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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: Sport Related Concussion
SubDisease: Comprehensive
Sub-Domain: Demographics
CRF: Demographics Form
Item count: 29 (29 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
C08147
Data source
DataSource
Source of the data provided on the case report form
Who filled out this form?
Brother;Chart/Medical record;Daughter;Father;Friend;Mother;Participant/subject;Physician;Sister;Son;Spouse;Other, specify;
Brother;Chart/Medical record;Daughter;Father;Friend;Mother;Participant/subject;Physician;Sister;Son;Spouse;Other, specify;
Alphanumeric
Select one. If other is selected, please write in response.
No references available
Adult;Pediatric
Supplemental
3.0
7/20/2013
Aliases for variable name not defined
Demographics Form
Demographics
Participant Characteristics
Data source
 
Multiple Pre-Defined Values Selected
       
C18667
Data source other text
DataSourcOTH
The free-text field related to 'Data source' specifying other text. Source of the data provided on the case report form
Other, specify:
  
Alphanumeric
No instructions available
No references available
Adult;Pediatric
Supplemental
1.0
5/27/2014
Aliases for variable name not defined
Demographics Form
Demographics
Participant Characteristics
 
4000
Free-Form Entry
       
C00007
Birth date
BirthDate
Date (and time, if applicable and known) the participant/subject was born
What is the subject's date of birth?
  
Date or Date & Time
Write in response.
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
7/25/2013
caBIG: PER_BIR_DT; SCI CDEs: BIRTHDT
Demographics Form
Demographics
Participant Characteristics
Birth date
 
Free-Form Entry
     
793
 
C00035
Gender type
GenderTyp
Self-reported gender of the participant/subject. Gender is the socially constructed identity of sex. Gender is equated with phenotypic sex. Gender may differ from the sex of an individual determined genetically.
What is the subject's gender?
Female;Male;Unknown;Unspecified;Not reported;
Female;Male;Unknown;Undifferentiated/Indeterminant/Intersex;Not reported;
Alphanumeric
Select one.
No references available
Adult;Pediatric
Supplemental
3.0
8/28/2013
caBIG: PRSN_GENDER_TXT_TP; SCI CDEs: GENDER
Demographics Form
Demographics
Participant Characteristics
Gender type
 
Single Pre-Defined Value Selected
     
2200604
 
C17396
Sex genotype type
SexGenotypTyp
The difference between male and female, based upon the interactions between genes and between the genotype and the environment. Genotype is identified based on the individual's reproductive organs and functions assigned by chromosomal complement.
Sex at birth
XX;XY;XXX;XYY;XXY;Other, specify;Unknown;Unspecified;
XX;XY;XXX;XYY;XXY;Other, specify;Unknown;Undifferentiated/Indeterminant/Intersex;
Alphanumeric
No instructions available
No references available
Adult;Pediatric
Supplemental
3.1
7/26/2018
Aliases for variable name not defined
Demographics Form
Demographics
Participant Characteristics
Sex participant or subject type
 
Single Pre-Defined Value Selected
       
C55578
Sexual orientation type
SexualOrientTyp
Self-reported sexual orientation of the participant/subject
Sexual orientation
Bisexual;Gay/Lesbian;Heterosexual;Not reported;Other;Unknown;
Bisexual;Gay/Lesbian;Heterosexual;Not reported;Other;Unknown;
Alphanumeric
Select one.
No references available
Adult;Pediatric
Supplemental
3.0
8/28/2013
Aliases for variable name not defined
Demographics Form
Demographics
Participant Characteristics
  
Multiple Pre-Defined Values Selected
       
C00023
Hand preference type
HandPrefTyp
Hand which the participant/subject uses predominantly, not necessarily the hand he/she writes with exclusively.
What is the subject's handedness preference, or dominant hand?
Left hand;Right hand;Both hands;Unknown;
Left hand;Right hand;Both hands;Unknown;
Alphanumeric
Select one.
No references available
Adult;Pediatric
Supplemental
3.0
7/25/2013
Aliases for variable name not defined
Demographics Form
Demographics
Participant Characteristics
Hand preference type
 
