CDE Detailed Report | NINDS Common Data Elements

Disease: content
Subdomain Name: Second Insults
CRF: welcome

Displaying 1 - 13 of 13

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	Input Restrictions
C05459	Cardiac arrest indicator	CardArrestInd	Indicator of cardiac arrest requiring cardiopulmonary resuscitation (i.e. at least two minutes of chest compressions). Cardiac arrest is a condition in which the heart suddenly and unexpectedly stops beating	Indicator of cardiac arrest requiring cardiopulmonary resuscitation (i.e. at least two minutes of chest compressions). Cardiac arrest is a condition in which the heart suddenly and unexpectedly stops beating	Did participant/subject expierence cardiac arrest?	Yes;No;Suspected;Unknown	Yes;No;Suspected;Unknown	Alphanumeric	Choose one. This element is recommended for pediatric studies. Second insults may aggravate processes of secondary damage in a brain already rendered vulnerable by the primary injury. The main physiologic insults relevant to TBI are hypotension, hyper- or hypothermia, hypoxia, and hypocapnia due to hyperventilation. The adverse effect of the occurrence of such insults both pre- and in-hospital is well established. Second insults are commonly defined by threshold values but these values are not well established in pediatrics. Based on the available data for pediatric TBI , thresholds of 80-180 mg/dL for glucose are recommended. A threshold for hemoglobin is more difficult to define given emerging data on the lower limit of hemoglobin safely tolerated by critically ill children in general and the variable effect of blood transfusion in children with severe TBI specifically.	McHugh GS, Engel DC, Butcher I, et al. Prognostic value of secondary insults in traumatic brain injury: results from the IMPACT study. J Neurotrauma. Feb 2007;24(2):287-93. Signorini DF, Andrews PJ, Jones PA, et al. Adding insult to injury: the prognostic value of early secondary insults for survival after traumatic brain injury. J Neurol Neurosurg Psychiatry. Jan 1999;66(1):26-31 Adelson PD, Bratton SL, Carney, NA, Chesnut RM, du Coudray HE, Goldstein B, Kochanek PM, Miller HC, Partington MD, Selden NR, Warden CR, Wright DW. uidelines for the acute medical management of severe traumatic brain injury in infants, children, and adolescents. Chapter 6. Threshold for treatment of intracranial hypertension. (2003a). Pediatr Crit Care Med 4:S25-S27.	Adult;Pediatric	Supplemental	3.00	2013-07-20 10:21:25.65	Second Insults and Other Complications	Second Insults	Disease/Injury Related Events	Single Pre-Defined Value Selected
C05460	Seizure indicator	SeizInd	Indicator of seizure activity	Indicator of seizure activity	Did participant/subject experience seizure(s)?	Yes;No;Suspected;Unknown	Yes;No;Suspected;Unknown	Alphanumeric	Choose one. Seizure activity in the brain may cause focal or generalized vasodilation with increased cerebral blood volume and high intracranial pressure. Moreover, metabolic requirements are increased in a situation where brain metabolism is already compromised. Seizures are therefore an important second insult following TBI.	McHugh GS, Engel DC, Butcher I, et al. Prognostic value of secondary insults in traumatic brain injury: results from the IMPACT study. J Neurotrauma. Feb 2007;24(2):287-93. Signorini DF, Andrews PJ, Jones PA, et al. Adding insult to injury: the prognostic value of early secondary insults for survival after traumatic brain injury. J Neurol Neurosurg Psychiatry. Jan 1999;66(1):26-31	Adult;Pediatric	Supplemental	3.00	2013-07-20 10:21:25.65	Second Insults and Other Complications	Second Insults	Disease/Injury Related Events	Single Pre-Defined Value Selected
