CDE Detailed Report

Disease: Unruptured Cerebral Aneurysms and Subarachnoid Hemorrhage
Sub-Domain: [php]
CRF: Galveston Orientation and Amnesia Test (GOAT)

Displaying 1 - 18 of 18
CDE ID CDE Name Variable Name Definition Short Description Additional Notes (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 / Guideline) Sub Domain Name Domain Name Size Input Restrictions Min Value Max Value Measurement Type External Id Loinc External Id Snomed External Id caDSR External Id CDISC
C07187 The Galveston Orientation and Amnesia Test (GOAT) - Time score GOATCrntTimeScore Scored ability to identify the current time, as part of the Galveston Orientation and Amnesia Test (GOAT). Scored ability to identify the current time, as part of the Galveston Orientation and Amnesia Test (GOAT). What time is it now? 0;1;2;3;4;5 Correct;Half an hour off;1 hour off;1.5 hours off;2 hours off;2.5 hours or more off Numeric Values

Minus one for every half-hour error.

Levin, H., O'Donnell, V., and Grossman, R. (1979). The Galveston Orientation and Amnesia Test. A practical scale to assess cognition after head injury. J Nerv Ment Dis 167(11), 675-684. Adult;Pediatric Supplemental 3.10 2015-03-04 00:00:00.0 Galveston Orientation and Amnesia Test (GOAT) [php] [php_1]

Single Pre-Defined Value Selected

C07177 The Galveston Orientation and Amnesia Test (GOAT) - Full name score GOATNameScore Scored ability to accurately state first and last name, as part of the Galveston Orientation and Amnesia Test (GOAT). Scored ability to accurately state first and last name, as part of the Galveston Orientation and Amnesia Test (GOAT). What is your name? 0;2 Correct;Incorrect Numeric Values

See instructions on form

Levin, H., O'Donnell, V., and Grossman, R. (1979). The Galveston Orientation and Amnesia Test. A practical scale to assess cognition after head injury. J Nerv Ment Dis 167(11), 675-684. Adult;Pediatric Supplemental 3.10 2015-03-04 00:00:00.0 Galveston Orientation and Amnesia Test (GOAT) [php] [php_1]

Single Pre-Defined Value Selected

C07188 The Galveston Orientation and Amnesia Test (GOAT) - Day week score GOATDayScore Scored ability to identify the current day of the week, as part of the Galveston Orientation and Amnesia Test (GOAT). Scored ability to identify the current day of the week, as part of the Galveston Orientation and Amnesia Test (GOAT). What day of the week is it? 0;1;2;3 Correct;1 day off;2 days off;3 days off Numeric Values

Minus one for each day error.

Levin, H., O'Donnell, V., and Grossman, R. (1979). The Galveston Orientation and Amnesia Test. A practical scale to assess cognition after head injury. J Nerv Ment Dis 167(11), 675-684. Adult;Pediatric Supplemental 3.10 2015-03-04 00:00:00.0 Galveston Orientation and Amnesia Test (GOAT) [php] [php_1]

Single Pre-Defined Value Selected

C07178 The Galveston Orientation and Amnesia Test (GOAT) - Born date score GOATBrnDateScore Scored ability to accurately state date of birth, as part of the Galveston Orientation and Amnesia Test (GOAT). Scored ability to accurately state date of birth, as part of the Galveston Orientation and Amnesia Test (GOAT). When were you born? 0;4 Correct;Incorrect Numeric Values

Record the date/time according to the ISO 8601, the International Standard for the representation of dates and times (http://www.iso.org/iso/home.html). The date/time should be recorded to the level of granularity known (e.g., year, year and month, compl

Levin, H., O'Donnell, V., and Grossman, R. (1979). The Galveston Orientation and Amnesia Test. A practical scale to assess cognition after head injury. J Nerv Ment Dis 167(11), 675-684. Adult;Pediatric Supplemental 3.10 2015-03-04 00:00:00.0 Galveston Orientation and Amnesia Test (GOAT) [php] [php_1]

Single Pre-Defined Value Selected

C07189 The Galveston Orientation and Amnesia Test (GOAT) - Day month score GOATDayMnthDateScore Scored ability to identify the current day of the month, as part of the Galveston Orientation and Amnesia Test (GOAT). Scored ability to identify the current day of the month, as part of the Galveston Orientation and Amnesia Test (GOAT). What day of the month is it? (i.e. the date) 0;1;2;3;4;5 Correct;1 day off;2 days off;3 days off;4 days off;5 days or more off Numeric Values

Minus one for each day error.

