selected
       
C19511
Seven days post traumatic brain injury seizure occurrence indicator
SevnDaysPstTBISeizOccurncInd
Indicator for the occurrence of seizure(s) later than seven days after the date of the traumatic brain injury
Did seizure(s) occur later than seven days after the date of the traumatic brain injury?
Yes;No;Unknown;
Yes;No;Unknown;
Alphanumeric
No instructions available
No references available
Adult;Pediatric
Supplemental
1.0
6/30/2014
Aliases for variable name not defined
Post-Traumatic Epilepsy Screening Form
Assessing Comorbidities
Outcomes and End Points
  
Single Pre-Defined Value Selected
       
C08007
Diagnosis first given date and time
DiagnosFirstGivnDateTime
Date (and time if applicable and known) the participant/subject was initially diagnosed with the disease or disorder
Date of diagnosis
  
Date or Date & Time
Record the date/time according to the ISO 8601, the International Standard for the representation of dates and times (http://www.iso.org/iso/home.html). The date/time should be recorded to the level of granularity known (e.g., year, year and month, complete date plus hours and minutes, etc.).
No references available
Adult;Pediatric
Supplemental
3.0
7/24/2013
Aliases for variable name not defined
Post-Traumatic Epilepsy Screening Form
Assessing Comorbidities
Outcomes and End Points
Diagnosis first given date and time
 
Free-Form Entry
       
C19512
Diagnosis giver type
DiagnosisGiverTyp
Type of professional who gave the diagnosis
Who gave this diagnosis?
Neurosurgeon;Neurologist;Pediatric Neurologist;Primary Care Physician;Pediatrician;Psychiatrist;Psychologist;Nurse Practitioner;
Neurosurgeon;Neurologist;Pediatric Neurologist;Primary Care Physician;Pediatrician;Psychiatrist;Psychologist;Nurse Practitioner;
Alphanumeric
No instructions available
No references available
Adult;Pediatric
Supplemental
1.0
6/30/2014
Aliases for variable name not defined
Post-Traumatic Epilepsy Screening Form
Assessing Comorbidities
Outcomes and End Points
  
Single Pre-Defined Value Selected
       
C19513
Seizure or epilepsy medication patient reception indicator
SeizEpilepMedicaPatntReceptInd
Indicator for the patient's reception of medication for seizures or epilepsy
Has the patient received medication for seizures or epilepsy?
Yes;No;Unknown;
Yes;No;Unknown;
Alphanumeric
No instructions available
No references available
Adult;Pediatric
Supplemental
1.0
6/30/2014
Aliases for variable name not defined
Post-Traumatic Epilepsy Screening Form
Assessing Comorbidities
Outcomes and End Points
  
Single Pre-Defined Value Selected
       
05-26-2017
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