CDE Detailed Report

Disease: Traumatic Brain Injury
Sub-Domain: Post-concussive/TBI-Related Symptoms
CRF: Post-Concussion Symptom Inventory (PCSI) Self-Report Assessment Form Pre and Post-Injury Report Ages 13-18

Displaying 1 - 31 of 31
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 / 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
C52336 Post-Concussion Symptom Inventory (PCSI) - Clumsy scale PCSIClumsyScl Scale to which the subject appeared to move in a clumsy manner, as part of the Post-Concussion Symptom Inventory (PCSI) Scale to which the subject appeared to move in a clumsy manner, as part of the Post-Concussion Symptom Inventory (PCSI Move in a clumsy manner 0;1;2;3;4;5;6 Not a problem;1;2;Moderate problem;4;5;Severe problem Numeric Values

We would like to know if you have had any of these symptoms before your injury. Next, we would like to know if these symptoms have changed after your injury. Please rate the symptom at two points in time- Before the Injury/Pre-Injury and Currently.
Please answer all the items the best that you can. Do not skip any items. Circle the number to tell us how much of a problem this symptom has been for you.

Sady MD, Vaughan CG, Gioia GA. Psychometric Characteristics of the Postconcussion Symptom Inventory in Children and Adolescents. Archives of Clinical Neuropsychology. 2014;29(4):348-363. Pediatric Supplemental 1.00 2016-12-29 16:48:25.0 Post-Concussion Symptom Inventory (PCSI) Self-Report Assessment Form Pre and Post-Injury Report Ages 13-18 Post-concussive/TBI-Related Symptoms Outcomes and End Points

Single Pre-Defined Value Selected

C00008 Age value AgeVal Value for participant/subject's age, calculated as elapsed time since the birth of the participant/subject Value for participant/subject's age, calculated as elapsed time since the birth of the participant/subjec Age: Numeric Values Sady MD, Vaughan CG, Gioia GA. Psychometric Characteristics of the Postconcussion Symptom Inventory in Children and Adolescents. Archives of Clinical Neuropsychology. 2014;29(4):348-363. Pediatric Supplemental 3.00 2013-08-28 16:08:00.453 Post-Concussion Symptom Inventory (PCSI) Self-Report Assessment Form Pre and Post-Injury Report Ages 13-18 Post-concussive/TBI-Related Symptoms Outcomes and End Points

Free-Form Entry

0 1800 month
C52326 Post-Concussion Symptom Inventory (PCSI) - Irritability scale PCSIIrritabilityScl Scale to which the subject expressed irritability, as part of the Post-Concussion Symptom Inventory (PCSI) Scale to which the subject expressed irritability, as part of the Post-Concussion Symptom Inventory (PCSI Irritability 0;1;2;3;4;5;6 Not a problem;1;2;Moderate problem;4;5;Severe problem Numeric Values

We would like to know if you have had any of these symptoms before your injury. Next, we would like to know if these symptoms have changed after your injury. Please rate the symptom at two points in time- Before the Injury/Pre-Injury and Currently.
Please answer all the items the best that you can. Do not skip any items. Circle the number to tell us how much of a problem this symptom has been for you.

Sady MD, Vaughan CG, Gioia GA. Psychometric Characteristics of the Postconcussion Symptom Inventory in Children and Adolescents. Archives of Clinical Neuropsychology. 2014;29(4):348-363. Pediatric Supplemental 1.00 2016-12-29 16:14:44.0 Post-Concussion Symptom Inventory (PCSI) Self-Report Assessment Form Pre and Post-Injury Report Ages 13-18 Post-concussive/TBI-Related Symptoms Outcomes and End Points

Single Pre-Defined Value Selected

C52337 Post-Concussion Symptom Inventory (PCSI) - Answer slowly scale PCSIAnswerSlowlyScl Scale to which the subject answered questions more slowly than usual, as part of the Post-Concussion Symptom Inventory (PCSI) Scale to which the subject answered questions more slowly than usual, as part of the Post-Concussion Symptom Inventory (PCSI Answer questions more slowly than usual 0;1;2;3;4;5;6 Not a problem;1;2;Moderate problem;4;5;Severe problem Numeric Values

We would like to know if you have had any of these symptoms before your injury. Next, we would like to know if these symptoms have changed after your injury. Please rate the symptom at two points in time- Before the Injury/Pre-Injury and Currently.
Please answer all the items the best that you can. Do not skip any items. Circle the number to tell us how much of a problem this symptom has been for you.