Single Pre-Defined Value Selected
     
2180147
 
C00030
Race USA category
RaceUSACat
The patient's self declared racial origination, independent of ethnic origination, using OMB approved categories.
What is the suject's racial background (as defined by OMB)?
American Indian or Alaska Native;Asian;Black or African-American;Native Hawaiian or Other Pacific Islander;White;Unknown;Not Reported;
A person having origins in any of the original peoples of North and South America (including Central America) , and who maintains tribal affiliation or community attachment.;A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.;A person having origins in any of the black racial groups of Africa. Terms such as “Haitian” can be used in addition to “Black or African American.”;A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.;A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.;Could not be determined or unsure;Not provided or unavailable;
Alphanumeric
Select all that apply.
The NIH Guidelines on Inclusion of Women and Minorities as Subjects in Clinical Research: The Office of Management and Budget (OMB) Directive No. 15 defines the minimum standard of basic racial and ethnic categories. (http://grants.nih.gov/grants/funding/women_min/guidelines_update.htm)
Collection of Race and Ethnicity Data in Clinical Trials (FDA, September 2005 - http://www.fda.gov/RegulatoryInformation/Guidances/ucm126340.htm)
Jorde LB and Wooding SP. Genetic variation, classification and “race”. Nature Genetics. 2004;36(11):S28-S33. Bhopal R and Donaldson L. White, European, Western, Caucasian, or What? Inappropriate labeling in Research on Race, Ethnicity, and Health. Amer J of Publ Health. 1998;88:1303-1307. NCI CDE Browser Public ID = 2192199
Adult;Pediatric
Supplemental
3.0
7/25/2013
RACE_CAT_TXT
Demographics Form
Demographics
Participant Characteristics
Race USA category
 
Multiple Pre-Defined Values Selected
     
2192199
 
C00031
Race expanded category
RaceCat
Category of race(s) or region(s) the participant/subject most closely identifies with
What is the subject's racial background (expanded categories)?
Black African American;Black African;Black Afro Carribean;South/Central American Indian;North American Indian;Alaskan Native;Inuit;South Asian;Far Eastern Asian;Western Asian;White North American;White South American;White European;White Middle Eastern;White African;White Australian;Hawaiian;Pacific Islander;Not reported;Other;Unknown;
Black African American (for OMB purposes, this value is considered to be part of Black or African-American);Black African (for OMB purposes, this value is considered to be part of Black or African-American);Black Afro Carribean (for OMB purposes, this value is considered to be part of Black or African-American);South/Central American Indian (for OMB purposes, this value is considered to be part of American Indian or Alaska Native);North American Indian (for OMB purposes, this value is considered to be part of American Indian or Alaska Native);Alaskan Native (for OMB purposes, this value is considered to be part of American Indian or Alaska Native);Inuit (for OMB purposes, this value is considered to be part of American Indian or Alaska Native);South Asian (Indian subcontinent) (for OMB purposes, this value is considered to be part of Asian);Far Eastern Asian (e.g., China, Japan, Korea, etc.) (for OMB purposes, this value is considered to be part of Asian);Western Asian (e.g., Pakistan, Iraq, Iran) (for OMB purposes, this value is considered to be part of Asian);White North American (for OMB purposes, this value is considered to be part of White);White South American (for OMB purposes, this value is considered to be part of White);White European (for OMB purposes, this value is considered to be part of White);White Middle Eastern (for OMB purposes, this value is considered to be part of White);White African (for OMB purposes, this value is considered to be part of White);White Australian (for OMB purposes, this value is considered to be part of White);Hawaiian (for OMB purposes, this value is considered to be part of Native Hawaiian or Other Pacific Islander);Pacific Islander (for OMB purposes, this value is considered to be part of Native Hawaiian or Other Pacific Islander);Not reported;Other;Unknown;
Alphanumeric
Select all that apply.
Choose all those with which the participant/ subject identifies. Race should be reported by the subject or caretaker.
The NIH Guidelines on Inclusion of Women and Minorities as Subjects in Clinical Research: The Office of Management and Budget (OMB) Directive No. 15 defines the minimum standard of basic racial and ethnic categories. (http://grants.nih.gov/grants/funding/women_min/guidelines_update.htm)
Collection of Race and Ethnicity Data in Clinical Trials (FDA, September 2005 - http://www.fda.gov/RegulatoryInformation/Guidances/ucm126340.htm)
Jorde LB and Wooding SP. Genetic variation, classification and “race”. Nature Genetics. 2004;36(11):S28-S33. Bhopal R and Donaldson L. White, European, Western, Caucasian, or What? Inappropriate labeling in Research on Race, Ethnicity, and Health. Amer J of Publ Health. 1998;88:1303-1307. NCI CDE Browser Public ID = 2192199
Adult;Pediatric
Supplemental
3.0
7/22/2013
Aliases for variable name not defined
Demographics Form
Demographics
Participant Characteristics
Race expanded category
 
