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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: Traumatic Brain Injury
SubDisease: Comprehensive
Sub-Domain: Second Insults
CRF: Second Insults and Other Complications
Item count: 13 (13 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
C05453
Hypotensive episode indicator
HypotnsnEpiInd
Indicator of hypotensive episode. In adults, hypotensive episode is defined as systolic blood pressure < 90 mmHg. In children, it is defined as systolic blood pressure < 5th percentile for age
Did participant/subject experience hypotensive episode?
Yes;No;Suspected;Unknown;
Yes;No;Suspected;Unknown;
Alphanumeric
Choose one.
McHugh GS, Engel DC, Butcher I, et al. Prognostic value of secondary insults in traumatic brain injury: results from the IMPACT study. J Neurotrauma. Feb 2007;24(2):287-93. Silverstone P. Pulse oxymetry of at the road side: a study of pulse oxymetry in immediate care. BMJ. Mar 1989;298(6675):711-13. Stocchetti N, Furlan A, Volta F. Hypoxemia and arterial hypotension at the accident side in head injury. J Trauma. 1996;40:764-67. De Witt DS, Jenkins LW, Prough DS. Enhanced vulnerability to secondary ischemic insults after experimental traumatic brain injury. New Horizon. Aug 1995;3(3):376-383.
Adult;Pediatric
Supplemental
3.0
7/20/2013
Aliases for variable name not defined
Second Insults and Other Complications
Second Insults
Disease/Injury Related Events
Hypotensive episode indicator
 
Single Pre-Defined Value Selected
       
C05457
Hypoxic episode indicator
HypxEpiInd
Indicator of hypoxic episode. Hypoxic episode is defined as partial pressure of oxygen in the blood (paO2) < 8kPa (60mmHg) or oxygen saturation (SaO2) < 90%
Did participant/subject experience hypoxic episode?
Yes;No;Suspected;Unknown;
Yes;No;Suspected;Unknown;
Alphanumeric
Choose one.
McHugh GS, Engel DC, Butcher I, et al. Prognostic value of secondary insults in traumatic brain injury: results from the IMPACT study. J Neurotrauma. Feb 2007;24(2):287-93. Silverstone P. Pulse oxymetry of at the road side: a study of pulse oxymetry in immediate care. BMJ. Mar 1989;298(6675):711-13. Stocchetti N, Furlan A, Volta F. Hypoxemia and arterial hypotension at the accident side in head injury. J Trauma. 1996;40:764-67. De Witt DS, Jenkins LW, Prough DS. Enhanced vulnerability to secondary ischemic insults after experimental traumatic brain injury. New Horizon. Aug 1995;3(3):376-383. Steyerberg EW, Mushkudiani N, Perel P, et al. Predicting outcome after traumatic brain injury: development and international validation of prognostic scores based on admission characteristics. PLoS Med. Aug 2008;5(8):e165. MRC CRASH Trial Collaborators. Predicting outcome after traumatic brain injury: practical prognostic models based on large cohort of international patients. BMJ. Feb 2008;336(7641):425-429. Signorini DF, Andrews PJ, Jones PA, et al. Adding insult to injury: the prognostic value of early secondary insults for survival after traumatic brain injury. J Neurol Neurosurg Psychiatry. Jan 1999;66(1):26-31 Pediatric-specific reference(s): Adelson PD, Bratton SL, Carney, NA, Chesnut RM, du Coudray HE, Goldstein B, Kochanek PM, Miller HC, Partington MD, Selden NR, Warden CR, Wright DW. Guidelines for the acute medical management of severe traumatic brain injury in infants, children, and adolescents. Chapter 6. Threshold for treatment of intracranial hypertension. (2003a). Pediatr Crit Care Med 4:S25-S27.
Adult;Pediatric
Supplemental
3.0
7/20/2013
Aliases for variable name not defined
Second Insults and Other Complications
Second Insults
Disease/Injury Related Events
Hypoxic episode indicator
 
