CDE Detailed Report

Disease: NeuroRehab
Subdomain Name: Other Clinical Data
CRF: Immediate Post-Concussion Assessment and Cognitive Testing (imPACT)

Displaying 1 - 50 of 109
CDE ID CDE Name Variable Name Definition Short Description Question Text Permissible Values Description Data Type Disease Specific Instructions Disease Specific Reference Population Classification (e.g., Core) Version Number Version Date CRF Name (CRF Module / Guidance) Subdomain Name Domain Name Size Input Restrictions Min Value Max Value Measurement Type External Id Loinc External Id Snomed External Id caDSR External Id CDISC
C21410 Immediate Post-Concussion Assessment Testing (ImPACT), the Post -Concussion Symptom Scale (PCSS) - Vomiting score ImPACTPCSSVomitingScore The subject's current vomiting rating score, as part of the Immediate Post-Concussion Assessment Testing (ImPACT), the Post -Concussion Symptom Scale (PCSS) The subject's current vomiting rating score, as part of the Immediate Post-Concussion Assessment Testing (ImPACT), the Post -Concussion Symptom Scale (PCSS Vomiting 1;2;3;4;5;6;0 Minor;Minor;Moderate;Moderate;Severe;Severe;Not experiencing this symptom Numeric Values Adult NeuroRehab Sport Related Concussion Core 1.00 2015-07-20 11:52:01.0 Immediate Post-Concussion Assessment and Cognitive Testing (imPACT) Other Clinical Data Assessments and Examinations

Single Pre-Defined Value Selected

C21442 Immediate Post-Concussion Assessment Testing (ImPACT) - Design memory delay correct distractor count ImPACTDesignMemDelayCorrDisCt The number of delayed correct distractors on the design memory module, as part of the Immediate Post-Concussion Assessment Testing (ImPACT) The number of delayed correct distractors on the design memory module, as part of the Immediate Post-Concussion Assessment Testing (ImPACT Correct distractors (delay) Numeric Values Adult NeuroRehab Sport Related Concussion Core 1.00 2015-07-20 11:52:01.0 Immediate Post-Concussion Assessment and Cognitive Testing (imPACT) Other Clinical Data Assessments and Examinations

Free-Form Entry

0 12
C21378 Immediate Post-Concussion Assessment Testing (ImPACT) - Headache treatment physician administered indicator ImPACTTreatHeadPhysicianInd Indicator of whether the subject was treated for headaches by a physician, as part of the Immediate Post-Concussion Assessment Testing (ImPACT) Indicator of whether the subject was treated for headaches by a physician, as part of the Immediate Post-Concussion Assessment Testing (ImPACT Treatment for headaches by physician No;Yes No;Yes Alphanumeric Adult NeuroRehab Sport Related Concussion Core 1.00 2015-07-20 11:52:01.0 Immediate Post-Concussion Assessment and Cognitive Testing (imPACT) Other Clinical Data Assessments and Examinations

Single Pre-Defined Value Selected

C21421 Immediate Post-Concussion Assessment Testing (ImPACT), the Post -Concussion Symptom Scale (PCSS) - Sadness score ImPACTPCSSSadnessScore The subject's current sadness rating score, as part of the Immediate Post-Concussion Assessment Testing (ImPACT), the Post -Concussion Symptom Scale (PCSS) The subject's current sadness rating score, as part of the Immediate Post-Concussion Assessment Testing (ImPACT), the Post -Concussion Symptom Scale (PCSS Sadness 1;2;3;4;5;6;0 Minor;Minor;Moderate;Moderate;Severe;Severe;Not experiencing this symptom Numeric Values Adult NeuroRehab Sport Related Concussion Core 1.00 2015-07-20 11:52:01.0 Immediate Post-Concussion Assessment and Cognitive Testing (imPACT) Other Clinical Data Assessments and Examinations

Single Pre-Defined Value Selected

C21453 Immediate Post-Concussion Assessment Testing (ImPACT) - Symbol match hidden average correct reaction time duration ImPACTSymbMatchHidAvgCorrRTDur The hidden average reaction time total correct duration, as part of the Immediate Post-Concussion Assessment Testing (ImPACT) The hidden average reaction time total correct duration, as part of the Immediate Post-Concussion Assessment Testing (ImPACT Avg. correct RT (hidden) Numeric Values Adult NeuroRehab Sport Related Concussion Core 1.00 2015-07-20 11:52:01.0 Immediate Post-Concussion Assessment and Cognitive Testing (imPACT) Other Clinical Data Assessments and Examinations

Free-Form Entry

0
C21389 Immediate Post-Concussion Assessment Testing (ImPACT) - Test version type ImPACTTestVersionType Type of test version used for the exam, as part of the Immediate Post-Concussion Assessment Testing (ImPACT) Type of test version used for the exam, as part of the Immediate Post-Concussion Assessment Testing (ImPACT Test Version Alphanumeric Adult NeuroRehab Sport Related Concussion Core 1.00 2015-07-20 11:52:01.0 Immediate Post-Concussion Assessment and Cognitive Testing (imPACT) Other Clinical Data Assessments and Examinations 10

Free-Form Entry

C21432 Immediate Post-Concussion Assessment Testing (ImPACT) - Word memory immediate correct distractor count ImPACTWordMemImmedCorrDisCt The number of immediate correct distractors identified on the word memory module, as part of the Immediate Post-Concussion Assessment Testing (ImPACT) The number of immediate correct distractors identified on the word memory module, as part of the Immediate Post-Concussion Assessment Testing (ImPACT Correct distractors (immed.) Numeric Values Adult NeuroRehab Sport Related Concussion Core 1.00 2015-07-20 11:52:01.0 Immediate Post-Concussion Assessment and Cognitive Testing (imPACT) Other Clinical Data Assessments and Examinations