C05461	Seizure presentation type	SeizPresentTyp	Type of seizure activity as convulsive or non-convulsive (diagnosed on EEG only, no motor manifestations)	Type of seizure activity as convulsive or non-convulsive (diagnosed on EEG only, no motor manifestations)	Presentation of seizure	Convulsive;Non-convulsive	Convulsive;Non-convulsive	Alphanumeric	Choose one. This element is only answered if the participant/subject had a seizure. This element is recommended for pediatric studies. Second insults are commonly defined by threshold values but these values are not well established in pediatrics. Based on the available data for pediatric TBI , thresholds of 80-180 mg/dL for glucose are recommended. A threshold for hemoglobin is more difficult to define given emerging data on the lower limit of hemoglobin safely tolerated by critically ill children in general and the variable effect of blood transfusion in children with severe TBI specifically.	Adelson PD, Bratton SL, Carney, NA, Chesnut RM, du Coudray HE, Goldstein B, Kochanek PM, Miller HC, Partington MD, Selden NR, Warden CR, Wright DW. uidelines for the acute medical management of severe traumatic brain injury in infants, children, and adolescents. Chapter 6. Threshold for treatment of intracranial hypertension. (2003a). Pediatr Crit Care Med 4:S25-S27.	Adult;Pediatric	Supplemental	3.00	2013-07-20 10:21:25.65	Second Insults and Other Complications	Second Insults	Disease/Injury Related Events	Single Pre-Defined Value Selected
C05462	Seizure duration type	SeizDurType	Seizure described as intermittent or status epilepticus. Convulsive status epilepticus (CSE) is defined as either 2 or more convulsions without complete recovery of consciousness between seizures (intermittent CSE) or as a single prolonged seizure that lasts for at least 30 minutes (continuous CSE)	Seizure described as intermittent or status epilepticus. Convulsive status epilepticus (CSE) is defined as either 2 or more convulsions without complete recovery of consciousness between seizures (intermittent CSE) or as a single prolonged seizure that lasts for at least 30 minutes (continuous CSE	Seizure duration type	Intermittent;Status epilepticus	Intermittent;Status epilepticus	Alphanumeric	Choose one. This element is only answered if the participant/subject had a seizure. This element is recommended for pediatric studies.	Ostrowsky K, Arzimanoglou A. Outcome and prognosis of status epilepticus in children. Semin Pediatr Neurol. 2010 Sep;17(3):195-200.	Adult;Pediatric	Supplemental	3.00	2013-07-20 10:21:25.65	Second Insults and Other Complications	Second Insults	Disease/Injury Related Events	Single Pre-Defined Value Selected
C05463	EEG monitoring type	EEGMonitorType	Type of electroencephalogram (EEG) monitoring	Type of electroencephalogram (EEG) monitoring	EEG monitoring type	Routine;Continuous/prolonged	Routine;Continuous/prolonged	Alphanumeric	Choose one. Response is obtained from medical charts and/or patient data management system. This element is recommended for pediatric studies.	No references available	Adult;Pediatric	Supplemental	3.00	2013-08-28 16:08:00.453	Second Insults and Other Complications	Second Insults	Disease/Injury Related Events	Single Pre-Defined Value Selected
C05453	Hypotensive episode indicator	HypotnsnEpiInd	Indicator of hypotensive episode. In adults, hypotensive episode is defined as systolic blood pressure < 90 mmHg. In children, it is defined as systolic blood pressure < 5th percentile for age	Indicator of hypotensive episode. In adults, hypotensive episode is defined as systolic blood pressure < 90 mmHg. In children, it is defined as systolic blood pressure < 5th percentile for age	Did participant/subject experience hypotensive episode?	Yes;No;Unknown;Suspected	Yes;No;Unknown;Suspected	Alphanumeric	Choose one.	McHugh GS, Engel DC, Butcher I, et al. Prognostic value of secondary insults in traumatic brain injury: results from the IMPACT study. J Neurotrauma. Feb 2007;24(2):287-93. Silverstone P. Pulse oxymetry of at the road side: a study of pulse oxymetry in immediate care. BMJ. Mar 1989;298(6675):711-13. Stocchetti N, Furlan A, Volta F. Hypoxemia and arterial hypotension at the accident side in head injury. J Trauma. 1996;40:764-67. De Witt DS, Jenkins LW, Prough DS. Enhanced vulnerability to secondary ischemic insults after experimental traumatic brain injury. New Horizon. Aug 1995;3(3):376-383.	Adult;Pediatric	Supplemental	3.00	2013-07-20 10:21:25.65	Second Insults and Other Complications	Second Insults	Disease/Injury Related Events	Single Pre-Defined Value Selected
