CDE Detailed Report
Disease: NeuroRehab
Subdomain Name: Other Clinical Data
CRF: Immediate Post-Concussion Assessment and Cognitive Testing (imPACT)
Displaying 1 - 50 of 109
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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 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 |
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| 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 |
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| 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 | |||||||||||
| 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 |
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| 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 |
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| 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 |
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| 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 |
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| 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 |
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| 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 | ||||||||||
| 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 |
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| 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 |
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| 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 |
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| 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 |
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| 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 | ||||||||||
| C21372 | Immediate Post-Concussion Assessment Testing (ImPACT) - Loss of consciousness concussion result count | ImPACTConcussResultLOCCt | Number of concussions that resulted in loss of consciousness (LOC), as part of the Immediate Post-Concussion Assessment Testing (ImPACT) | Number of concussions that resulted in loss of consciousness (LOC), as part of the Immediate Post-Concussion Assessment Testing (ImPACT | Concussions that resulted in loss of consciousness | 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 | |||||||||||
| C21404 | Immediate Post-Concussion Assessment Testing (ImPACT) - Impulse control Reliable Change Index (RCI) exceeded indicator | ImPACTImplseCntrlRCIExceedInd | Indicator of whether the subject's composite score in impulse control 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 impulse control 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 |
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| C21447 | Immediate Post-Concussion Assessment Testing (ImPACT) - X and O interference average correct reaction time duration | ImPACTXOInterAvgCorrRTDur | The interference average correct reaction time duration on the X's and O's module, as part of the Immediate Post-Concussion Assessment Testing (ImPACT) | The interference average correct reaction time duration on the X's and O's module, as part of the Immediate Post-Concussion Assessment Testing (ImPACT | Avg. correct RT (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 | |||||||||||
| C21383 | Immediate Post-Concussion Assessment Testing (ImPACT) - Psychiatric condition treatment administered indicator | ImPACTTreatPsychiatricCondInd | Indicator of whether the subject has received treatment for a psychiatric condition such as depression or anxiety, as part of the Immediate Post-Concussion Assessment Testing (ImPACT) | Indicator of whether the subject has received treatment for a psychiatric condition such as depression or anxiety, as part of the Immediate Post-Concussion Assessment Testing (ImPACT | Treatment for psychiatric condition (depression, anxiety) | 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 |
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| C21415 | Immediate Post-Concussion Assessment Testing (ImPACT), the Post -Concussion Symptom Scale (PCSS) - Sleep greater than normal duration score | ImPACTPCSSSlpMoreThnUsualScore | The subject's current sleep more than usual rating score, as part of the Immediate Post-Concussion Assessment Testing (ImPACT), the Post -Concussion Symptom Scale (PCSS) | The subject's current sleep more than usual rating score, as part of the Immediate Post-Concussion Assessment Testing (ImPACT), the Post -Concussion Symptom Scale (PCSS | Sleeping more than usual | 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 |
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| C21426 | Immediate Post-Concussion Assessment Testing (ImPACT), the Post -Concussion Symptom Scale (PCSS) - Mental fog assessment score | ImPACTPCSSFeelMentFogScore | The subject's current feeling mentally foggy rating score, as part of the Immediate Post-Concussion Assessment Testing (ImPACT), the Post -Concussion Symptom Scale (PCSS) | The subject's current feeling mentally foggy rating score, as part of the Immediate Post-Concussion Assessment Testing (ImPACT), the Post -Concussion Symptom Scale (PCSS | Feeling mentally foggy | 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 |
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| C02014 | Medication prior or concomitant name | MedctnPriorConcomName | Name of the prior/concomitant agent or drug administered | Name of the prior/concomitant agent or drug administere | Prior or concomitant medication name | Alphanumeric | Adult | NeuroRehab Sport Related Concussion Core | 3.00 | 2013-08-28 16:08:00.453 | Immediate Post-Concussion Assessment and Cognitive Testing (imPACT) | Other Clinical Data | Assessments and Examinations | 4000 |
