of0
Export
 
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: Headache
Sub-Domain: Imaging Diagnostics
CRF: Nociceptive Blink Reflex and Pain-Related Evoked Potentials
Item count: 25 (25 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
C02494
Imaging study date and time
ImgStdyDateTime
Date (and time, if applicable and known) the radiologic study was obtained.
Date of test
  
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
8/28/2013
Refer to SCI CDE Annotated Form
Nociceptive Blink Reflex and Pain-Related Evoked Potentials
Imaging Diagnostics
Assessments and Examinations
Imaging study date and time
 
Free-Form Entry
       
C15523
Imaging evoked potential technique type
ImgEVTechniqueTyp
Type of technique the participant/subject used as part of the Blink Reflex and Evoked Potential Imaging test
Technique
nBR;PREP;
nBR;PREP;
Alphanumeric
Choose all that apply
No references available
Adult;Pediatric
Supplemental
3.0
7/16/2013
Aliases for variable name not defined
Nociceptive Blink Reflex and Pain-Related Evoked Potentials
Imaging Diagnostics
Assessments and Examinations
Imaging blink reflex and evoked potential technique type
 
Multiple Pre-Defined Values Selected
       
C15525
Imaging evoked potential electrical nociceptive stimulation manufacturer name
ImgEVElctrclNcptveStmnMaNam
The name of the electrical nociceptive stimulation manufacturer used as part of the Blink Reflex and Evoked Potential Imaging test
Manufacturer
  
Alphanumeric
Indicate equipment manufacturer and model
No references available
Adult;Pediatric
Supplemental
3.0
7/16/2013
Aliases for variable name not defined
Nociceptive Blink Reflex and Pain-Related Evoked Potentials
Imaging Diagnostics
Assessments and Examinations
Imaging blink reflex electrical nociceptive stimulation manufacturer name
255
Free-Form Entry
       
C15530
Imaging evoked potential electrical nociceptive stimulation model name
ImgEVElctrclNcptveStmnMNam
The name of the electrical nociceptive stimulation model used as part of the Blink Reflex and Evoked Potential Imaging test
Model
  
Alphanumeric
Indicate equipment manufacturer and model
No references available
Adult;Pediatric
Supplemental
3.0
7/16/2013
Aliases for variable name not defined
Nociceptive Blink Reflex and Pain-Related Evoked Potentials
Imaging Diagnostics
Assessments and Examinations
Imaging blink reflex electrical nociceptive stimulation model name
255
Free-Form Entry
       
C55783
Imaging evoked potential (EV) laser nociceptive stimulation manufacturer name
ImgEVLaserNcptveStmnMaNam
The name of the laser nociceptive stimulation manufacturer used as part of the Blink Reflex and Evoked Potential Imaging test
Manufacturer
  
Alphanumeric
No instructions available
No references available
Adult;Pediatric
Supplemental
3.0
7/16/2013
Aliases for variable name not defined
Nociceptive Blink Reflex and Pain-Related Evoked Potentials
Imaging Diagnostics
Assessments and Examinations
 
255
Free-Form Entry
       
C55784
Imaging evoked potential (EV) laser nociceptive stimulation model name
ImgEVLaserNcptveStmnMNam
The name of the laser nociceptive stimulation model used as part of the Blink Reflex and Evoked Potential Imaging test
Model
  
Alphanumeric
No instructions available
No references available
Adult;Pediatric
Supplemental
3.0
7/16/2013
Aliases for variable name not defined
Nociceptive Blink Reflex and Pain-Related Evoked Potentials
Imaging Diagnostics
Assessments and Examinations
 
255
Free-Form Entry
       
C55785
Imaging evoked potential (EV) Chemical nociceptive stimulation method name
ImgEVChemNcptveStmnMeNam
The name of the chemical nociceptive stimulation method used as part of the Blink Reflex and Evoked Potential Imaging test
Method
  