Free-Form Entry

0 12
C21368 Immediate Post-Concussion Assessment Testing (ImPACT) - Current sport type ImPACTCurrentSportType Type of sport the subject participates currently, as part of the Immediate Post-Concussion Assessment Testing (ImPACT) Type of sport the subject participates currently, as part of the Immediate Post-Concussion Assessment Testing (ImPACT Current sport Alphanumeric Adult NeuroRehab Sport Related Concussion Core 1.00 2015-07-20 11:52:01.0 Immediate Post-Concussion Assessment and Cognitive Testing (imPACT) Other Clinical Data Assessments and Examinations 100

Free-Form Entry

C21464 Immediate Post-Concussion Assessment Testing (ImPACT) - Invalid assessment indicator ImPACTInvalidAssInd Indicator of whether the data is considered to be invalid, as part of the Immediate Post-Concussion Assessment Testing (ImPACT) Indicator of whether the data is considered to be invalid, as part of the Immediate Post-Concussion Assessment Testing (ImPACT No;Yes;Unknown No;Yes;Unknown Alphanumeric Adult NeuroRehab Sport Related Concussion Core 1.00 2015-07-20 11:52:01.0 Immediate Post-Concussion Assessment and Cognitive Testing (imPACT) Other Clinical Data Assessments and Examinations

Single Pre-Defined Value Selected

C21400 Immediate Post-Concussion Assessment Testing (ImPACT) - Reaction time composite percentage value ImPACTReactTimeCompPercVal The percentile of the subject's reaction time composite score (if available), as part of the Immediate Post-Concussion Assessment Testing (ImPACT) The percentile of the subject's reaction time composite score (if available), as part of the Immediate Post-Concussion Assessment Testing (ImPACT Reaction time composite Numeric Values Adult NeuroRehab Sport Related Concussion Core 1.00 2015-07-20 11:52:01.0 Immediate Post-Concussion Assessment and Cognitive Testing (imPACT) Other Clinical Data Assessments and Examinations

Free-Form Entry

0 100
C21411 Immediate Post-Concussion Assessment Testing (ImPACT), the Post -Concussion Symptom Scale (PCSS) - Balance problem score ImPACTPCSSBalanceProblemScore The subject's current balance problems rating score, as part of the Immediate Post-Concussion Assessment Testing (ImPACT), the Post -Concussion Symptom Scale (PCSS) The subject's current balance problems rating score, as part of the Immediate Post-Concussion Assessment Testing (ImPACT), the Post -Concussion Symptom Scale (PCSS Balance problems 1;2;3;4;5;6;0 Minor;Minor;Moderate;Moderate;Severe;Severe;Not experiencing this symptom Numeric Values Adult NeuroRehab Sport Related Concussion Core 1.00 2015-07-20 11:52:01.0 Immediate Post-Concussion Assessment and Cognitive Testing (imPACT) Other Clinical Data Assessments and Examinations

Single Pre-Defined Value Selected

C21443 Immediate Post-Concussion Assessment Testing (ImPACT) - Design memory delay percent correct percentage value ImPACTDesignMemDelCorrPercVal The delayed memory percent correct number on the design memory module, as part of the Immediate Post-Concussion Assessment Testing (ImPACT) The delayed memory percent correct number on the design memory module, as part of the Immediate Post-Concussion Assessment Testing (ImPACT Delayed memory pct. Correct Numeric Values Adult NeuroRehab Sport Related Concussion Core 1.00 2015-07-20 11:52:01.0 Immediate Post-Concussion Assessment and Cognitive Testing (imPACT) Other Clinical Data Assessments and Examinations

Free-Form Entry

0 100
C21379 Immediate Post-Concussion Assessment Testing (ImPACT) - Migraine treatment physician administered indicator ImPACTTreatMigPhysicianInd Indicator of whether the subject was treated for migraine by a physician, as part of the Immediate Post-Concussion Assessment Testing (ImPACT) Indicator of whether the subject was treated for migraine by a physician, as part of the Immediate Post-Concussion Assessment Testing (ImPACT Treatment for migraine headaches by physician No;Yes No;Yes Alphanumeric Adult NeuroRehab Sport Related Concussion Core 1.00 2015-07-20 11:52:01.0 Immediate Post-Concussion Assessment and Cognitive Testing (imPACT) Other Clinical Data Assessments and Examinations

Single Pre-Defined Value Selected

C21422 Immediate Post-Concussion Assessment Testing (ImPACT), the Post -Concussion Symptom Scale (PCSS) - Nervousness score ImPACTPCSSNervousnessScore The subject's current nervousness rating score, as part of the Immediate Post-Concussion Assessment Testing (ImPACT), the Post -Concussion Symptom Scale (PCSS) The subject's current nervousness rating score, as part of the Immediate Post-Concussion Assessment Testing (ImPACT), the Post -Concussion Symptom Scale (PCSS Nervousness 1;2;3;4;5;6;0 Minor;Minor;Moderate;Moderate;Severe;Severe;Not experiencing this symptom Numeric Values Adult NeuroRehab Sport Related Concussion Core 1.00 2015-07-20 11:52:01.0 Immediate Post-Concussion Assessment and Cognitive Testing (imPACT) Other Clinical Data Assessments and Examinations