Levin, H., O'Donnell, V., and Grossman, R. (1979). The Galveston Orientation and Amnesia Test. A practical scale to assess cognition after head injury. J Nerv Ment Dis 167(11), 675-684. Adult;Pediatric Supplemental 3.10 2015-03-04 00:00:00.0 Galveston Orientation and Amnesia Test (GOAT) [php] [php_1]

Single Pre-Defined Value Selected

C07179 The Galveston Orientation and Amnesia Test (GOAT) - Live location score GOATLiveLocScore Scored ability to accurately state place of residence, as part of the Galveston Orientation and Amnesia Test (GOAT). Scored ability to accurately state place of residence, as part of the Galveston Orientation and Amnesia Test (GOAT). Where do you live? 0;4 Correct;Incorrect Numeric Values

Town is sufficient.

Levin, H., O'Donnell, V., and Grossman, R. (1979). The Galveston Orientation and Amnesia Test. A practical scale to assess cognition after head injury. J Nerv Ment Dis 167(11), 675-684. Adult;Pediatric Supplemental 3.10 2015-03-04 00:00:00.0 Galveston Orientation and Amnesia Test (GOAT) [php] [php_1]

Single Pre-Defined Value Selected

C07190 The Galveston Orientation and Amnesia Test (GOAT) - Month score GOATMnthScore Scored ability to identify the current month, as part of the Galveston Orientation and Amnesia Test (GOAT). Scored ability to identify the current month, as part of the Galveston Orientation and Amnesia Test (GOAT). What is the month? 0;5;10;15 Correct;1 month off;2 months off;3 months or more off Numeric Values

Minus five for each month error.

Levin, H., O'Donnell, V., and Grossman, R. (1979). The Galveston Orientation and Amnesia Test. A practical scale to assess cognition after head injury. J Nerv Ment Dis 167(11), 675-684. Adult;Pediatric Supplemental 3.10 2015-03-04 00:00:00.0 Galveston Orientation and Amnesia Test (GOAT) [php] [php_1]

Single Pre-Defined Value Selected

C07180 The Galveston Orientation and Amnesia Test (GOAT) - City location score GOATCityLocScore Scored ability to accurately name the city the subject is currently located, as part of the Galveston Orientation and Amnesia Test (GOAT). Scored ability to accurately name the city the subject is currently located, as part of the Galveston Orientation and Amnesia Test (GOAT). Where are you now? City 0;5 Correct;Incorrect Numeric Values

Must give actual town.

Levin, H., O'Donnell, V., and Grossman, R. (1979). The Galveston Orientation and Amnesia Test. A practical scale to assess cognition after head injury. J Nerv Ment Dis 167(11), 675-684. Adult;Pediatric Supplemental 3.10 2015-03-04 00:00:00.0 Galveston Orientation and Amnesia Test (GOAT) [php] [php_1]

Single Pre-Defined Value Selected

C07191 The Galveston Orientation and Amnesia Test (GOAT) - Year identification score GOATYearScore Scored ability to identify the current year, as part of the Galveston Orientation and Amnesia Test (GOAT). Scored ability to identify the current year, as part of the Galveston Orientation and Amnesia Test (GOAT). What is the year? 0;10;20;30 Correct;1 year off;2 years off;3 years or more off Numeric Values

Minus ten for each year error.