Alphanumeric
No instructions available
No references available
Adult;Pediatric
Supplemental
3.0
7/16/2013
Aliases for variable name not defined
Nociceptive Blink Reflex and Pain-Related Evoked Potentials
Imaging Diagnostics
Assessments and Examinations
 
255
Free-Form Entry
       
C55786
Imaging evoked potential (EV) Chemical nociceptive stimulation substance name
ImgEVChemNcptveStmnSubNam
The name of the chemical nociceptive stimulation substance used as part of the Blink Reflex and Evoked Potential Imaging test
Substance
  
Alphanumeric
No instructions available
No references available
Adult;Pediatric
Supplemental
3.0
7/16/2013
Aliases for variable name not defined
Nociceptive Blink Reflex and Pain-Related Evoked Potentials
Imaging Diagnostics
Assessments and Examinations
 
255
Free-Form Entry
       
C15535
Imaging evoked potential recording system manufacturer name
ImgEVRecordingSystemManufNam
The name of the recording system manufacturer used as part of the Blink Reflex and Evoked Potential Imaging test
Manufacturer
  
Alphanumeric
Indicate equipment manufacturer and model
No references available
Adult;Pediatric
Supplemental
3.0
7/16/2013
Aliases for variable name not defined
Nociceptive Blink Reflex and Pain-Related Evoked Potentials
Imaging Diagnostics
Assessments and Examinations
Imaging blink reflex recording system manufacturer name
255
Free-Form Entry
       
C15542
Imaging evoked potential recording system model name
ImgEVRecordingSystemMoNam
The name of the recording system model used as part of the Blink Reflex and Evoked Potential Imaging test
Model
  
Alphanumeric
Indicate equipment manufacturer and model
No references available
Adult;Pediatric
Supplemental
3.0
7/16/2013
Aliases for variable name not defined
Nociceptive Blink Reflex and Pain-Related Evoked Potentials
Imaging Diagnostics
Assessments and Examinations
Imaging blink reflex recording system model type
255
Free-Form Entry
       
C15531
Imaging evoked potential stimulation frequency value
ImgEVStimulationFreqVal
The stimulation frequency used on the participant/subject as part of the Blink Reflex and Evoked Potential Imaging test
Stimulation frequency (include units)
  
Numeric Values
Suggested one stimulus every 20 seconds. Include units
Rossi S, Hallett M, Rossini PM, et. Al. and The Safety of TMS Consensus Group. Safety, ethical considerations, and application guidelines for the use of transcranial magnetic stimulation in clinical practice and research. Clinical Neurophysiology 2009;120:2008-2039. Wasserman EM. Risk and safety of repetitive transcranial magnetic stimulation: report and suggested guidelines from the International Workshop on the Safety of Repetitive Transcranial Magnetic Stimulation, June 5-7, 1996. Electroencephalography and Clinical Neurophysiology 1998;108:1-16.
Adult;Pediatric
Supplemental
3.0
7/16/2013
Aliases for variable name not defined
Nociceptive Blink Reflex and Pain-Related Evoked Potentials
Imaging Diagnostics
Assessments and Examinations
Imaging stimulation frequency value
 
Free-Form Entry
  
Hertz
    
C15551
Imaging evoked potential stimulus type
ImgEVStimulusTyp
Type of stimulus used on participant/subject as part of the Blink Reflex and Evoked Potential Imaging test
Stimulus
Single pulse;Double pulse;Triple pulse;
Single pulse;Double pulse;Triple pulse;
Alphanumeric
Triple pulse is suggested
No references available
Adult;Pediatric
Supplemental
3.0
7/16/2013
Aliases for variable name not defined
Nociceptive Blink Reflex and Pain-Related Evoked Potentials
Imaging Diagnostics
Assessments and Examinations
Imaging stimulus type
 
Single Pre-Defined Value Selected
       
C15554
Imaging evoked potential interpulse interval 5ms value
ImgEVInterpulseIntrvl5MsVal
Interpulse interval at 5ms used on participant/subject as part of the Blink Reflex and Evoked Potential Imaging test
Interpulse intervals
  