Multiple Pre-Defined Values Selected
       
C00020
Ethnicity USA category
EthnUSACat
Category of ethnicity the participant/subject most closely identifies with
What is the subject's ethnic background?
Hispanic or Latino;Not Hispanic or Latino;Unknown;Not reported;Other, specify;
A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race. The term “Spanish origin” can also be used in addition to “Hispanic or Latino.”;A person not meeting the definition for Hispanic or Latino.;Could not be determined or unsure;Not reported;Other, specify;
Alphanumeric
Select one. If other is selected, please write in response.
The NIH Guidelines on Inclusion of Women and Minorities as Subjects in Clinical Research: The Office of Management and Budget Directive No. 15 defines the minimum standard of basic racial and ethnic categories. (http://grants.nih.gov/grants/funding/women_min/guidelines_update.htm)
Collection of Race and Ethnicity Data in Clinical Trials (FDA, September 2005 - http://www.fda.gov/RegulatoryInformation/Guidances/ucm126340.htm)
Adult;Pediatric
Supplemental
3.0
8/28/2013
ETHN_GRP_CAT_TXT
Demographics Form
Demographics
Participant Characteristics
Ethnicity USA category
 
Single Pre-Defined Value Selected
     
2192217
 
C00004
Birth country ISO code
BirthCntryISOCode
Code (ISO 3166-1 alpha-2 code) for country where the participant/subject was born
What is the subject's birth country (use ISO code)?
AU;CA;MX;GB;US;
AUSTRALIA;CANADA;MEXICO;UNITED KINGDOM;UNITED STATES;
Alphanumeric
Select one: If other is selected, please write in response.
No references available
Adult;Pediatric
Supplemental
3.0
7/24/2013
Aliases for variable name not defined
Demographics Form
Demographics
Participant Characteristics
Birth country ISO 3166-1 alpha-2 code
 
Single Pre-Defined Value Selected
       
C00005
Birth country name
BirthCntryName
Name for country where the participant/subject was born
What is the subject's birth country name?
  
Alphanumeric
Write in response.
No references available
Adult;Pediatric
Supplemental
3.0
7/24/2013
Aliases for variable name not defined
Demographics Form
Demographics
Participant Characteristics
Birth country name
255
Free-Form Entry
       
C10676
Country of residence code
CntryResdnceISOCode
Code (ISO 3166-1 alpha-2) for the country where the participant/subject currently lives.
What is the subject's country of residence?
US;CA;GB;MX;AU;Other, specify;
USA (US);Canada (CA);United Kingdom (GB);Mexico (MX);Australia (AU);Other, specify;
Alphanumeric
Select one: If other is selected, please write in response.
Choose only one country which the subject/participant currently lives. If the country code is not included on the form and therefore the country is written-in under 'Other, specify' then code the data later using ISO 3166-1 alpha-2 codes. ISO 3166-1 alpha-2 codes (http://www.iso.org/iso/iso_3166_code_lists)
ISO 3166-1 alpha-2 codes (http://www.iso.org/iso/iso_3166_code_lists)
Adult;Pediatric
Supplemental
3.0
7/11/2013
Aliases for variable name not defined
Demographics Form
Demographics
Participant Characteristics
Country of residence ISO 3166-1 alpha-2 code
 
Single Pre-Defined Value Selected
       
C18806
Country of residence other text
CntryResdnceISOOTH
The free-text field related to 'Country of residence code' specifying other text. Code (ISO 3166-1 alpha-2) for the country where the participant/subject currently lives.
Other, specify:
  
Alphanumeric
Choose only one country which the subject/participant currently lives. If the country code is not included on the form and therefore the country is written-in under 'Other, specify' then code the data later using ISO 3166-1 alpha-2 codes. ISO 3166-1 alpha-2 codes (http://www.iso.org/iso/iso_3166_code_lists)
ISO 3166-1 alpha-2 codes (http://www.iso.org/iso/iso_3166_code_lists)
Adult;Pediatric
Supplemental
3.0
7/11/2013
Aliases for variable name not defined
Demographics Form
Demographics
Participant Characteristics
 
4000
Free-Form Entry
       
C14123
Country of residence name
CntryResdnceName
Country where the participant/subject currently lives.
What is the subject's current country of residence name?
  