Single Pre-Defined Value Selected

C00004 Birth country ISO code BirthCntryISOCode Code (ISO 3166-1 alpha-2 code) for country where the participant/subject was born Code (ISO 3166-1 alpha-2 code) for country where the participant/subject was born Native country/region AF;AX;AL;DZ;AS;AD;AO;AI;AQ;AG;AR;AM;AW;AU;AT;AZ;BS;BH;BD;BB;BY;BE;BZ;BJ;BM;BT;BO;BQ;BA;BW;BV;BR;IO;BN;BG;BF;BI;KH;CM;CA;CV;KY;CF;TD;CL;CN;CX;CC;CO;KM;CG;CD;CK;CR;CI;HR;CU;CW;CY;CZ;DK;DJ;DM;DO;EC;EG;SV;GQ;ER;EE;ET;FK;FO;FJ;FI;FR;GF;PF;TF;GA;GM;GE;DE;GH;GI;GR;GL;GD;GP;GU;GT;GG;GN;GW;GY;HT;HM;VA;HN;HK;HU;IS;IN;ID;IR;IQ;IE;IM;IL;IT;JM;JP;JE;JO;KZ;KE;KI;KP;KR;KW;KG;LA;LV;LB;LS;LR;LY;LI;LT;LU;MO;MK;MG;MW;MY;MV;ML;MT;MH;MQ;MR;MU;YT;MX;FM;MD;MC;MN;ME;MS;MA;MZ;MM;NA;NR;NP;NL;NC;NZ;NI;NE;NG;NU;NF;MP;NO;OM;PK;PW;PS;PA;PG;PY;PE;PH;PN;PL;PT;PR;QA;RE;RO;RU;RW;BL;SH;KN;LC;MF;PM;VC;WS;SM;ST;SA;SN;RS;SC;SL;SG;SX;SK;SI;SB;SO;ZA;GS;SS;ES;LK;SD;SR;SJ;SZ;SE;CH;SY;TW;TJ;TZ;TH;TL;TG;TK;TO;TT;TN;TR;TM;TC;TV;UG;UA;AE;GB;US;UM;UY;UZ;VU;VE;VN;VG;VI;WF;EH;YE;ZM;ZW AFGHANISTAN;ALAND ISLANDS;ALBANIA;ALGERIA;AMERICAN SAMOA;ANDORRA;ANGOLA;ANGUILLA;ANTARCTICA;ANTIGUA AND BARBUDA;ARGENTINA;ARMENIA;ARUBA;AUSTRALIA;AUSTRIA;AZERBAIJAN;BAHAMAS;BAHRAIN;BANGLADESH;BARBADOS;BELARUS;BELGIUM;BELIZE;BENIN;BERMUDA;BHUTAN;BOLIVIA, PLURINATIONAL STATE OF;BONAIRE, SINT EUSTATIUS AND SABA;BOSNIA AND HERZEGOVINA;BOTSWANA;BOUVET ISLAND;BRAZIL;BRITISH INDIAN OCEAN TERRITORY;BRUNEI DARUSSALAM;BULGARIA;BURKINA FASO;BURUNDI;CAMBODIA;CAMEROON;CANADA;CAPE VERDE;CAYMAN ISLANDS;CENTRAL AFRICAN REPUBLIC;CHAD;CHILE;CHINA;CHRISTMAS ISLAND;COCOS (KEELING) ISLANDS;COLOMBIA;COMOROS;CONGO;CONGO, THE DEMOCRATIC REPUBLIC OF THE;COOK ISLANDS;COSTA RICA;COTE D'IVOIRE;CROATIA;CUBA;CURACAO;CYPRUS;CZECH REPUBLIC;DENMARK;DJIBOUTI;DOMINICA;DOMINICAN REPUBLIC;ECUADOR;EGYPT;EL SALVADOR;EQUATORIAL GUINEA;ER;ESTONIA;ETHIOPIA;FALKLAND ISLANDS (MALVINAS);FAROE ISLANDS;FIJI;FINLAND;FRANCE;FRENCH GUIANA;FRENCH POLYNESIA;FRENCH SOUTHERN TERRITORIES;GABON;GAMBIA;GEORGIA;GERMANY;GHANA;GIBRALTAR;GREECE;GREENLAND;GRENADA;GUADELOUPE;GUAM;GUATEMALA;GUERNSEY;GUINEA;GUINEA-BISSAU;GUYANA;HAITI;HEARD ISLAND AND MCDONALD ISLANDS;HOLY SEE (VATICAN CITY STATE);HONDURAS;HONG KONG;HUNGARY;ICELAND;INDIA;INDONESIA;IRAN, ISLAMIC REPUBLIC OF;IRAQ;IRELAND;ISLE OF MAN;ISRAEL;ITALY;JAMAICA;JAPAN;JERSEY;JORDAN;KAZAKHSTAN;KENYA;KIRIBATI;KOREA, DEMOCRATIC PEOPLE'S REPUBLIC OF;KOREA, REPUBLIC OF;KUWAIT;KYRGYZSTAN;LAO PEOPLE'S DEMOCRATIC REPUBLIC;LATVIA;LEBANON;LESOTHO;LIBERIA;LIBYA;LIECHTENSTEIN;LITHUANIA;LUXEMBOURG;MACAO;MACEDONIA, THE FORMER YUGOSLAV REPUBLIC OF;MADAGASCAR;MALAWI;MALAYSIA;MALDIVES;MALI;MALTA;MARSHALL ISLANDS;MARTINIQUE;MAURITANIA;MAURITIUS;MAYOTTE;MEXICO;MICRONESIA, FEDERATED STATES OF;MOLDOVA, REPUBLIC OF;MONACO;MONGOLIA;MONTENEGRO;MONTSERRAT;MOROCCO;MOZAMBIQUE;MYANMAR;NAMIBIA;NAURU;NEPAL;NETHERLANDS;NEW CALEDONIA;NEW ZEALAND;NICARAGUA;NIGER;NIGERIA;NIUE;NORFOLK ISLAND;NORTHERN MARIANA ISLANDS;NORWAY;OMAN;PAKISTAN;PALAU;PALESTINIAN TERRITORY, OCCUPIED;PANAMA;PAPUA NEW GUINEA;PARAGUAY;PERU;PHILIPPINES;PITCAIRN;POLAND;PORTUGAL;PUERTO RICO;QATAR;REUNION;ROMANIA;RUSSIAN FEDERATION;RWANDA;SAINT BARTHELEMY;SAINT HELENA, ASCENSION AND TRISTAN DA CUNHA;SAINT KITTS AND NEVIS;SAINT LUCIA;SAINT MARTIN (FRENCH PART);SAINT PIERRE AND MIQUELON;SAINT VINCENT AND THE GRENADINES;SAMOA;SAN MARINO;SAO TOME AND PRINCIPE;SAUDI ARABIA;SENEGAL;SERBIA;SEYCHELLES;SIERRA LEONE;SINGAPORE;SINT MAARTEN (DUTCH PART);SLOVAKIA;SLOVENIA;SOLOMON ISLANDS;SOMALIA;SOUTH AFRICA;SOUTH GEORGIA AND THE SOUTH SANDWICH ISLANDS;SOUTH SUDAN;SPAIN;SRI LANKA;SUDAN;SURINAME;SVALBARD AND JAN MAYEN;SWAZILAND;SWEDEN;SWITZERLAND;SYRIAN ARAB REPUBLIC;TAIWAN, PROVINCE OF CHINA;TAJIKISTAN;TANZANIA, UNITED REPUBLIC OF;THAILAND;TIMOR-LESTE;TOGO;TOKELAU;TONGA;TRINIDAD AND TOBAGO;TUNISIA;TURKEY;TURKMENISTAN;TURKS AND CAICOS ISLANDS;TUVALU;UGANDA;UKRAINE;UNITED ARAB EMIRATES;UNITED KINGDOM;UNITED STATES;UNITED STATES MINOR OUTLYING ISLANDS;URUGUAY;UZBEKISTAN;VANUATU;VENEZUELA, BOLIVARIAN REPUBLIC OF;VIET NAM;VIRGIN ISLANDS, BRITISH;VIRGIN ISLANDS, U.S.;WALLIS AND FUTUNA;WESTERN SAHARA;YEMEN;ZAMBIA;ZIMBABWE Alphanumeric Adult NeuroRehab Sport Related Concussion Core 3.00 2013-07-24 21:00:23.88 Immediate Post-Concussion Assessment and Cognitive Testing (imPACT) Other Clinical Data Assessments and Examinations