Levin, H., O'Donnell, V., and Grossman, R. (1979). The Galveston Orientation and Amnesia Test. A practical scale to assess cognition after head injury. J Nerv Ment Dis 167(11), 675-684. Adult;Pediatric Supplemental 3.10 2015-03-04 00:00:00.0 Galveston Orientation and Amnesia Test (GOAT) [php] [php_1]

Single Pre-Defined Value Selected

C07181 The Galveston Orientation and Amnesia Test (GOAT) - building location score GOATBuldngLocScore Scored ability to accurately identify the building they are currently located, as part of the Galveston Orientation and Amnesia Test (GOAT). Scored ability to accurately identify the building they are currently located, as part of the Galveston Orientation and Amnesia Test (GOAT). Where are you now? Building 0;5 Correct;Incorrect Numeric Values

Usually in hospital or rehab center. Actual name necessary.

Levin, H., O'Donnell, V., and Grossman, R. (1979). The Galveston Orientation and Amnesia Test. A practical scale to assess cognition after head injury. J Nerv Ment Dis 167(11), 675-684. Adult;Pediatric Supplemental 3.10 2015-03-04 00:00:00.0 Galveston Orientation and Amnesia Test (GOAT) [php] [php_1]

Single Pre-Defined Value Selected

C07192 The Galveston Orientation and Amnesia Test (GOAT) - Total score GOATTotalScore Total score, as part of the Galveston Orientation and Amnesia Test (GOAT). Total score, as part of the Galveston Orientation and Amnesia Test (GOAT). Total actual score (100 - total error) = 100 - Numeric Values

Subtract total error from 100. Can be negative number. The total score can be interpreted as follows: 76-100 = Normal / 66-75 = Borderline /

Levin, H., O'Donnell, V., and Grossman, R. (1979). The Galveston Orientation and Amnesia Test. A practical scale to assess cognition after head injury. J Nerv Ment Dis 167(11), 675-684. Adult;Pediatric Supplemental 3.10 2015-03-04 00:00:00.0 Galveston Orientation and Amnesia Test (GOAT) [php] [php_1]

Free-Form Entry

-8 100
C07182 The Galveston Orientation and Amnesia Test (GOAT) - Hospital admittance date score GOATHospAdmtDateScore Scored ability to accurately identify hospital admittance date, as part of the Galveston Orientation and Amnesia Test (GOAT). Scored ability to accurately identify hospital admittance date, as part of the Galveston Orientation and Amnesia Test (GOAT). When were you admitted to this hospital? 0;5 Correct;Incorrect Numeric Values

Record the date/time according to the ISO 8601, the International Standard for the representation of dates and times (http://www.iso.org/iso/home.html). The date/time should be recorded to the level of granularity known (e.g., year, year and month, compl

Levin, H., O'Donnell, V., and Grossman, R. (1979). The Galveston Orientation and Amnesia Test. A practical scale to assess cognition after head injury. J Nerv Ment Dis 167(11), 675-684. Adult;Pediatric Supplemental 3.10 2015-03-04 00:00:00.0 Galveston Orientation and Amnesia Test (GOAT) [php] [php_1]

Single Pre-Defined Value Selected

C20333 The Galveston Orientation and Amnesia Test (GOAT) - Pre injury event detail score GOATPreInjuEventDetailScore Scored ability to provide specific details about the last event before injury, as part of the Galveston Orientation and Amnesia Test (GOAT). Scored ability to provide specific details about the last event before injury, as part of the Galveston Orientation and Amnesia Test (GOAT). Can you describe in detail (e.g., date, time, companions) the first event you can recall before the injury? 0;5 Correct;Incorrect Numeric Values

See instructions on form

Levin, H., O'Donnell, V., and Grossman, R. (1979). The Galveston Orientation and Amnesia Test. A practical scale to assess cognition after head injury. J Nerv Ment Dis 167(11), 675-684. Adult;Pediatric Supplemental 1.00 2015-03-04 10:21:26.0 Galveston Orientation and Amnesia Test (GOAT) [php] [php_1]

Single Pre-Defined Value Selected

C07183 The Galveston Orientation and Amnesia Test (GOAT) - Mode of Transportation score GOATModeTranspScore Scored ability to accurately identify the mode of transportation to the hospital, as part of the Galveston Orientation and Amnesia Test (GOAT). Scored ability to accurately identify the mode of transportation to the hospital, as part of the Galveston Orientation and Amnesia Test (GOAT). How did you get here? 0;5 Correct;Incorrect Numeric Values

Mode of transport.

