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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| C00004 | Birth country ISO code | BirthCntryISOCode | Code (ISO 3166-1 alpha-2 code) for country where the participant was born | Code (ISO 3166-1 alpha-2 code) for country where the participant 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 | 3.1 | 10/16/2024 8:51:21 AM | Immediate Post-Concussion Assessment and Cognitive Testing (imPACT) | Other Clinical Data | Assessments and Examinations |
Single Pre-Defined Value Selected |
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| 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 | ||||||||||
| 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 |
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| 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 |
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| 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 |
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| 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 |
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| 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 |
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| 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 |
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| C00005 | Birth country name | BirthCntryName | Name for country where the participant was born | Name for country where the participant was born | Native country/region | Alphanumeric | Adult | NeuroRehab Sport Related Concussion Core | 3.1 | 10/16/2024 8:51:20 AM | Immediate Post-Concussion Assessment and Cognitive Testing (imPACT) | Other Clinical Data | Assessments and Examinations | 255 |
Free-Form Entry |
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| 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 | ||||||||||
| 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 |
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| 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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| 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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| 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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| 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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| 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 | ||||||||||
| 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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| 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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| 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 | ||||||||||
| 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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| 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 |