Single Pre-Defined Value Selected

C21454 Immediate Post-Concussion Assessment Testing (ImPACT) - Color match total correct count ImPACTColorMatchTotCorrCt The number of total correct on the color match module, as part of the Immediate Post-Concussion Assessment Testing (ImPACT) The number of total correct on the color match module, as part of the Immediate Post-Concussion Assessment Testing (ImPACT Total correct Numeric Values Adult NeuroRehab Sport Related Concussion Core 1.00 2015-07-20 11:52:01.0 Immediate Post-Concussion Assessment and Cognitive Testing (imPACT) Other Clinical Data Assessments and Examinations

Free-Form Entry

0
C21390 Immediate Post-Concussion Assessment Testing (ImPACT) - Verbal memory composite score ImPACTVerbMemoryCompScore Verbal memory composite score, as part of the Immediate Post-Concussion Assessment Testing (ImPACT) Verbal memory composite score, as part of the Immediate Post-Concussion Assessment Testing (ImPACT Memory composite (verbal) Numeric Values Adult NeuroRehab Sport Related Concussion Core 1.00 2015-07-20 11:52:01.0 Immediate Post-Concussion Assessment and Cognitive Testing (imPACT) Other Clinical Data Assessments and Examinations

Free-Form Entry

0 100
C21433 Immediate Post-Concussion Assessment Testing (ImPACT) - Word memory learning correct percentage value ImPACTWordMemLearnCorrPercVal The learning percent correct number on the word memory module, as part of the Immediate Post-Concussion Assessment Testing (ImPACT) The learning percent correct number on the word memory module, as part of the Immediate Post-Concussion Assessment Testing (ImPACT Learning percent correct Numeric Values Adult NeuroRehab Sport Related Concussion Core 1.00 2015-07-20 11:52:01.0 Immediate Post-Concussion Assessment and Cognitive Testing (imPACT) Other Clinical Data Assessments and Examinations

Free-Form Entry

0 100
C21369 Immediate Post-Concussion Assessment Testing (ImPACT) - Primary position event class text ImPACTPrimPosEventClassText Primary type of position/event/class, as part of the Immediate Post-Concussion Assessment Testing (ImPACT) Primary type of position/event/class, as part of the Immediate Post-Concussion Assessment Testing (ImPACT Primary position/event/class Alphanumeric Adult NeuroRehab Sport Related Concussion Core 1.00 2015-07-20 11:52:01.0 Immediate Post-Concussion Assessment and Cognitive Testing (imPACT) Other Clinical Data Assessments and Examinations 400