Levin, H., O'Donnell, V., and Grossman, R. (1979). The Galveston Orientation and Amnesia Test. A practical scale to assess cognition after head injury. J Nerv Ment Dis 167(11), 675-684. Adult;Pediatric Supplemental 3.10 2015-03-04 00:00:00.0 Galveston Orientation and Amnesia Test (GOAT) [php] [php_1]

Single Pre-Defined Value Selected

C20334 The Galveston Orientation and Amnesia Test (GOAT) - Error sum value GOATErrorSumVal Galveston Orientation and Amnesia Test (GOAT) sum of errors score Galveston Orientation and Amnesia Test (GOAT) sum of errors score Total error points Numeric Values

Sum the error points from questions 1–10.

Levin, H., O'Donnell, V., and Grossman, R. (1979). The Galveston Orientation and Amnesia Test. A practical scale to assess cognition after head injury. J Nerv Ment Dis 167(11), 675-684. Adult;Pediatric Supplemental 1.00 2015-03-04 10:21:26.0 Galveston Orientation and Amnesia Test (GOAT) [php] [php_1]

Free-Form Entry

0 108
C07184 The Galveston Orientation and Amnesia Test (GOAT) - Post injury event score GOATFirstEvntScore Scored ability to provide specific details about the first event after injury, as part of the Galveston Orientation and Amnesia Test (GOAT). Scored ability to provide specific details about the first event after injury, as part of the Galveston Orientation and Amnesia Test (GOAT). What is the first event you can remember after the injury? 0;5 Correct;Incorrect Numeric Values

See instructions on form

Levin, H., O'Donnell, V., and Grossman, R. (1979). The Galveston Orientation and Amnesia Test. A practical scale to assess cognition after head injury. J Nerv Ment Dis 167(11), 675-684. Adult;Pediatric Supplemental 3.10 2015-03-04 00:00:00.0 Galveston Orientation and Amnesia Test (GOAT) [php] [php_1]

Single Pre-Defined Value Selected

C07185 The Galveston Orientation and Amnesia Test (GOAT) - Post injury event detail score GOATDetailScore Scored ability to identify the detail of the first event the subject can remember after the accident, as part of the Galveston Orientation and Amnesia Test (GOAT). Scored ability to identify the detail of the first event the subject can remember after the accident, as part of the Galveston Orientation and Amnesia Test (GOAT). Can you describe in detail (e.g., date, time, companions) the first event you can recall after injury? 0;5 Correct;Incorrect Numeric Values

See instructions on form

Levin, H., O'Donnell, V., and Grossman, R. (1979). The Galveston Orientation and Amnesia Test. A practical scale to assess cognition after head injury. J Nerv Ment Dis 167(11), 675-684. Adult;Pediatric Supplemental 3.10 2015-03-04 00:00:00.0 Galveston Orientation and Amnesia Test (GOAT) [php] [php_1]

Single Pre-Defined Value Selected

C07186 The Galveston Orientation and Amnesia Test (GOAT) - Pre injury event score GOATLastEvntScore Scored ability to accurately recall the last event before injury, as part of the Galveston Orientation and Amnesia Test (GOAT). Scored ability to accurately recall the last event before injury, as part of the Galveston Orientation and Amnesia Test (GOAT). Can you describe the last event you can recall before the accident? 0;5 Correct;Incorrect Numeric Values

See instructions on form

Levin, H., O'Donnell, V., and Grossman, R. (1979). The Galveston Orientation and Amnesia Test. A practical scale to assess cognition after head injury. J Nerv Ment Dis 167(11), 675-684. Adult;Pediatric Supplemental 3.10 2015-03-04 00:00:00.0 Galveston Orientation and Amnesia Test (GOAT) [php] [php_1]

Single Pre-Defined Value Selected

CSV