Single Pre-Defined Value Selected
       
C05459
Cardiac arrest indicator
CardArrestInd
Indicator of cardiac arrest requiring cardiopulmonary resuscitation (i.e. at least two minutes of chest compressions). Cardiac arrest is a condition in which the heart suddenly and unexpectedly stops beating
Did participant/subject expierence cardiac arrest?
Yes;No;Suspected;Unknown;
Yes;No;Suspected;Unknown;
Alphanumeric
Choose one. This element is recommended for pediatric studies. Second insults may aggravate processes of secondary damage in a brain already rendered vulnerable by the primary injury. The main physiologic insults relevant to TBI are hypotension, hyper- or hypothermia, hypoxia, and hypocapnia due to hyperventilation. The adverse effect of the occurrence of such insults both pre- and in-hospital is well established. Second insults are commonly defined by threshold values but these values are not well established in pediatrics. Based on the available data for pediatric TBI , thresholds of 80-180 mg/dL for glucose are recommended. A threshold for hemoglobin is more difficult to define given emerging data on the lower limit of hemoglobin safely tolerated by critically ill children in general and the variable effect of blood transfusion in children with severe TBI specifically.
McHugh GS, Engel DC, Butcher I, et al. Prognostic value of secondary insults in traumatic brain injury: results from the IMPACT study. J Neurotrauma. Feb 2007;24(2):287-93. Signorini DF, Andrews PJ, Jones PA, et al. Adding insult to injury: the prognostic value of early secondary insults for survival after traumatic brain injury. J Neurol Neurosurg Psychiatry. Jan 1999;66(1):26-31 Adelson PD, Bratton SL, Carney, NA, Chesnut RM, du Coudray HE, Goldstein B, Kochanek PM, Miller HC, Partington MD, Selden NR, Warden CR, Wright DW. uidelines for the acute medical management of severe traumatic brain injury in infants, children, and adolescents. Chapter 6. Threshold for treatment of intracranial hypertension. (2003a). Pediatr Crit Care Med 4:S25-S27.
Adult;Pediatric
Supplemental
3.0
7/20/2013
Aliases for variable name not defined
Second Insults and Other Complications
Second Insults
Disease/Injury Related Events
Cardiac arrest indicator
 
Single Pre-Defined Value Selected
       
C05460
Seizure indicator
SeizInd
Indicator of seizure activity
Did participant/subject experience seizure(s)?
Yes;No;Suspected;Unknown;
Yes;No;Suspected;Unknown;
Alphanumeric
Choose one. Seizure activity in the brain may cause focal or generalized vasodilation with increased cerebral blood volume and high intracranial pressure. Moreover, metabolic requirements are increased in a situation where brain metabolism is already compromised. Seizures are therefore an important second insult following TBI.
McHugh GS, Engel DC, Butcher I, et al. Prognostic value of secondary insults in traumatic brain injury: results from the IMPACT study. J Neurotrauma. Feb 2007;24(2):287-93. Signorini DF, Andrews PJ, Jones PA, et al. Adding insult to injury: the prognostic value of early secondary insults for survival after traumatic brain injury. J Neurol Neurosurg Psychiatry. Jan 1999;66(1):26-31
Adult;Pediatric
Supplemental
3.0
7/20/2013
Aliases for variable name not defined
Second Insults and Other Complications
Second Insults
Disease/Injury Related Events
Seizure indicator
 