Free-Form Entry |
3162728 | ||||||||||
| C21458 | Immediate Post-Concussion Assessment Testing (ImPACT) - Three letters total sequence correct count | ImPACTThreeLetTotSeqCorrCt | The number of total sequence items correct on the three letters module, as part of the Immediate Post-Concussion Assessment Testing (ImPACT) | The number of total sequence items correct on the three letters module, as part of the Immediate Post-Concussion Assessment Testing (ImPACT | Total sequence 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 | 5 | ||||||||||
| C21394 | Immediate Post-Concussion Assessment Testing (ImPACT) - Visual memory composite percentage value | ImPACTVisMemCompPercVal | The percentile of the subject's visual memory composite score (if available), as part of the Immediate Post-Concussion Assessment Testing (ImPACT) | The percentile of the subject's visual memory composite score (if available), 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 | ||||||||||
| C21437 | Immediate Post-Concussion Assessment Testing (ImPACT) - Word memory total percent correct percentage value | ImPACTWordMemTotCorrPercVal | The total percent correct on the word memory module, as part of the Immediate Post-Concussion Assessment Testing (ImPACT) | The total percent correct on the word 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 | ||||||||||
| C21373 | Immediate Post-Concussion Assessment Testing (ImPACT) - Confusion concussion result count | ImPACTConcussResultConfCt | Number of concussions that resulted in confusion, as part of the Immediate Post-Concussion Assessment Testing (ImPACT) | Number of concussions that resulted in confusion, as part of the Immediate Post-Concussion Assessment Testing (ImPACT | Concussions that resulted in confusion | 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 | |||||||||||
| C21405 | Immediate Post-Concussion Assessment Testing (ImPACT) - Total symptom Reliable Change Index (RCI) exceeded indicator | ImPACTTotalSymptomRCIExceedInd | Indicator of whether the subject's total symptom score exceeded the Reliable Change Index (RCI), as part of the Immediate Post-Concussion Assessment Testing (ImPACT) | Indicator of whether the subject's total symptom score 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 |
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| C21448 | Immediate Post-Concussion Assessment Testing (ImPACT) - X and O interference total incorrect count | ImPACTXOInterTotIncorrCt | The interference total incorrect number on the X's and O's module, as part of the Immediate Post-Concussion Assessment Testing (ImPACT) | The interference total incorrect number on the X's and O's module, as part of the Immediate Post-Concussion Assessment Testing (ImPACT | Total incorrect (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 | |||||||||||
| C21384 | Immediate Post-Concussion Assessment Testing (ImPACT) - Dyslexia diagnosis indicator | ImPACTDxDyslexiaInd | Indicator of whether the subject has been diagnosed with dyslexia, as part of the Immediate Post-Concussion Assessment Testing (ImPACT) | Indicator of whether the subject has been diagnosed with dyslexia, as part of the Immediate Post-Concussion Assessment Testing (ImPACT | Diagnosed with Dyslexia | 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 |
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| C21416 | Immediate Post-Concussion Assessment Testing (ImPACT), the Post -Concussion Symptom Scale (PCSS) - Sleep less than normal duration score | ImPACTPCSSSlpLessThnUsualScore | The subject's current sleep less than usual rating score, as part of the Immediate Post-Concussion Assessment Testing (ImPACT), the Post -Concussion Symptom Scale (PCSS) | The subject's current sleep less than usual rating score, as part of the Immediate Post-Concussion Assessment Testing (ImPACT), the Post -Concussion Symptom Scale (PCSS | Sleeping less than usual | 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 |
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| C21427 | Immediate Post-Concussion Assessment Testing (ImPACT), the Post -Concussion Symptom Scale (PCSS) - Concentration difficultly assessment score | ImPACTPCSSDiffConcentrateScore | The subject's current difficulty concentrating rating score, as part of the Immediate Post-Concussion Assessment Testing (ImPACT), the Post -Concussion Symptom Scale (PCSS) | The subject's current difficulty concentrating rating score, as part of the Immediate Post-Concussion Assessment Testing (ImPACT), the Post -Concussion Symptom Scale (PCSS | Difficulty concentrating | 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 |
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| C21363 | Immediate Post-Concussion Assessment Testing (ImPACT) - Second language spoken year duration | ImPACTSecondLanguageYrDur | The count of years the subject spoke a language, as part of the Immediate Post-Concussion Assessment Testing (ImPACT) | The count of years the subject spoke a language, as part of the Immediate Post-Concussion Assessment Testing (ImPACT | Years speaking | 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 | |||||||||||
| C21459 | Immediate Post-Concussion Assessment Testing (ImPACT) - Three letters total letters correct count | ImPACTThreeLetTotLetCorrCt | The number of total correct letters on the three letters module, as part of the Immediate Post-Concussion Assessment Testing (ImPACT) | The number of total correct letters on the three letters module, as part of the Immediate Post-Concussion Assessment Testing (ImPACT | Total letters 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 | 15 | ||||||||||