Free-Form Entry

C21524 Language secondary text LangSecondaryTxt Text for the language the participant/subject speaks second-most often Text for the language the participant/subject speaks second-most often Secondary language eng;spa;sgn;chi;fre;ger;Other, specify English;Spanish;Sign Languages;Chinese languages;French;German;Other, specify Alphanumeric Adult NeuroRehab Sport Related Concussion Core 3.00 2013-07-20 10:21:25.65 Immediate Post-Concussion Assessment and Cognitive Testing (imPACT) Other Clinical Data Assessments and Examinations

Single Pre-Defined Value Selected

C21401 Immediate Post-Concussion Assessment Testing (ImPACT) - Reaction time Reliable Change Index (RCI) exceeded indicator ImPACTReactTimeRCIExceedInd Indicator of whether the subject's composite score in reaction time exceeded the Reliable Change Index (RCI), as part of the Immediate Post-Concussion Assessment Testing (ImPACT) Indicator of whether the subject's composite score in reaction time exceeded the Reliable Change Index (RCI), as part of the Immediate Post-Concussion Assessment Testing (ImPACT No;Yes No;Yes Alphanumeric Adult NeuroRehab Sport Related Concussion Core 1.00 2015-07-20 11:52:01.0 Immediate Post-Concussion Assessment and Cognitive Testing (imPACT) Other Clinical Data Assessments and Examinations

Single Pre-Defined Value Selected

C21412 Immediate Post-Concussion Assessment Testing (ImPACT), the Post -Concussion Symptom Scale (PCSS) - Dizziness score ImPACTPCSSDizzinessScore The subject's current dizziness rating score, as part of the Immediate Post-Concussion Assessment Testing (ImPACT), the Post -Concussion Symptom Scale (PCSS) The subject's current dizziness rating score, as part of the Immediate Post-Concussion Assessment Testing (ImPACT), the Post -Concussion Symptom Scale (PCSS Dizziness 1;2;3;4;5;6;0 Minor;Minor;Moderate;Moderate;Severe;Severe;Not experiencing this symptom Numeric Values Adult NeuroRehab Sport Related Concussion Core 1.00 2015-07-20 11:52:01.0 Immediate Post-Concussion Assessment and Cognitive Testing (imPACT) Other Clinical Data Assessments and Examinations

Single Pre-Defined Value Selected

C21444 Immediate Post-Concussion Assessment Testing (ImPACT) - Design memory total correct percentage value ImPACTDesignMemTotCorrPercVal The total percent correct on the design memory module, as part of the Immediate Post-Concussion Assessment Testing (ImPACT) The total percent correct on the design memory module, as part of the Immediate Post-Concussion Assessment Testing (ImPACT Total percent correct Numeric Values Adult NeuroRehab Sport Related Concussion Core 1.00 2015-07-20 11:52:01.0 Immediate Post-Concussion Assessment and Cognitive Testing (imPACT) Other Clinical Data Assessments and Examinations

Free-Form Entry

0 100
C21380 Immediate Post-Concussion Assessment Testing (ImPACT) - Epilepsy seizure treatment administered indicator ImPACTTreatEpilepSeizInd Indicator of whether the subject was treated for epilepsy/seizures, as part of the Immediate Post-Concussion Assessment Testing (ImPACT) Indicator of whether the subject was treated for epilepsy/seizures, as part of the Immediate Post-Concussion Assessment Testing (ImPACT Treatment for epilepsy/seizures: No;Yes No;Yes Alphanumeric Adult NeuroRehab Sport Related Concussion Core 1.00 2015-07-20 11:52:01.0 Immediate Post-Concussion Assessment and Cognitive Testing (imPACT) Other Clinical Data Assessments and Examinations

Single Pre-Defined Value Selected

C21423 Immediate Post-Concussion Assessment Testing (ImPACT), the Post -Concussion Symptom Scale (PCSS) - Emotional greater than normal score ImPACTPCSSFeelEmotionalScore The subject's current feeling more emotional rating score, as part of the Immediate Post-Concussion Assessment Testing (ImPACT), the Post -Concussion Symptom Scale (PCSS) The subject's current feeling more emotional rating score, as part of the Immediate Post-Concussion Assessment Testing (ImPACT), the Post -Concussion Symptom Scale (PCSS Feeling more emotional 1;2;3;4;5;6;0 Minor;Minor;Moderate;Moderate;Severe;Severe;Not experiencing this symptom Numeric Values Adult NeuroRehab Sport Related Concussion Core 1.00 2015-07-20 11:52:01.0 Immediate Post-Concussion Assessment and Cognitive Testing (imPACT) Other Clinical Data Assessments and Examinations

Single Pre-Defined Value Selected

C00005 Birth country name BirthCntryName Name for country where the participant/subject was born Name for country where the participant/subject was born Native country/region Alphanumeric Adult NeuroRehab Sport Related Concussion Core 3.00 2013-07-24 21:00:23.88 Immediate Post-Concussion Assessment and Cognitive Testing (imPACT) Other Clinical Data Assessments and Examinations 255