C05464	Hyperventilation indicator	HyperventInd	Indicator of hyperventilation. Hyperventilation is defined as rapid, deep breathing, possibly exceeding 40 breaths/minute	Indicator of hyperventilation. Hyperventilation is defined as rapid, deep breathing, possibly exceeding 40 breaths/minute	Did participant/subject experience hyperventilation?	Yes;No;Unknown;Suspected	Yes;No;Unknown;Suspected	Alphanumeric	Choose one. Response is obtained from medical charts and/or patient data management system.	Chesnut RM, Marshall LF, Klauber MR, Blunt BA, Baldwin N, Eisenberg HM, Jane JA, Marmarou A, Foulkes MA. The role of secondary brain injury in determining outcome from severe head injury. J Trauma. 1993 Feb;34(2):216-22. McHugh GS, Engel DC, Butcher I, et al. Prognostic value of secondary insults in traumatic brain injury: results from the IMPACT study. J Neurotrauma. Feb 2007;24(2):287-93. Signorini DF, Andrews PJ, Jones PA, et al. Adding insult to injury: the prognostic value of early secondary insults for survival after traumatic brain injury. J Neurol Neurosurg Psychiatry. Jan 1999;66(1):26-31 Adelson PD, Bratton SL, Carney, NA, Chesnut RM, du Coudray HE, Goldstein B, Kochanek PM, Miller HC, Partington MD, Selden NR, Warden CR, Wright DW. uidelines for the acute medical management of severe traumatic brain injury in infants, children, and adolescents. Chapter 6. Threshold for treatment of intracranial hypertension. (2003a). Pediatr Crit Care Med 4:S25-S27.	Adult;Pediatric	Supplemental	3.00	2013-07-20 10:21:25.65	Second Insults and Other Complications	Second Insults	Disease/Injury Related Events	Single Pre-Defined Value Selected
C05454	Hypertension indicator	HypertensInd	Indicator of hypertension. In adults, hypertension is defined as a systolic pressure >= 140 and a diastolic >= 90. In children, it is defined as systolic blood pressure >95th percentile for age	Indicator of hypertension. In adults, hypertension is defined as a systolic pressure >= 140 and a diastolic >= 90. In children, it is defined as systolic blood pressure >95th percentile for ag	Did participant/subject experience hypertension?	Yes;No;Unknown;Suspected	Yes;No;Unknown;Suspected	Alphanumeric	Choose one. This element is recommended for pediatric studies. Second insults may aggravate processes of secondary damage in a brain already rendered vulnerable by the primary injury. The main physiologic insults relevant to TBI are hypotension, hyper- or hypothermia, hypoxia, and hypocapnia due to hyperventilation. The adverse effect of the occurrence of such insults both pre- and in-hospital is well established. Second insults are commonly defined by threshold values but these values are not well established in pediatrics. Based on the available data for pediatric TBI , thresholds of 80-180 mg/dL for glucose are recommended. A threshold for hemoglobin is more difficult to define given emerging data on the lower limit of hemoglobin safely tolerated by critically ill children in general and the variable effect of blood transfusion in children with severe TBI specifically.	McHugh GS, Engel DC, Butcher I, et al. Prognostic value of secondary insults in traumatic brain injury: results from the IMPACT study. J Neurotrauma. Feb 2007;24(2):287-93. Signorini DF, Andrews PJ, Jones PA, et al. Adding insult to injury: the prognostic value of early secondary insults for survival after traumatic brain injury. J Neurol Neurosurg Psychiatry. Jan 1999;66(1):26-31 Adelson PD, Bratton SL, Carney, NA, Chesnut RM, du Coudray HE, Goldstein B, Kochanek PM, Miller HC, Partington MD, Selden NR, Warden CR, Wright DW. uidelines for the acute medical management of severe traumatic brain injury in infants, children, and adolescents. Chapter 6. Threshold for treatment of intracranial hypertension. (2003a). Pediatr Crit Care Med 4:S25-S27.	Adult;Pediatric	Supplemental	3.00	2013-07-20 10:21:25.65	Second Insults and Other Complications	Second Insults	Disease/Injury Related Events	Single Pre-Defined Value Selected