| C21395 | Immediate Post-Concussion Assessment Testing (ImPACT) - Visual memory Reliable Change Index (RCI) exceeded indicator | ImPACTVisMemRCIExceedInd | Indicator of whether the subject's composite score in visual 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 visual 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 |
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| C21438 | Immediate Post-Concussion Assessment Testing (ImPACT) - Design memory immediate hit count | ImPACTDesignMemImmedHitCt | The number of immediate hits on the design memory module, as part of the Immediate Post-Concussion Assessment Testing (ImPACT) | The number of immediate hits on the design memory module, as part of the Immediate Post-Concussion Assessment Testing (ImPACT | Hits (Immediate) | 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 | ||||||||||
| C21374 | Immediate Post-Concussion Assessment Testing (ImPACT) - Memory loss post injury concussion result count | ImPACTConcussResMemLossAftCt | Number of concussions that resulted in loss of memory of events immediately after injury, as part of the Immediate Post-Concussion Assessment Testing (ImPACT) | Number of concussions that resulted in loss of memory of events immediately after injury, as part of the Immediate Post-Concussion Assessment Testing (ImPACT | Concussions that resulted in difficulty remembering events that occurred immediately after injury | 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 | |||||||||||
| C21406 | Immediate Post-Concussion Assessment Testing (ImPACT) - Cognitive efficiency index score | ImPACTCogEfficiencyIndexScore | Cognitive efficiency index score (CEI) is the subject's cognitive efficiency index score, as part of the Immediate Post-Concussion Assessment Testing (ImPACT) | Cognitive efficiency index score (CEI) is the subject's cognitive efficiency index score, as part of the Immediate Post-Concussion Assessment Testing (ImPACT | Cognitive Efficiency Index: | 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 |
-1 | 1 | ||||||||||
| C21417 | Immediate Post-Concussion Assessment Testing (ImPACT), the Post -Concussion Symptom Scale (PCSS) - Drowsiness score | ImPACTPCSSDrowsinessScore | The subject's current drowsiness rating score, as part of the Immediate Post-Concussion Assessment Testing (ImPACT), the Post -Concussion Symptom Scale (PCSS) | The subject's current drowsiness rating score, as part of the Immediate Post-Concussion Assessment Testing (ImPACT), the Post -Concussion Symptom Scale (PCSS | Drowsiness | 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 |
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| C21449 | Immediate Post-Concussion Assessment Testing (ImPACT) - X and O interference average incorrect reaction time duration | ImPACTXOInterAvgIncorrRTDur | The interference average incorrect reaction time duration on the X's and O's module, as part of the Immediate Post-Concussion Assessment Testing (ImPACT) | The interference average incorrect reaction time duration on the X's and O's module, as part of the Immediate Post-Concussion Assessment Testing (ImPACT | Avg. incorrect RT (interfer.) | 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 | |||||||||||
| C21385 | Immediate Post-Concussion Assessment Testing (ImPACT) - Autism diagnosis indicator | ImPACTDxAutismInd | Indicator of whether the subject has been diagnosed with autism, as part of the Immediate Post-Concussion Assessment Testing (ImPACT) | Indicator of whether the subject has been diagnosed with autism, as part of the Immediate Post-Concussion Assessment Testing (ImPACT | Diagnosed with Autism | 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 |
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| C21428 | Immediate Post-Concussion Assessment Testing (ImPACT), the Post -Concussion Symptom Scale (PCSS) - Memory difficulty assessment score | ImPACTPCSSDiffRemeberScore | The subject's current difficulty remembering rating score, as part of the Immediate Post-Concussion Assessment Testing (ImPACT), the Post -Concussion Symptom Scale (PCSS) | The subject's current difficulty remembering rating score, as part of the Immediate Post-Concussion Assessment Testing (ImPACT), the Post -Concussion Symptom Scale (PCSS | Difficulty remembering | 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 |
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| C21364 | Immediate Post-Concussion Assessment Testing (ImPACT) - Speech therapy receive indicator | ImPACTReceivedSpeechTherInd | Indicator of whether the subject received speech therapy | Indicator of whether the subject received speech therap | Received speech therapy | No;Yes | No;Yes | Alphanumeric |
N/A |
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 |
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| C21460 | Immediate Post-Concussion Assessment Testing (ImPACT) - Three letters percent of total letters correct percentage value | ImPACTThreLetPctTotLetCorPVal | The numeric percentage of total letters correct on the three letters module, as part of the Immediate Post-Concussion Assessment Testing (ImPACT) | The numeric percentage of total letters correct on the three letters module, as part of the Immediate Post-Concussion Assessment Testing (ImPACT | Pct. of total letters 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 |