Sady MD, Vaughan CG, Gioia GA. Psychometric Characteristics of the Postconcussion Symptom Inventory in Children and Adolescents. Archives of Clinical Neuropsychology. 2014;29(4):348-363. Pediatric Supplemental 1.00 2016-12-29 16:51:40.0 Post-Concussion Symptom Inventory (PCSI) Self-Report Assessment Form Pre and Post-Injury Report Ages 13-18 Post-concussive/TBI-Related Symptoms Outcomes and End Points

Single Pre-Defined Value Selected

C06005 Data collected date and time DataCollDateTime Date (and time, if applicable and known) the data were collected. This may be the date/time a particular examination or procedure was performed Date (and time, if applicable and known) the data were collected. This may be the date/time a particular examination or procedure was performe Today's date: Date or Date & Time Sady MD, Vaughan CG, Gioia GA. Psychometric Characteristics of the Postconcussion Symptom Inventory in Children and Adolescents. Archives of Clinical Neuropsychology. 2014;29(4):348-363. Pediatric Supplemental 3.00 2013-07-24 21:00:23.88 Post-Concussion Symptom Inventory (PCSI) Self-Report Assessment Form Pre and Post-Injury Report Ages 13-18 Post-concussive/TBI-Related Symptoms Outcomes and End Points

Free-Form Entry

C52327 Post-Concussion Symptom Inventory (PCSI) - Sadness scale PCSISadnessScl Scale to which the subject expressed sadness, as part of the Post-Concussion Symptom Inventory (PCSI) Scale to which the subject expressed sadness, as part of the Post-Concussion Symptom Inventory (PCSI Sadness 0;1;2;3;4;5;6 Not a problem;1;2;Moderate problem;4;5;Severe problem Numeric Values

We would like to know if you have had any of these symptoms before your injury. Next, we would like to know if these symptoms have changed after your injury. Please rate the symptom at two points in time- Before the Injury/Pre-Injury and Currently.
Please answer all the items the best that you can. Do not skip any items. Circle the number to tell us how much of a problem this symptom has been for you.

Sady MD, Vaughan CG, Gioia GA. Psychometric Characteristics of the Postconcussion Symptom Inventory in Children and Adolescents. Archives of Clinical Neuropsychology. 2014;29(4):348-363. Pediatric Supplemental 1.00 2016-12-29 16:19:54.0 Post-Concussion Symptom Inventory (PCSI) Self-Report Assessment Form Pre and Post-Injury Report Ages 13-18 Post-concussive/TBI-Related Symptoms Outcomes and End Points

Single Pre-Defined Value Selected

C52338 Post-Concussion Symptom Inventory (PCSI) - Generally different scale PCSIGenerallyDifferentScale Scale to which the subject generally seemed to be acting differently than before the injury, as part of the Post-Concussion Symptom Inventory (PCSI) Scale to which the subject generally seemed to be acting differently than before the injury, as part of the Post-Concussion Symptom Inventory (PCSI In general, to what degree do you feel "differently" than before the injury (not feeling like yourself)? 0;1;2;3;4 No Difference;1;2;3;Major Difference Numeric Values

Circle your rating with "0" indicating "Normal" (No Difference)
and "4" indicating "Very Different" (Major Difference)

Sady MD, Vaughan CG, Gioia GA. Psychometric Characteristics of the Postconcussion Symptom Inventory in Children and Adolescents. Archives of Clinical Neuropsychology. 2014;29(4):348-363. Pediatric Supplemental 1.00 2016-12-29 16:54:02.0 Post-Concussion Symptom Inventory (PCSI) Self-Report Assessment Form Pre and Post-Injury Report Ages 13-18 Post-concussive/TBI-Related Symptoms Outcomes and End Points