Numeric Values
No additional instructions
No references available
Adult;Pediatric
Supplemental
3.0
7/16/2013
Aliases for variable name not defined
Nociceptive Blink Reflex and Pain-Related Evoked Potentials
Imaging Diagnostics
Assessments and Examinations
Imaging interpulse interval value
 
Free-Form Entry
       
C15544
Imaging stimulation intensity value
ImgStimlIntenVal
Stimulation intensity used on imaging.
Stimulation intensity (include units)
  
Numeric Values
Not more than 2.0mA; Include units
No references available
Adult;Pediatric
Supplemental
3.0
7/16/2013
Aliases for variable name not defined
Nociceptive Blink Reflex and Pain-Related Evoked Potentials
Imaging Diagnostics
Assessments and Examinations
Imaging stimulation intensity value
 
Free-Form Entry
       
C15552
Imaging stimuli duration
ImgStimuliDur
Duration of stimuli used on imaging test.
Duration of stimuli
  
Numeric Values
Record in 1000 microseconds
No references available
Adult;Pediatric
Supplemental
3.0
7/16/2013
Aliases for variable name not defined
Nociceptive Blink Reflex and Pain-Related Evoked Potentials
Imaging Diagnostics
Assessments and Examinations
Imaging stimuli duration
 
Free-Form Entry
  
millisecond
    
C55787
Imaging evoked potential (EV) recording parameter type
ImagEVRecordParaTyp
The type of recording parameter used for the imaging, as part of the Blink Reflex and Pain-Related Evoked Potentials Test.
Recording parameters
bandwidth (low-high);sweep length (in ms);sampling rate (in kHz);
bandwidth (low-high);sweep length (in ms);sampling rate (in kHz);
Alphanumeric
No instructions available
No references available
Adult;Pediatric
Supplemental
1.0
5/31/2017
Aliases for variable name not defined
Nociceptive Blink Reflex and Pain-Related Evoked Potentials
Imaging Diagnostics
Assessments and Examinations
  
Multiple Pre-Defined Values Selected
       
C15562
Imaging total pulse count
ImgTotalPulseCt
Total number of pulses used on imaging.
Total number of averaged responses
  
Numeric Values
15-20 pulses suggested
No references available
Adult;Pediatric
Supplemental
3.0
7/16/2013
Aliases for variable name not defined
Nociceptive Blink Reflex and Pain-Related Evoked Potentials
Imaging Diagnostics
Assessments and Examinations
Imaging total pulse count
 
Free-Form Entry
  
pulse
    
C55788
Imaging evoked potentials (EV) averaged response sequential block responses per block number
ImagEVAvgRespnsSeqBloPerBloNum
The number of sequential blocks of averaged responses and the number of responses in each block, as part of the Blink Reflex and Pain-Related Evoked Potentials Imaging test.
Number of sequential blocks of averaged responses & number of responses in each block
  
Numeric Values
Indicated whether block averaging is used, number per block and interval between blocks.
No references available
Adult;Pediatric
Supplemental
1.0
5/31/2017
Aliases for variable name not defined
Nociceptive Blink Reflex and Pain-Related Evoked Potentials
Imaging Diagnostics
Assessments and Examinations
  
Free-Form Entry
       
C02411
Laterality type
LatTyp
Laterality type relative to the anatomic site of the body examined or affected
Stimulation side
Right;Left;Bilateral;
Right;Left;Bilateral;
Alphanumeric
(e.g. pain side)
No references available
Adult;Pediatric
Supplemental
3.0
8/28/2013
Aliases for variable name not defined
Nociceptive Blink Reflex and Pain-Related Evoked Potentials
Imaging Diagnostics
Assessments and Examinations
Laterality type
 