Single Pre-Defined Value Selected
       
C05461
Seizure presentation type
SeizPresentTyp
Type of seizure activity as convulsive or non-convulsive (diagnosed on EEG only, no motor manifestations)
Presentation of seizure
Convulsive;Non-convulsive;
Convulsive;Non-convulsive;
Alphanumeric
Choose one. This element is only answered if the participant/subject had a seizure. This element is recommended for pediatric studies. Second insults are commonly defined by threshold values but these values are not well established in pediatrics. Based on the available data for pediatric TBI , thresholds of 80-180 mg/dL for glucose are recommended. A threshold for hemoglobin is more difficult to define given emerging data on the lower limit of hemoglobin safely tolerated by critically ill children in general and the variable effect of blood transfusion in children with severe TBI specifically.
Adelson PD, Bratton SL, Carney, NA, Chesnut RM, du Coudray HE, Goldstein B, Kochanek PM, Miller HC, Partington MD, Selden NR, Warden CR, Wright DW. uidelines for the acute medical management of severe traumatic brain injury in infants, children, and adolescents. Chapter 6. Threshold for treatment of intracranial hypertension. (2003a). Pediatr Crit Care Med 4:S25-S27.
Adult;Pediatric
Supplemental
3.0
7/20/2013
Aliases for variable name not defined
Second Insults and Other Complications
Second Insults
Disease/Injury Related Events
Seizure presentation type
 
Single Pre-Defined Value Selected
       
C05454
Hypertension indicator
HypertensInd
Indicator of hypertension. In adults, hypertension is defined as a systolic pressure >= 140 and a diastolic >= 90. In children, it is defined as systolic blood pressure >95th percentile for age.
Did participant/subject experience hypertension?
Yes;No;Suspected;Unknown;
Yes;No;Suspected;Unknown;
Alphanumeric
Choose one. This element is recommended for pediatric studies. Second insults may aggravate processes of secondary damage in a brain already rendered vulnerable by the primary injury. The main physiologic insults relevant to TBI are hypotension, hyper- or hypothermia, hypoxia, and hypocapnia due to hyperventilation. The adverse effect of the occurrence of such insults both pre- and in-hospital is well established. Second insults are commonly defined by threshold values but these values are not well established in pediatrics. Based on the available data for pediatric TBI , thresholds of 80-180 mg/dL for glucose are recommended. A threshold for hemoglobin is more difficult to define given emerging data on the lower limit of hemoglobin safely tolerated by critically ill children in general and the variable effect of blood transfusion in children with severe TBI specifically.
McHugh GS, Engel DC, Butcher I, et al. Prognostic value of secondary insults in traumatic brain injury: results from the IMPACT study. J Neurotrauma. Feb 2007;24(2):287-93. Signorini DF, Andrews PJ, Jones PA, et al. Adding insult to injury: the prognostic value of early secondary insults for survival after traumatic brain injury. J Neurol Neurosurg Psychiatry. Jan 1999;66(1):26-31 Adelson PD, Bratton SL, Carney, NA, Chesnut RM, du Coudray HE, Goldstein B, Kochanek PM, Miller HC, Partington MD, Selden NR, Warden CR, Wright DW. uidelines for the acute medical management of severe traumatic brain injury in infants, children, and adolescents. Chapter 6. Threshold for treatment of intracranial hypertension. (2003a). Pediatr Crit Care Med 4:S25-S27.
Adult;Pediatric
Supplemental
3.0
7/20/2013
Aliases for variable name not defined
Second Insults and Other Complications
Second Insults
Disease/Injury Related Events
Hypertension indicator
 
Single Pre-Defined Value Selected
       
C05455
Hypothermia indicator
HypothermInd
Indicator of hypothermia. Hypothermia is defined as core temperature < 35 degrees Celsius
Did participant/subject experience hypothermia?
Yes;No;Suspected;Unknown;
Yes;No;Suspected;Unknown;
Alphanumeric
Choose one. Add date stamp for when assessed. Recommend collection at least during initial medical treatment. Second insults may be systemic (extracranial or intracranial). Second insults aggravate processes of secondary damage in a brain already rendered vulnerable by the primary injury. The occurrence of second insults occurring before hospital admission in patients with more severe injuries, is frequent: oxygen saturation below 90% is found in 44 to 55% of cases and hypotension in 20 to 30%. The occurrence of second insults is strongly associated with poorer outcome. Hypoxia, hypotension and inadvertent hypocapnia are the most frequent causes of jugular desaturations, and periods of low brain tissue oxygen tension. The depth and duration of systemic second insults during the clinical course is related to poorer outcome.
McHugh GS, Engel DC, Butcher I, et al. Prognostic value of secondary insults in traumatic brain injury: results from the IMPACT study. J Neurotrauma. Feb 2007;24(2):287-93. Silverstone P. Pulse oxymetry of at the road side: a study of pulse oxymetry in immediate care. BMJ. Mar 1989;298(6675):711-13. Stocchetti N, Furlan A, Volta F. Hypoxemia and arterial hypotension at the accident side in head injury. J Trauma. 1996;40:764-67. De Witt DS, Jenkins LW, Prough DS. Enhanced vulnerability to secondary ischemic insults after experimental traumatic brain injury. New Horizon. Aug 1995;3(3):376-383.
Adult;Pediatric
Supplemental
3.0
7/20/2013
Aliases for variable name not defined
Second Insults and Other Complications
Second Insults
Disease/Injury Related Events
Hypothermia indicator
 