Free-Form Entry

C21455 Immediate Post-Concussion Assessment Testing (ImPACT) - Color match average correct reaction time duration ImPACTColorMatchAvgCorrRTDur The average correct reaction time duration on the color match module, as part of the Immediate Post-Concussion Assessment Testing (ImPACT) The average correct reaction time duration on the color match module, as part of the Immediate Post-Concussion Assessment Testing (ImPACT Avg. correct RT Numeric Values Adult NeuroRehab Sport Related Concussion Core 1.00 2015-07-20 11:52:01.0 Immediate Post-Concussion Assessment and Cognitive Testing (imPACT) Other Clinical Data Assessments and Examinations

Free-Form Entry

0
C21391 Immediate Post-Concussion Assessment Testing (ImPACT) - Verbal memory composite percentage value ImPACTVerbMemCompPercVal The percentile of the subject's verbal memory composite score (if available), as part of the Immediate Post-Concussion Assessment Testing (ImPACT) The percentile of the subject's verbal memory composite score (if available), as part of the Immediate Post-Concussion Assessment Testing (ImPACT Memory composite (verbal) Numeric Values Adult NeuroRehab Sport Related Concussion Core 1.00 2015-07-20 11:52:01.0 Immediate Post-Concussion Assessment and Cognitive Testing (imPACT) Other Clinical Data Assessments and Examinations

Free-Form Entry

0 100
C21434 Immediate Post-Concussion Assessment Testing (ImPACT) - Word memory delay hit count ImPACTWordMemDelayHitCt The number of delayed hits on the word memory module, as part of the Immediate Post-Concussion Assessment Testing (ImPACT) The number of delayed hits on the word memory module, as part of the Immediate Post-Concussion Assessment Testing (ImPACT Hits (delay) Numeric Values Adult NeuroRehab Sport Related Concussion Core 1.00 2015-07-20 11:52:01.0 Immediate Post-Concussion Assessment and Cognitive Testing (imPACT) Other Clinical Data Assessments and Examinations

Free-Form Entry

0 12
C21370 Immediate Post-Concussion Assessment Testing (ImPACT) - Current participation level type ImPACTCurrentPartLvlTyp Current type of level of participation in sports, as part of the Immediate Post-Concussion Assessment Testing (ImPACT) Current type of level of participation in sports, as part of the Immediate Post-Concussion Assessment Testing (ImPACT Current level of participation Pro;Semi-Pro;Collegiate;HS;JHS Pro;Semi-Pro;Collegiate;HS;JHS Alphanumeric Adult NeuroRehab Sport Related Concussion Core 1.00 2015-07-20 11:52:01.0 Immediate Post-Concussion Assessment and Cognitive Testing (imPACT) Other Clinical Data Assessments and Examinations

Single Pre-Defined Value Selected

C21525 Language secondary ISO code LangSecondaryCode Code (ISO 639-2) for the language the participant/subject speaks second-most often Code (ISO 639-2) for the language the participant/subject speaks second-most often Secondary language ISO code Alphanumeric Adult NeuroRehab Sport Related Concussion Core 3.00 2013-07-20 10:21:25.65 Immediate Post-Concussion Assessment and Cognitive Testing (imPACT) Other Clinical Data Assessments and Examinations 255

Free-Form Entry

C21402 Immediate Post-Concussion Assessment Testing (ImPACT) - Impulse control composite score ImPACTImplseCntrlCompScore Impulse control composite score, as part of the Immediate Post-Concussion Assessment Testing (ImPACT) Impulse control composite score, as part of the Immediate Post-Concussion Assessment Testing (ImPACT Impulse control composite Numeric Values Adult NeuroRehab Sport Related Concussion Core 1.00 2015-07-20 11:52:01.0 Immediate Post-Concussion Assessment and Cognitive Testing (imPACT) Other Clinical Data Assessments and Examinations

Free-Form Entry

0
C21413 Immediate Post-Concussion Assessment Testing (ImPACT), the Post -Concussion Symptom Scale (PCSS) - Fatigue score ImPACTPCSSFatigueScore The subject's current fatigue rating score, as part of the Immediate Post-Concussion Assessment Testing (ImPACT), the Post -Concussion Symptom Scale (PCSS) The subject's current fatigue rating score, as part of the Immediate Post-Concussion Assessment Testing (ImPACT), the Post -Concussion Symptom Scale (PCSS Fatigue 1;2;3;4;5;6;0 Minor;Minor;Moderate;Moderate;Severe;Severe;Not experiencing this symptom Numeric Values Adult NeuroRehab Sport Related Concussion Core 1.00 2015-07-20 11:52:01.0 Immediate Post-Concussion Assessment and Cognitive Testing (imPACT) Other Clinical Data Assessments and Examinations

Single Pre-Defined Value Selected

C21445 Immediate Post-Concussion Assessment Testing (ImPACT) - X and O memory total correct count ImPACTXOMemTotCorrectCt The memory total correct on the X's and O's module, as part of the Immediate Post-Concussion Assessment Testing (ImPACT) The memory total correct on the X's and O's module, as part of the Immediate Post-Concussion Assessment Testing (ImPACT Total correct (memory) Numeric Values Adult NeuroRehab Sport Related Concussion Core 1.00 2015-07-20 11:52:01.0 Immediate Post-Concussion Assessment and Cognitive Testing (imPACT) Other Clinical Data Assessments and Examinations

Free-Form Entry

0 12
C21381 Immediate Post-Concussion Assessment Testing (ImPACT) - Brain surgery patient medical history indicator ImPACTHxBrainSurgInd Indicator of whether the subject has a history of brain surgery, as part of the Immediate Post-Concussion Assessment Testing (ImPACT) Indicator of whether the subject has a history of brain surgery, as part of the Immediate Post-Concussion Assessment Testing (ImPACT History of brain surgery No;Yes No;Yes Alphanumeric Adult NeuroRehab Sport Related Concussion Core 1.00 2015-07-20 11:52:01.0 Immediate Post-Concussion Assessment and Cognitive Testing (imPACT) Other Clinical Data Assessments and Examinations