Alphanumeric
Write in response.
No references available
Adult;Pediatric
Supplemental
3.0
6/21/2013
Aliases for variable name not defined
Demographics Form
Demographics
Participant Characteristics
Country of residence name
255
Free-Form Entry
       
C00025
Language primary text
LangPrimryTxt
Text for the language the participant/subject speaks most often
What is the subject's primary language (use ISO code)?
eng;spa;sgn;chi;fre;ger;Other, specify;
English;Spanish;Sign Languages;Chinese languages;French;German;Other, specify;
Alphanumeric
Write in response.
Select one. If other is selected, please write in response.
ISO 639-2 language codes (http://www.loc.gov/standards/iso639-2/php/code_list.php)
Adult;Pediatric
Supplemental
3.0
7/20/2013
Aliases for variable name not defined
Demographics Form
Demographics
Participant Characteristics
Language primary text
 
Single Pre-Defined Value Selected
       
C18732
Language primary other text
LangPrimryOTH
The free-text field related to 'Language primary text' specifying other text. Text for the language the participant/subject speaks most often
Other, specify:
  
Alphanumeric
Text for participant's/subject's primary language. It may be easier to record the full name of the language and code the data later using the ISO 639-2 codes.
ISO 639-2 language codes (http://www.loc.gov/standards/iso639-2/php/code_list.php)
Adult;Pediatric
Supplemental
1.0
5/27/2014
Aliases for variable name not defined
Demographics Form
Demographics
Participant Characteristics
 
4000
Free-Form Entry
       
C00028
Language spoken fluent ISO code
LangSpokeFluentISOCode
Code (ISO 639-2)for each language that the participant/subject speaks fluently
What are the ISO codes for each language the subject can speak fluently? The ISO codes represent the international codes for each country.
English (eng);Spanish (spa);German (ger);Chinese (chi);French/Creole (cpf);Arabic;Russian (rus);Italian (ita);Polish (pol);Other specify;American Sign Language (sgn);Chinese languages (Chi);
English (eng);Spanish (spa);German (ger);Chinese (chi);French/Creole (cpf);Arabic (ara);Russian (rus);Italian (ita);Polish (pol);Other specify;American Sign Language (sgn);Chinese languages (Chi);
Alphanumeric
Write in response.
It may be easier to record the full name of the language and code the data later using the ISO 639-2 codes.
ISO 639-2 language codes (http://www.loc.gov/standards/iso639-2/php/code_list.php)
Adult;Pediatric
Supplemental
3.0
7/20/2013
Aliases for variable name not defined
Demographics Form
Demographics
Participant Characteristics
Language spoken fluently ISO 639-2 code
 
Multiple Pre-Defined Values Selected
       
C00026
Language spoken Fluent text
LangSpokeFluentTxt
Text for each language that the participant/subject speaks fluently
Please list each language the subject can speak fluently:
  
Alphanumeric
Write in response.
No references available
Adult;Pediatric
Supplemental
3.0
7/20/2013
Aliases for variable name not defined
Demographics Form
Demographics
Participant Characteristics
Language spoken fluently text
255
Free-Form Entry
       
C00029
Language written fluent ISO code
LangWrtnFlntlyTxtISOCode
Code (ISO 639-2) for each language that the participant/subject writes fluently
What are the ISO codes for each language the subject can write fluently?
  
Alphanumeric
Write in response.
Text for all languages participant/subject writes fluently. It may be easier to record the full name of the language and code the data later using the ISO 639-2 codes.
ISO 639-2 language codes (http://www.loc.gov/standards/iso639-2/php/code_list.php)
Adult;Pediatric
Supplemental
3.0
7/20/2013
Aliases for variable name not defined
Demographics Form
Demographics
Participant Characteristics
Language written fluently ISO 639-2 code
255
Free-Form Entry
       
C00027
Language written Fluent text
LangWrtnFlntlyTxt
Text for each language that the participant/subject writes fluently
Please list each language the subject can write fluently:
  
Alphanumeric
Write in response.
Text for all languages participant/subject writes fluently. It may be easier to record the full name of the language and code the data later using the ISO 639-2 codes.
ISO 639-2 language codes (http://www.loc.gov/standards/iso639-2/php/code_list.php)
Adult;Pediatric
Supplemental
3.0
7/20/2013
Aliases for variable name not defined
Demographics Form
Demographics
Participant Characteristics
Language written fluently text
255
Free-Form Entry
       