Single Pre-Defined Value Selected

C21117 Subject name SubjectName Name of subject/participant Name of subject/participan Patient Name: Alphanumeric Sady MD, Vaughan CG, Gioia GA. Psychometric Characteristics of the Postconcussion Symptom Inventory in Children and Adolescents. Archives of Clinical Neuropsychology. 2014;29(4):348-363. Pediatric Supplemental 1.00 2015-06-12 15:16:39.0 Post-Concussion Symptom Inventory (PCSI) Self-Report Assessment Form Pre and Post-Injury Report Ages 13-18 Post-concussive/TBI-Related Symptoms Outcomes and End Points 255

Free-Form Entry

C52328 Post-Concussion Symptom Inventory (PCSI) - Nervousness scale PCSINervousnessScl Scale to which the subject expressed nervousness, as part of the Post-Concussion Symptom Inventory (PCSI) Scale to which the subject expressed nervousness, as part of the Post-Concussion Symptom Inventory (PCSI Nervousness 0;1;2;3;4;5;6 Not a problem;1;2;Moderate problem;4;5;Severe problem Numeric Values

We would like to know if you have had any of these symptoms before your injury. Next, we would like to know if these symptoms have changed after your injury. Please rate the symptom at two points in time- Before the Injury/Pre-Injury and Currently.
Please answer all the items the best that you can. Do not skip any items. Circle the number to tell us how much of a problem this symptom has been for you.

Sady MD, Vaughan CG, Gioia GA. Psychometric Characteristics of the Postconcussion Symptom Inventory in Children and Adolescents. Archives of Clinical Neuropsychology. 2014;29(4):348-363. Pediatric Supplemental 1.00 2016-12-29 16:24:33.0 Post-Concussion Symptom Inventory (PCSI) Self-Report Assessment Form Pre and Post-Injury Report Ages 13-18 Post-concussive/TBI-Related Symptoms Outcomes and End Points

Single Pre-Defined Value Selected

C52715 Post-Concussion Symptom Inventory (PCSI) - Total score PCSITotalScore Total score, as a part of the Post-Concussion Symptom Inventory (PCSI) Total score, as a part of the Post-Concussion Symptom Inventory (PCSI Total PCSI Score Numeric Values

This is the total score of the all the subscales in the instrument, calculated at two points in time- Before the Injury/Pre-Injury and Currently.

Sady MD, Vaughan CG, Gioia GA. Psychometric Characteristics of the Postconcussion Symptom Inventory in Children and Adolescents. Archives of Clinical Neuropsychology. 2014;29(4):348-363. Pediatric Supplemental 1.00 2017-01-30 10:14:16.0 Post-Concussion Symptom Inventory (PCSI) Self-Report Assessment Form Pre and Post-Injury Report Ages 13-18 Post-concussive/TBI-Related Symptoms Outcomes and End Points

Free-Form Entry

0 120
C52318 Post-Concussion Symptom Inventory (PCSI) - Headache scale PCSIHeadacheScl Scale to which the subject complained of headaches, as part of the Post-Concussion Symptom Inventory (PCSI) Scale to which the subject complained of headaches, as part of the Post-Concussion Symptom Inventory (PCSI Headache 0;1;2;3;4;5;6 Not a problem;1;2;Moderate problem;4;5;Severe problem Numeric Values

We would like to know if you have had any of these symptoms before your injury. Next, we would like to know if these symptoms have changed after your injury. Please rate the symptom at two points in time- Before the Injury/Pre-Injury and Currently.
Please answer all the items the best that you can. Do not skip any items. Circle the number to tell us how much of a problem this symptom has been for you.