C05465	Aspiration indicator	AspiratnInd	Indicator of foreign material breathed into the airway	Indicator of foreign material breathed into the airway	Did participant/subject experience aspiration of foreign materials?	Yes;No;Unknown;Suspected	Yes;No;Unknown;Suspected	Alphanumeric	Choose one. Response is obtained from medical charts and/or patient data management system. This element is recommended for pediatric studies. Second insults may aggravate processes of secondary damage in a brain already rendered vulnerable by the primary injury. The main physiologic insults relevant to TBI are hypotension, hyper- or hypothermia, hypoxia, and hypocapnia due to hyperventilation. The adverse effect of the occurrence of such insults both pre- and in-hospital is well established. Second insults are commonly defined by threshold values but these values are not well established in pediatrics. Based on the available data for pediatric TBI , thresholds of 80-180 mg/dL for glucose are recommended. A threshold for hemoglobin is more difficult to define given emerging data on the lower limit of hemoglobin safely tolerated by critically ill children in general and the variable effect of blood transfusion in children with severe TBI specifically.	Chesnut RM, Marshall LF, Klauber MR, Blunt BA, Baldwin N, Eisenberg HM, Jane JA, Marmarou A, Foulkes MA. The role of secondary brain injury in determining outcome from severe head injury. J Trauma. 1993 Feb;34(2):216-22. McHugh GS, Engel DC, Butcher I, et al. Prognostic value of secondary insults in traumatic brain injury: results from the IMPACT study. J Neurotrauma. Feb 2007;24(2):287-93. Signorini DF, Andrews PJ, Jones PA, et al. Adding insult to injury: the prognostic value of early secondary insults for survival after traumatic brain injury. J Neurol Neurosurg Psychiatry. Jan 1999;66(1):26-31 Adelson PD, Bratton SL, Carney, NA, Chesnut RM, du Coudray HE, Goldstein B, Kochanek PM, Miller HC, Partington MD, Selden NR, Warden CR, Wright DW. uidelines for the acute medical management of severe traumatic brain injury in infants, children, and adolescents. Chapter 6. Threshold for treatment of intracranial hypertension. (2003a). Pediatr Crit Care Med 4:S25-S27.	Adult;Pediatric	Supplemental	3.00	2013-07-20 10:21:25.65	Second Insults and Other Complications	Second Insults	Disease/Injury Related Events	Single Pre-Defined Value Selected
C05455	Hypothermia indicator	HypothermInd	Indicator of hypothermia. Hypothermia is defined as core temperature < 35 degrees Celsius	Indicator of hypothermia. Hypothermia is defined as core temperature < 35 degrees Celsius	Did participant/subject experience hypothermia?	Yes;No;Unknown;Suspected	Yes;No;Unknown;Suspected	Alphanumeric	Choose one. Add date stamp for when assessed. Recommend collection at least during initial medical treatment. Second insults may be systemic (extracranial or intracranial). Second insults aggravate processes of secondary damage in a brain already rendered vulnerable by the primary injury. The occurrence of second insults occurring before hospital admission in patients with more severe injuries, is frequent: oxygen saturation below 90% is found in 44 to 55% of cases and hypotension in 20 to 30%. The occurrence of second insults is strongly associated with poorer outcome. Hypoxia, hypotension and inadvertent hypocapnia are the most frequent causes of jugular desaturations, and periods of low brain tissue oxygen tension. The depth and duration of systemic second insults during the clinical course is related to poorer outcome.	McHugh GS, Engel DC, Butcher I, et al. Prognostic value of secondary insults in traumatic brain injury: results from the IMPACT study. J Neurotrauma. Feb 2007;24(2):287-93. Silverstone P. Pulse oxymetry of at the road side: a study of pulse oxymetry in immediate care. BMJ. Mar 1989;298(6675):711-13. Stocchetti N, Furlan A, Volta F. Hypoxemia and arterial hypotension at the accident side in head injury. J Trauma. 1996;40:764-67. De Witt DS, Jenkins LW, Prough DS. Enhanced vulnerability to secondary ischemic insults after experimental traumatic brain injury. New Horizon. Aug 1995;3(3):376-383.	Adult;Pediatric	Supplemental	3.00	2013-07-20 10:21:25.65	Second Insults and Other Complications	Second Insults	Disease/Injury Related Events	Single Pre-Defined Value Selected