C21805
Caregiver primary extended type
CaregvPrimryExtendType
Type of relationship between the person who acts as the primary caregiver for the participant/subject and the participant/subject
What is the relationahip between the person who acts as the primary caregiver for the subject and the subject?
Adoptive father;Adoptive mother;Adoptive parents;Biological father;Biological father - not a primary caregiver;Biological mother;Biological mother - not a primary caregiver;Biological parents;Child;Grandfather;Grandmother;Home aide;Legal guardian;Long-term care/nursing facility staff;Parent;Relative;Self;Sibling;Spouse or partner;Stepfather;Stepmother;Stepparent;Unknown;Other, specify;
Adoptive father;Adoptive mother;Adoptive parents;Biological father;Biological father - not a primary caregiver;Biological mother;Biological mother - not a primary caregiver;Biological parents;Child;Grandfather;Grandmother;Home aide;Legal guardian;Long-term care/nursing facility staff;Parent;Relative;Self;Sibling;Spouse or partner;Stepfather;Stepmother;Stepparent;Unknown;Other, specify;
Alphanumeric
Select all that apply. If other is selected, please write in response.
Type of relationship between the person who acts as the primary caregiver for the participant/subject and the participant/subject
No references available
Adult;Pediatric
Supplemental
1.0
6/3/2016
Aliases for variable name not defined
Demographics Form
Demographics
Participant Characteristics
  
Multiple Pre-Defined Values Selected
       
C21806
Parent alive status
ParentAliveStatus
Specifies whether the participant's/subjects parents are still living
What are the living statuses of the subject's parents?
Mother alive;Father alive;Father deceased;Mother deceased;Mother unknown;Father unknown;
Mother alive;Father alive;Father deceased;Mother deceased;Mother unknown;Father unknown;
Alphanumeric
Select all that apply.
Specifies whether the participant's/subjects parents are still living

Answer for both parents
No references available
Adult;Pediatric
Supplemental
1.0
6/3/2016
Aliases for variable name not defined
Demographics Form
Demographics
Participant Characteristics
  
Multiple Pre-Defined Values Selected
       
C22684
Parent gender type
ParentGenderTyp
Self-reported gender of the participant's/subject's parent. Gender is the socially constructed identity of sex. Gender is equated with phenotypic sex. Gender may differ from the sex of a parent determined genetically.
What is the parent, guardian or caregiver's gender?
Female;Male;Unknown;Unspecified;Not reported;
Female;Male;Unknown;Undifferentiated/Indeterminant/Intersex;Not reported;
Alphanumeric
Select one.
Self-reported gender of the participant's/subject's parent. Gender is the socially constructed identity of sex.

Choose one. Response is obtained by report of the participant/subject or parent, guardian, or caretaker.
No references available
Adult;Pediatric
Supplemental
3.0
8/28/2013
Aliases for variable name not defined
Demographics Form
Demographics
Participant Characteristics
  
Single Pre-Defined Value Selected
     
2200604
 
C22688
Parent Race USA Category
ParentRaceUSACat
The participant's/subject's parent self declared racial origination, independent of ethnic origination, using OMB approved categories.
What is the parent, guardian, or caregiver's race, based on the OBM race standards?
American Indian or Alaska Native;Asian;Black or African-American;Native Hawaiian or Other Pacific Islander;White;Unknown;Not Reported;
A person having origins in any of the original peoples of North and South America (including Central America) , and who maintains tribal affiliation or community attachment.;A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.;A person having origins in any of the black racial groups of Africa. Terms such as “Haitian” can be used in addition to “Black or African American.”;A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.;A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.;Could not be determined or unsure;Not provided or unavailable;
Alphanumeric
Select all that apply.
The participant's/subject's parent self declared racial origination, independent of ethnic origination, using OMB approved categories.

Response is obtained by report of the participant/subject or caretaker. Collecting information on race may not be allowed in some countries for concerns related to discrimination. In other countries, however, these concerns are considered a reason for recording race in order to guarantee equal access to care. Investigators receiving funding from the US National Institutes of Health (NIH) are required to report the number of subjects enrolled on an annual basis using the racial categories listed.
No references available
Adult;Pediatric
Supplemental
3.0
7/25/2013
Aliases for variable name not defined
Demographics Form
Demographics
Participant Characteristics
  
Multiple Pre-Defined Values Selected
     
2192199
 
12-19-2018
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