Single Pre-Defined Value Selected

C21424 Immediate Post-Concussion Assessment Testing (ImPACT), the Post -Concussion Symptom Scale (PCSS) - Numbness tingling assessment score ImPACTPCSSNumbTingleScore The subject's current numbness or tingling rating score, as part of the Immediate Post-Concussion Assessment Testing (ImPACT), the Post -Concussion Symptom Scale (PCSS) The subject's current numbness or tingling rating score, as part of the Immediate Post-Concussion Assessment Testing (ImPACT), the Post -Concussion Symptom Scale (PCSS Numbness or tingling 1;2;3;4;5;6;0 Minor;Minor;Moderate;Moderate;Severe;Severe;Not experiencing this symptom Numeric Values Adult NeuroRehab Sport Related Concussion Core 1.00 2015-07-20 11:52:01.0 Immediate Post-Concussion Assessment and Cognitive Testing (imPACT) Other Clinical Data Assessments and Examinations

Single Pre-Defined Value Selected

C00024 Language primary ISO code LangPrimryCode Code (ISO 639-2) for the language the participant/subject speaks most often Code (ISO 639-2) for the language the participant/subject speaks most often Native language Alphanumeric Adult NeuroRehab Sport Related Concussion Core 3.00 2013-07-20 10:21:25.65 Immediate Post-Concussion Assessment and Cognitive Testing (imPACT) Other Clinical Data Assessments and Examinations 255

Free-Form Entry

C21456 Immediate Post-Concussion Assessment Testing (ImPACT) - Color match total commission count ImPACTColorMatchTotCommCt The number of total commissions on the color match module, as part of the Immediate Post-Concussion Assessment Testing (ImPACT) The number of total commissions on the color match module, as part of the Immediate Post-Concussion Assessment Testing (ImPACT Total commissions Numeric Values Adult NeuroRehab Sport Related Concussion Core 1.00 2015-07-20 11:52:01.0 Immediate Post-Concussion Assessment and Cognitive Testing (imPACT) Other Clinical Data Assessments and Examinations

Free-Form Entry

0
C21392 Immediate Post-Concussion Assessment Testing (ImPACT) - Verbal memory Reliable Change Index (RCI) exceed indicator ImPACTVerbMemRCIExceedInd Indicator of whether the subject's composite score in verbal memory exceeded the Reliable Change Index (RCI), as part of the Immediate Post-Concussion Assessment Testing (ImPACT) Indicator of whether the subject's composite score in verbal memory exceeded the Reliable Change Index (RCI), as part of the Immediate Post-Concussion Assessment Testing (ImPACT No;Yes No;Yes Alphanumeric Adult NeuroRehab Sport Related Concussion Core 1.00 2015-07-20 11:52:01.0 Immediate Post-Concussion Assessment and Cognitive Testing (imPACT) Other Clinical Data Assessments and Examinations

Single Pre-Defined Value Selected

C21435 Immediate Post-Concussion Assessment Testing (ImPACT) - Word memory delay correct distractor count ImPACTWordMemDelayCorrDisCt The number of delay correct distractors identified on the word memory module, as part of the Immediate Post-Concussion Assessment Testing (ImPACT) The number of delay correct distractors identified on the word memory module, as part of the Immediate Post-Concussion Assessment Testing (ImPACT Correct distractors (delay) Numeric Values Adult NeuroRehab Sport Related Concussion Core 1.00 2015-07-20 11:52:01.0 Immediate Post-Concussion Assessment and Cognitive Testing (imPACT) Other Clinical Data Assessments and Examinations

Free-Form Entry

0 12
C21371 Immediate Post-Concussion Assessment Testing (ImPACT) - Current participation level year count ImPACTYrsExpLevelCt Number of years experience at current participation level, as part of the Immediate Post-Concussion Assessment Testing (ImPACT) Number of years experience at current participation level, as part of the Immediate Post-Concussion Assessment Testing (ImPACT Years of experience at this level Numeric Values Adult NeuroRehab Sport Related Concussion Core 1.00 2015-07-20 11:52:01.0 Immediate Post-Concussion Assessment and Cognitive Testing (imPACT) Other Clinical Data Assessments and Examinations

Free-Form Entry

0
C21403 Immediate Post-Concussion Assessment Testing (ImPACT) - Impulse control composite percentage value ImPACTImplseCntrlCompPercVal The percentile of the subject's impulse control composite score (if available), as part of the Immediate Post-Concussion Assessment Testing (ImPACT) The percentile of the subject's impulse control composite score (if available), as part of the Immediate Post-Concussion Assessment Testing (ImPACT Impulse control composite Numeric Values Adult NeuroRehab Sport Related Concussion Core 1.00 2015-07-20 11:52:01.0 Immediate Post-Concussion Assessment and Cognitive Testing (imPACT) Other Clinical Data Assessments and Examinations