C05456	Hyperthermia indicator	HyperthermInd	Indicator of hyperthermia. Hyperthermia is defined as core temperature > 38 degrees Celsius	Indicator of hyperthermia. Hyperthermia is defined as core temperature > 38 degrees Celsius	Did participant/subject experience hyperthermia?	Yes;No;Unknown;Suspected	Yes;No;Unknown;Suspected	Alphanumeric	Choose one. This element is recommended for pediatric studies. Second insults may aggravate processes of secondary damage in a brain already rendered vulnerable by the primary injury. The main physiologic insults relevant to TBI are hypotension, hyper- or hypothermia, hypoxia, and hypocapnia due to hyperventilation. The adverse effect of the occurrence of such insults both pre- and in-hospital is well established. Second insults are commonly defined by threshold values but these values are not well established in pediatrics. Based on the available data for pediatric TBI , thresholds of 80-180 mg/dL for glucose are recommended. A threshold for hemoglobin is more difficult to define given emerging data on the lower limit of hemoglobin safely tolerated by critically ill children in general and the variable effect of blood transfusion in children with severe TBI specifically.	McHugh GS, Engel DC, Butcher I, et al. Prognostic value of secondary insults in traumatic brain injury: results from the IMPACT study. J Neurotrauma. Feb 2007;24(2):287-93. Signorini DF, Andrews PJ, Jones PA, et al. Adding insult to injury: the prognostic value of early secondary insults for survival after traumatic brain injury. J Neurol Neurosurg Psychiatry. Jan 1999;66(1):26-31 Adelson PD, Bratton SL, Carney, NA, Chesnut RM, du Coudray HE, Goldstein B, Kochanek PM, Miller HC, Partington MD, Selden NR, Warden CR, Wright DW. uidelines for the acute medical management of severe traumatic brain injury in infants, children, and adolescents. Chapter 6. Threshold for treatment of intracranial hypertension. (2003a). Pediatr Crit Care Med 4:S25-S27.	Adult;Pediatric	Supplemental	3.00	2013-07-20 10:21:25.65	Second Insults and Other Complications	Second Insults	Disease/Injury Related Events	Single Pre-Defined Value Selected
C05457	Hypoxic episode indicator	HypxEpiInd	Indicator of hypoxic episode. Hypoxic episode is defined as partial pressure of oxygen in the blood (paO2) < 8kPa (60mmHg) or oxygen saturation (SaO2) < 90%	Indicator of hypoxic episode. Hypoxic episode is defined as partial pressure of oxygen in the blood (paO2) < 8kPa (60mmHg) or oxygen saturation (SaO2) < 90%	Did participant/subject experience hypoxic episode?	Yes;No;Unknown;Suspected	Yes;No;Unknown;Suspected	Alphanumeric	Choose one.	McHugh GS, Engel DC, Butcher I, et al. Prognostic value of secondary insults in traumatic brain injury: results from the IMPACT study. J Neurotrauma. Feb 2007;24(2):287-93. Silverstone P. Pulse oxymetry of at the road side: a study of pulse oxymetry in immediate care. BMJ. Mar 1989;298(6675):711-13. Stocchetti N, Furlan A, Volta F. Hypoxemia and arterial hypotension at the accident side in head injury. J Trauma. 1996;40:764-67. De Witt DS, Jenkins LW, Prough DS. Enhanced vulnerability to secondary ischemic insults after experimental traumatic brain injury. New Horizon. Aug 1995;3(3):376-383. Steyerberg EW, Mushkudiani N, Perel P, et al. Predicting outcome after traumatic brain injury: development and international validation of prognostic scores based on admission characteristics. PLoS Med. Aug 2008;5(8):e165. MRC CRASH Trial Collaborators. Predicting outcome after traumatic brain injury: practical prognostic models based on large cohort of international patients. BMJ. Feb 2008;336(7641):425-429. Signorini DF, Andrews PJ, Jones PA, et al. Adding insult to injury: the prognostic value of early secondary insults for survival after traumatic brain injury. J Neurol Neurosurg Psychiatry. Jan 1999;66(1):26-31 Pediatric-specific reference(s): Adelson PD, Bratton SL, Carney, NA, Chesnut RM, du Coudray HE, Goldstein B, Kochanek PM, Miller HC, Partington MD, Selden NR, Warden CR, Wright DW. Guidelines for the acute medical management of severe traumatic brain injury in infants, children, and adolescents. Chapter 6. Threshold for treatment of intracranial hypertension. (2003a). Pediatr Crit Care Med 4:S25-S27.	Adult;Pediatric	Supplemental	3.00	2013-07-20 10:21:25.65	Second Insults and Other Complications	Second Insults	Disease/Injury Related Events	Single Pre-Defined Value Selected