Single Pre-Defined Value Selected
       
C15573
Imaging stimulation target type
ImgStimlTargetTyp
The type of stimulation target of the imaging test.
Stimulation target
V1;V2;V3;
V1;V2;V3;
Alphanumeric
No additional instructions
Rossi S, Hallett M, Rossini PM, et. Al. and The Safety of TMS Consensus Group. Safety, ethical considerations, and application guidelines for the use of transcranial magnetic stimulation in clinical practice and research. Clinical Neurophysiology 2009;120:2008-2039. Wasserman EM. Risk and safety of repetitive transcranial magnetic stimulation: report and suggested guidelines from the International Workshop on the Safety of Repetitive Transcranial Magnetic Stimulation, June 5-7, 1996. Electroencephalography and Clinical Neurophysiology 1998;108:1-16.
Adult;Pediatric
Supplemental
3.0
7/16/2013
Aliases for variable name not defined
Nociceptive Blink Reflex and Pain-Related Evoked Potentials
Imaging Diagnostics
Assessments and Examinations
Imaging stimulation target type
 
Single Pre-Defined Value Selected
       
C55774
Imaging headache relation time type
ImagHeadacheRelTimeTyp
The type of timing of the imaging in relation to headache.
Stimulation timing
Inter-Ictal;Ictal;Peri-Ictal;
Inter-Ictal;Ictal;Peri-Ictal;
Alphanumeric
Report the timing of the study in relation to the headache. The precise time windows of peri-ictal and inter-ictal vary with headache type. For episodic migraine, an interval of at least 72h from the last and before the next attack is generally accepted as "inter-ictal".
No references available
Adult;Pediatric
Supplemental
1.0
5/31/2017
Aliases for variable name not defined
Nociceptive Blink Reflex and Pain-Related Evoked Potentials
Imaging Diagnostics
Assessments and Examinations
  
Single Pre-Defined Value Selected
       
C55775
Imaging ictal pain intensity value
ImagIctPainIntensVal
The value related to the intensity of the subject's pain if the timing is ictal
If ictal, pain intensity at time of recordings
  
Numeric Values
No instructions available
No references available
Adult;Pediatric
Supplemental
1.0
5/31/2017
Aliases for variable name not defined
Nociceptive Blink Reflex and Pain-Related Evoked Potentials
Imaging Diagnostics
Assessments and Examinations
  
Free-Form Entry
0
10
     
C55776
Imaging ictal headache since onset duration
ImagIctHeadSinceOnsetDur
The duration of time since the onset of the subject's headache if it was ictal.
If ictal, duration of time since onset of headache (include units)
  
Numeric Values
No instructions available
No references available
Adult;Pediatric
Supplemental
1.0
5/31/2017
Aliases for variable name not defined
Nociceptive Blink Reflex and Pain-Related Evoked Potentials
Imaging Diagnostics
Assessments and Examinations
  
Free-Form Entry
       
C55777
Imaging inter peri ictal headache since end duration
ImagInterPeriIctHeadSincEndDur
The duration of time since the end of the subject's last inter-ictal or peri-ictal headahe.
If inter-ictal or peri-ictal, duration of time since end of last headache (include units)
  
Numeric Values
No instructions available
No references available
Adult;Pediatric
Supplemental
1.0
5/31/2017
Aliases for variable name not defined
Nociceptive Blink Reflex and Pain-Related Evoked Potentials
Imaging Diagnostics
Assessments and Examinations
  
Free-Form Entry
       
C55778
Imaging inter peri ictal next headache start duration
ImagInterPeriIctNextHeStartDur
The duration of time until the start of the subject's next inter-ictal or peri-ictal headache.
If inter-ictal or peri-ictal, duration of time until start of next headache (include units)
  
Numeric Values
No instructions available
No references available
Adult;Pediatric
Supplemental
1.0
5/31/2017
Aliases for variable name not defined
Nociceptive Blink Reflex and Pain-Related Evoked Potentials
Imaging Diagnostics
Assessments and Examinations
  
Free-Form Entry
       
07-15-2019
Page 1 of 1