Single Pre-Defined Value Selected
       
C05456
Hyperthermia indicator
HyperthermInd
Indicator of hyperthermia. Hyperthermia is defined as core temperature > 38 degrees Celsius
Did participant/subject experience hyperthermia?
Yes;No;Suspected;Unknown;
Yes;No;Suspected;Unknown;
Alphanumeric
Choose one. This element is recommended for pediatric studies. Second insults may aggravate processes of secondary damage in a brain already rendered vulnerable by the primary injury. The main physiologic insults relevant to TBI are hypotension, hyper- or hypothermia, hypoxia, and hypocapnia due to hyperventilation. The adverse effect of the occurrence of such insults both pre- and in-hospital is well established. Second insults are commonly defined by threshold values but these values are not well established in pediatrics. Based on the available data for pediatric TBI , thresholds of 80-180 mg/dL for glucose are recommended. A threshold for hemoglobin is more difficult to define given emerging data on the lower limit of hemoglobin safely tolerated by critically ill children in general and the variable effect of blood transfusion in children with severe TBI specifically.
McHugh GS, Engel DC, Butcher I, et al. Prognostic value of secondary insults in traumatic brain injury: results from the IMPACT study. J Neurotrauma. Feb 2007;24(2):287-93. Signorini DF, Andrews PJ, Jones PA, et al. Adding insult to injury: the prognostic value of early secondary insults for survival after traumatic brain injury. J Neurol Neurosurg Psychiatry. Jan 1999;66(1):26-31 Adelson PD, Bratton SL, Carney, NA, Chesnut RM, du Coudray HE, Goldstein B, Kochanek PM, Miller HC, Partington MD, Selden NR, Warden CR, Wright DW. uidelines for the acute medical management of severe traumatic brain injury in infants, children, and adolescents. Chapter 6. Threshold for treatment of intracranial hypertension. (2003a). Pediatr Crit Care Med 4:S25-S27.
Adult;Pediatric
Supplemental
3.0
7/20/2013
Aliases for variable name not defined
Second Insults and Other Complications
Second Insults
Disease/Injury Related Events
Hyperthermia indicator
 