C05458	Inadvertent hypocapnia indicator	InadvertHypocapniaInd	Indicator of inadvertent hypocapnia episode. Inadvertent hypocapnia is defined as the partial pressure of carbon dioxide in the blood (paCo2) <= 25 mmHg (3.3 kPa), not deliberately employed to treat elevated intracranial pressure	Indicator of inadvertent hypocapnia episode. Inadvertent hypocapnia is defined as the partial pressure of carbon dioxide in the blood (paCo2) <= 25 mmHg (3.3 kPa), not deliberately employed to treat elevated intracranial pressure	Did participant/subject experience an inadvertent hypocapnia episode?	Yes;No;Unknown;Suspected	Yes;No;Unknown;Suspected	Alphanumeric	Choose one. Response obtained from medical charts and/or patient data management system. Add date stamp for when assessed. Recommend collection at least during initial medical treatment. Many types of second insults may occur in the in-hospital situation, both systemic and intracranial. Systemic second insults may for example also include episodes of hypoglaecemia, hyponatremia, hypernatremia, hyperthermia and many more. We chose to recommend to document the clinically most relevant and frequently occurring second insults: hypoxia, hypotension, inadvertent hypocapnia and seizure activity. Hypoxia, hypotension and inadvertent hypocapnia are the most frequent causes of jugular desaturations, and periods of low brain tissue oxygen tension. The depth and duration of systemic second insults during the clinical course is related to poorer outcome. In the intensive care environment with continuous monitoring, accurate detection of the number and duration of episodes of second insults should be possible. Thus permitting an accurate documentation of the number, depth and duration of these insults individually and summated per insult over a given period. Unfortunately, most commercially available monitoring systems do not include dedicated software to facilitate this approach. We therefore recommend to simply document the occurrence of second insults, differentiating single episodes of short duration from multiple episodes or those of more prolonged duration, as these latter may have more profound effects in aggravating secondary brain damage. Pediatric-specific notes: Second insults are commonly defined by threshold values but these values are not well established in pediatrics. Based on the available data for pediatric TBI , thresholds of 80-180 mg/dL for glucose are recommended. A threshold for hemoglobin is more difficult to define given emerging data on the lower limit of hemoglobin safely tolerated by critically ill children in general and the variable effect of blood transfusion in children with severe TBI specifically.	McHugh GS, Engel DC, Butcher I, et al. Prognostic value of secondary insults in traumatic brain injury: results from the IMPACT study. J Neurotrauma. Feb 2007;24(2):287-93. Signorini DF, Andrews PJ, Jones PA, et al. Adding insult to injury: the prognostic value of early secondary insults for survival after traumatic brain injury. J Neurol Neurosurg Psychiatry. Jan 1999;66(1):26-31 Pediatric reference: Adelson PD, Bratton SL, Carney, NA, Chesnut RM, du Coudray HE, Goldstein B, Kochanek PM, Miller HC, Partington MD, Selden NR, Warden CR, Wright DW. uidelines for the acute medical management of severe traumatic brain injury in infants, children, and adolescents. Chapter 6. Threshold for treatment of intracranial hypertension. (2003a). Pediatr Crit Care Med 4:S25-S27.	Adult;Pediatric	Supplemental	3.00	2013-07-20 10:21:25.65	Second Insults and Other Complications	Second Insults	Disease/Injury Related Events	Single Pre-Defined Value Selected