Sady MD, Vaughan CG, Gioia GA. Psychometric Characteristics of the Postconcussion Symptom Inventory in Children and Adolescents. Archives of Clinical Neuropsychology. 2014;29(4):348-363. Pediatric Supplemental 1.00 2016-12-29 15:20:57.0 Post-Concussion Symptom Inventory (PCSI) Self-Report Assessment Form Pre and Post-Injury Report Ages 13-18 Post-concussive/TBI-Related Symptoms Outcomes and End Points

Single Pre-Defined Value Selected

C52329 Post-Concussion Symptom Inventory (PCSI) - Feeling more emotional scale PCSIFeelMoreEmotionalScl Scale to which the subject was feeling more emotional, as part of the Post-Concussion Symptom Inventory (PCSI) Scale to which the subject was feeling more emotional, as part of the Post-Concussion Symptom Inventory (PCSI Feeling more emotional 0;1;2;3;4;5;6 Not a problem;1;2;Moderate problem;4;5;Severe problem Numeric Values

We would like to know if you have had any of these symptoms before your injury. Next, we would like to know if these symptoms have changed after your injury. Please rate the symptom at two points in time- Before the Injury/Pre-Injury and Currently.
Please answer all the items the best that you can. Do not skip any items. Circle the number to tell us how much of a problem this symptom has been for you.

Sady MD, Vaughan CG, Gioia GA. Psychometric Characteristics of the Postconcussion Symptom Inventory in Children and Adolescents. Archives of Clinical Neuropsychology. 2014;29(4):348-363. Pediatric Supplemental 1.00 2016-12-29 16:26:54.0 Post-Concussion Symptom Inventory (PCSI) Self-Report Assessment Form Pre and Post-Injury Report Ages 13-18 Post-concussive/TBI-Related Symptoms Outcomes and End Points

Single Pre-Defined Value Selected

C52717 Post-Concussion Symptom Inventory (PCSI) - Physical factor subscale score PCSIPhysicalFactorSubsclScore Score of the physical content-based factor subscale, as a part of the Post-Concussion Symptom Inventory (PCSI) Score of the physical content-based factor subscale, as a part of the Post-Concussion Symptom Inventory (PCSI Physical Factor Numeric Values

This is the sum score of the questions in the physical content-based factor subscale (questions 1-4,7,8,17,19), calculated at two points in time- Before the Injury/Pre-Injury and Currently.

Sady MD, Vaughan CG, Gioia GA. Psychometric Characteristics of the Postconcussion Symptom Inventory in Children and Adolescents. Archives of Clinical Neuropsychology. 2014;29(4):348-363. Pediatric Supplemental 1.00 2017-01-30 10:30:19.0 Post-Concussion Symptom Inventory (PCSI) Self-Report Assessment Form Pre and Post-Injury Report Ages 13-18 Post-concussive/TBI-Related Symptoms Outcomes and End Points

Free-Form Entry

0 48
C52319 Post-Concussion Symptom Inventory (PCSI) - Nausea scale PCSINauseaScl Scale to which the subject complained of nausea, as part of the Post-Concussion Symptom Inventory (PCSI) Scale to which the subject complained of nausea, as part of the Post-Concussion Symptom Inventory (PCSI Nausea 0;1;2;3;4;5;6 Not a problem;1;2;Moderate problem;4;5;Severe problem Numeric Values

We would like to know if you have had any of these symptoms before your injury. Next, we would like to know if these symptoms have changed after your injury. Please rate the symptom at two points in time- Before the Injury/Pre-Injury and Currently.
Please answer all the items the best that you can. Do not skip any items. Circle the number to tell us how much of a problem this symptom has been for you.

Sady MD, Vaughan CG, Gioia GA. Psychometric Characteristics of the Postconcussion Symptom Inventory in Children and Adolescents. Archives of Clinical Neuropsychology. 2014;29(4):348-363. Pediatric Supplemental 1.00 2016-12-29 15:54:39.0 Post-Concussion Symptom Inventory (PCSI) Self-Report Assessment Form Pre and Post-Injury Report Ages 13-18 Post-concussive/TBI-Related Symptoms Outcomes and End Points