Free-Form Entry

0 100
C21414 Immediate Post-Concussion Assessment Testing (ImPACT), the Post -Concussion Symptom Scale (PCSS) - Falling asleep trouble score ImPACTPCSSTroubFallAsleepScore The subject's current trouble falling asleep rating score, as part of the Immediate Post-Concussion Assessment Testing (ImPACT), the Post -Concussion Symptom Scale (PCSS) The subject's current trouble falling asleep rating score, as part of the Immediate Post-Concussion Assessment Testing (ImPACT), the Post -Concussion Symptom Scale (PCSS Trouble falling asleep 1;2;3;4;5;6;0 Minor;Minor;Moderate;Moderate;Severe;Severe;Not experiencing this symptom Numeric Values Adult NeuroRehab Sport Related Concussion Core 1.00 2015-07-20 11:52:01.0 Immediate Post-Concussion Assessment and Cognitive Testing (imPACT) Other Clinical Data Assessments and Examinations

Single Pre-Defined Value Selected

C21446 Immediate Post-Concussion Assessment Testing (ImPACT) - X and O interference total correct count ImPACTXOInterTotCorrCt The interference total correct on the X's and O's module, as part of the Immediate Post-Concussion Assessment Testing (ImPACT) The interference total correct on the X's and O's module, as part of the Immediate Post-Concussion Assessment Testing (ImPACT Total correct (interference) Numeric Values Adult NeuroRehab Sport Related Concussion Core 1.00 2015-07-20 11:52:01.0 Immediate Post-Concussion Assessment and Cognitive Testing (imPACT) Other Clinical Data Assessments and Examinations

Free-Form Entry

0
C21382 Immediate Post-Concussion Assessment Testing (ImPACT) - Substance alcohol abuse treatment administered indicator ImPACTTreatSubAlcoholAbusInd Indicator of whether the subject has received treatment for substance or alcohol abuse, as part of the Immediate Post-Concussion Assessment Testing (ImPACT) Indicator of whether the subject has received treatment for substance or alcohol abuse, as part of the Immediate Post-Concussion Assessment Testing (ImPACT Treatment for substance/alcohol abuse No;Yes No;Yes Alphanumeric Adult NeuroRehab Sport Related Concussion Core 1.00 2015-07-20 11:52:01.0 Immediate Post-Concussion Assessment and Cognitive Testing (imPACT) Other Clinical Data Assessments and Examinations

Single Pre-Defined Value Selected

C21425 Immediate Post-Concussion Assessment Testing (ImPACT), the Post -Concussion Symptom Scale (PCSS) - Slowed down assessment score ImPACTPCSSFeelSlowDownScore The subject's current feeling slowed down rating score, as part of the Immediate Post-Concussion Assessment Testing (ImPACT), the Post -Concussion Symptom Scale (PCSS) The subject's current feeling slowed down rating score, as part of the Immediate Post-Concussion Assessment Testing (ImPACT), the Post -Concussion Symptom Scale (PCSS Feeling slowed down 1;2;3;4;5;6;0 Minor;Minor;Moderate;Moderate;Severe;Severe;Not experiencing this symptom Numeric Values Adult NeuroRehab Sport Related Concussion Core 1.00 2015-07-20 11:52:01.0 Immediate Post-Concussion Assessment and Cognitive Testing (imPACT) Other Clinical Data Assessments and Examinations

Single Pre-Defined Value Selected

C00025 Language primary text LangPrimryTxt Text for the language the participant/subject speaks most often Text for the language the participant/subject speaks most often Native language eng;spa;sgn;chi;fre;ger;Other, specify English;Spanish;Sign Languages;Chinese languages;French;German;Other, specify Alphanumeric Adult NeuroRehab Sport Related Concussion Core 3.00 2013-07-20 10:21:25.65 Immediate Post-Concussion Assessment and Cognitive Testing (imPACT) Other Clinical Data Assessments and Examinations

Single Pre-Defined Value Selected

C21457 Immediate Post-Concussion Assessment Testing (ImPACT) - Color match average commissions reaction time duration ImPACTColorMatchAvgCommRTDur The average commissions reaction time duration on the color match module, as part of the Immediate Post-Concussion Assessment Testing (ImPACT) The average commissions reaction time duration on the color match module, as part of the Immediate Post-Concussion Assessment Testing (ImPACT Avg. commissions RT Numeric Values Adult NeuroRehab Sport Related Concussion Core 1.00 2015-07-20 11:52:01.0 Immediate Post-Concussion Assessment and Cognitive Testing (imPACT) Other Clinical Data Assessments and Examinations

Free-Form Entry

0
C21393 Immediate Post-Concussion Assessment Testing (ImPACT) - Visual memory composite score ImPACTVisMemoryCompScore Visual memory composite score, as part of the Immediate Post-Concussion Assessment Testing (ImPACT) Visual memory composite score, as part of the Immediate Post-Concussion Assessment Testing (ImPACT Memory composite (visual) Numeric Values Adult NeuroRehab Sport Related Concussion Core 1.00 2015-07-20 11:52:01.0 Immediate Post-Concussion Assessment and Cognitive Testing (imPACT) Other Clinical Data Assessments and Examinations

Free-Form Entry

0 100
C21436 Immediate Post-Concussion Assessment Testing (ImPACT) - Word memory delayed percent correct percentage value ImPACTWordMemDelayCorrPercVal The delayed memory percent correct number on the word memory module, as part of the Immediate Post-Concussion Assessment Testing (ImPACT) The delayed memory percent correct number on the word memory module, as part of the Immediate Post-Concussion Assessment Testing (ImPACT Delayed memory pct. Correct Numeric Values Adult NeuroRehab Sport Related Concussion Core 1.00 2015-07-20 11:52:01.0 Immediate Post-Concussion Assessment and Cognitive Testing (imPACT) Other Clinical Data Assessments and Examinations

Free-Form Entry

0 100
CSV