Single Pre-Defined Value Selected
       
C05458
Inadvertent hypocapnia indicator
InadvertHypocapniaInd
Indicator of inadvertent hypocapnia episode. Inadvertent hypocapnia is defined as the partial pressure of carbon dioxide in the blood (paCo2) <= 25 mmHg (3.3 kPa), not deliberately employed to treat elevated intracranial pressure
Did participant/subject experience an inadvertent hypocapnia episode?
Yes;No;Suspected;Unknown;
Yes;No;Suspected;Unknown;
Alphanumeric
Choose one. Response obtained from medical charts and/or patient data management system. Add date stamp for when assessed. Recommend collection at least during initial medical treatment. Many types of second insults may occur in the in-hospital situation, both systemic and intracranial. Systemic second insults may for example also include episodes of hypoglaecemia, hyponatremia, hypernatremia, hyperthermia and many more. We chose to recommend to document the clinically most relevant and frequently occurring second insults: hypoxia, hypotension, inadvertent hypocapnia and seizure activity. Hypoxia, hypotension and inadvertent hypocapnia are the most frequent causes of jugular desaturations, and periods of low brain tissue oxygen tension. The depth and duration of systemic second insults during the clinical course is related to poorer outcome. In the intensive care environment with continuous monitoring, accurate detection of the number and duration of episodes of second insults should be possible. Thus permitting an accurate documentation of the number, depth and duration of these insults individually and summated per insult over a given period. Unfortunately, most commercially available monitoring systems do not include dedicated software to facilitate this approach. We therefore recommend to simply document the occurrence of second insults, differentiating single episodes of short duration from multiple episodes or those of more prolonged duration, as these latter may have more profound effects in aggravating secondary brain damage. Pediatric-specific notes: Second insults are commonly defined by threshold values but these values are not well established in pediatrics. Based on the available data for pediatric TBI , thresholds of 80-180 mg/dL for glucose are recommended. A threshold for hemoglobin is more difficult to define given emerging data on the lower limit of hemoglobin safely tolerated by critically ill children in general and the variable effect of blood transfusion in children with severe TBI specifically.
McHugh GS, Engel DC, Butcher I, et al. Prognostic value of secondary insults in traumatic brain injury: results from the IMPACT study. J Neurotrauma. Feb 2007;24(2):287-93. Signorini DF, Andrews PJ, Jones PA, et al. Adding insult to injury: the prognostic value of early secondary insults for survival after traumatic brain injury. J Neurol Neurosurg Psychiatry. Jan 1999;66(1):26-31 Pediatric reference: Adelson PD, Bratton SL, Carney, NA, Chesnut RM, du Coudray HE, Goldstein B, Kochanek PM, Miller HC, Partington MD, Selden NR, Warden CR, Wright DW. uidelines for the acute medical management of severe traumatic brain injury in infants, children, and adolescents. Chapter 6. Threshold for treatment of intracranial hypertension. (2003a). Pediatr Crit Care Med 4:S25-S27.
Adult;Pediatric
Supplemental
3.0
7/20/2013
Aliases for variable name not defined
Second Insults and Other Complications
Second Insults
Disease/Injury Related Events
Inadvertent hypocapnia indicator
 
Single Pre-Defined Value Selected
       
C05462
Seizure duration type
SeizDurType
Seizure described as intermittent or status epilepticus. Convulsive status epilepticus (CSE) is defined as either 2 or more convulsions without complete recovery of consciousness between seizures (intermittent CSE) or as a single prolonged seizure that lasts for at least 30 minutes (continuous CSE).
Seizure duration type
Intermittent;Status epilepticus;
Intermittent;Status epilepticus;
Alphanumeric
Choose one. This element is only answered if the participant/subject had a seizure. This element is recommended for pediatric studies.
Ostrowsky K, Arzimanoglou A. Outcome and prognosis of status epilepticus in children. Semin Pediatr Neurol. 2010 Sep;17(3):195-200.
Adult;Pediatric
Supplemental
3.0
7/20/2013
Aliases for variable name not defined
Second Insults and Other Complications
Second Insults
Disease/Injury Related Events
Seizure duration type
 
Single Pre-Defined Value Selected
       
C05463
EEG monitoring type
EEGMonitorType
Type of electroencephalogram (EEG) monitoring
EEG monitoring type
Routine;Continuous/prolonged;
Routine;Continuous/prolonged;
Alphanumeric
Choose one. Response is obtained from medical charts and/or patient data management system. This element is recommended for pediatric studies.
No references available
Adult;Pediatric
Supplemental
3.0
8/28/2013
Aliases for variable name not defined
Second Insults and Other Complications
Second Insults
Disease/Injury Related Events
EEG monitoring type
 
Single Pre-Defined Value Selected
       
C05464
Hyperventilation indicator
HyperventInd
Indicator of hyperventilation. Hyperventilation is defined as rapid, deep breathing, possibly exceeding 40 breaths/minute
Did participant/subject experience hyperventilation?
Yes;No;Suspected;Unknown;
Yes;No;Suspected;Unknown;
Alphanumeric
Choose one. Response is obtained from medical charts and/or patient data management system.
Chesnut RM, Marshall LF, Klauber MR, Blunt BA, Baldwin N, Eisenberg HM, Jane JA, Marmarou A, Foulkes MA. The role of secondary brain injury in determining outcome from severe head injury. J Trauma. 1993 Feb;34(2):216-22. McHugh GS, Engel DC, Butcher I, et al. Prognostic value of secondary insults in traumatic brain injury: results from the IMPACT study. J Neurotrauma. Feb 2007;24(2):287-93. Signorini DF, Andrews PJ, Jones PA, et al. Adding insult to injury: the prognostic value of early secondary insults for survival after traumatic brain injury. J Neurol Neurosurg Psychiatry. Jan 1999;66(1):26-31 Adelson PD, Bratton SL, Carney, NA, Chesnut RM, du Coudray HE, Goldstein B, Kochanek PM, Miller HC, Partington MD, Selden NR, Warden CR, Wright DW. uidelines for the acute medical management of severe traumatic brain injury in infants, children, and adolescents. Chapter 6. Threshold for treatment of intracranial hypertension. (2003a). Pediatr Crit Care Med 4:S25-S27.
Adult;Pediatric
Supplemental
3.0
7/20/2013
Aliases for variable name not defined
Second Insults and Other Complications
Second Insults
Disease/Injury Related Events
Hyperventilation indicator
 
Single Pre-Defined Value Selected
       
C05465
Aspiration indicator
AspiratnInd
Indicator of foreign material breathed into the airway
Did participant/subject experience aspiration of foreign materials?
Yes;No;Suspected;Unknown;
Yes;No;Suspected;Unknown;
Alphanumeric
Choose one. Response is obtained from medical charts and/or patient data management system. This element is recommended for pediatric studies. Second insults may aggravate processes of secondary damage in a brain already rendered vulnerable by the primary injury. The main physiologic insults relevant to TBI are hypotension, hyper- or hypothermia, hypoxia, and hypocapnia due to hyperventilation. The adverse effect of the occurrence of such insults both pre- and in-hospital is well established. Second insults are commonly defined by threshold values but these values are not well established in pediatrics. Based on the available data for pediatric TBI , thresholds of 80-180 mg/dL for glucose are recommended. A threshold for hemoglobin is more difficult to define given emerging data on the lower limit of hemoglobin safely tolerated by critically ill children in general and the variable effect of blood transfusion in children with severe TBI specifically.
Chesnut RM, Marshall LF, Klauber MR, Blunt BA, Baldwin N, Eisenberg HM, Jane JA, Marmarou A, Foulkes MA. The role of secondary brain injury in determining outcome from severe head injury. J Trauma. 1993 Feb;34(2):216-22. McHugh GS, Engel DC, Butcher I, et al. Prognostic value of secondary insults in traumatic brain injury: results from the IMPACT study. J Neurotrauma. Feb 2007;24(2):287-93. Signorini DF, Andrews PJ, Jones PA, et al. Adding insult to injury: the prognostic value of early secondary insults for survival after traumatic brain injury. J Neurol Neurosurg Psychiatry. Jan 1999;66(1):26-31 Adelson PD, Bratton SL, Carney, NA, Chesnut RM, du Coudray HE, Goldstein B, Kochanek PM, Miller HC, Partington MD, Selden NR, Warden CR, Wright DW. uidelines for the acute medical management of severe traumatic brain injury in infants, children, and adolescents. Chapter 6. Threshold for treatment of intracranial hypertension. (2003a). Pediatr Crit Care Med 4:S25-S27.
Adult;Pediatric
Supplemental
3.0
7/20/2013
Aliases for variable name not defined
Second Insults and Other Complications
Second Insults
Disease/Injury Related Events
Aspiration indicator
 
Single Pre-Defined Value Selected
       
12-11-2018
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