Single Pre-Defined Value Selected

C52330 Post-Concussion Symptom Inventory (PCSI) - Feeling slowed down scale PCSIFeelSlowedDownScl Scale to which the subject was feeling slowed down, as part of the Post-Concussion Symptom Inventory (PCSI) Scale to which the subject was feeling slowed down, as part of the Post-Concussion Symptom Inventory (PCSI Feeling slowed down 0;1;2;3;4;5;6 Not a problem;1;2;Moderate problem;4;5;Severe problem Numeric Values

We would like to know if you have had any of these symptoms before your injury. Next, we would like to know if these symptoms have changed after your injury. Please rate the symptom at two points in time- Before the Injury/Pre-Injury and Currently.
Please answer all the items the best that you can. Do not skip any items. Circle the number to tell us how much of a problem this symptom has been for you.

Sady MD, Vaughan CG, Gioia GA. Psychometric Characteristics of the Postconcussion Symptom Inventory in Children and Adolescents. Archives of Clinical Neuropsychology. 2014;29(4):348-363. Pediatric Supplemental 1.00 2016-12-29 16:29:16.0 Post-Concussion Symptom Inventory (PCSI) Self-Report Assessment Form Pre and Post-Injury Report Ages 13-18 Post-concussive/TBI-Related Symptoms Outcomes and End Points

Single Pre-Defined Value Selected

C52719 Post-Concussion Symptom Inventory (PCSI) - Fatigue factor subscale score PCSIFatigueFactorSubsclScore Score of the fatigue content-based factor subscale, as a part of the Post-Concussion Symptom Inventory (PCSI) Score of the fatigue content-based factor subscale, as a part of the Post-Concussion Symptom Inventory (PCSI Fatigue Factor Numeric Values

This is the sum score of the questions in the fatigue content-based factor subscale (questions 5,6), calculated at two points in time- Before the Injury/Pre-Injury and Currently.

Sady MD, Vaughan CG, Gioia GA. Psychometric Characteristics of the Postconcussion Symptom Inventory in Children and Adolescents. Archives of Clinical Neuropsychology. 2014;29(4):348-363. Pediatric Supplemental 1.00 2017-01-30 10:30:19.0 Post-Concussion Symptom Inventory (PCSI) Self-Report Assessment Form Pre and Post-Injury Report Ages 13-18 Post-concussive/TBI-Related Symptoms Outcomes and End Points

Free-Form Entry

0 18
C52320 Post-Concussion Symptom Inventory (PCSI) - Balance problem scale PCSIBalanceProbScl Scale to which the subject experienced balance problems, as part of the Post-Concussion Symptom Inventory (PCSI) Scale to which the subject experienced balance problems, as part of the Post-Concussion Symptom Inventory (PCSI Balance problems 0;1;2;3;4;5;6 Not a problem;1;2;Moderate problem;4;5;Severe problem Numeric Values

We would like to know if you have had any of these symptoms before your injury. Next, we would like to know if these symptoms have changed after your injury. Please rate the symptom at two points in time- Before the Injury/Pre-Injury and Currently.
Please answer all the items the best that you can. Do not skip any items. Circle the number to tell us how much of a problem this symptom has been for you.

Sady MD, Vaughan CG, Gioia GA. Psychometric Characteristics of the Postconcussion Symptom Inventory in Children and Adolescents. Archives of Clinical Neuropsychology. 2014;29(4):348-363. Pediatric Supplemental 1.00 2016-12-29 15:57:37.0 Post-Concussion Symptom Inventory (PCSI) Self-Report Assessment Form Pre and Post-Injury Report Ages 13-18 Post-concussive/TBI-Related Symptoms Outcomes and End Points

Single Pre-Defined Value Selected

C52331 Post-Concussion Symptom Inventory (PCSI) - Feeling mentally foggy scale PCSIMentallyFoggyScl Scale to which the subject was feeling mentally foggy, as part of the Post-Concussion Symptom Inventory (PCSI) Scale to which the subject was feeling mentally foggy, as part of the Post-Concussion Symptom Inventory (PCSI Feeling mentally foggy 0;1;2;3;4;5;6 Not a problem;1;2;Moderate problem;4;5;Severe problem Numeric Values

We would like to know if you have had any of these symptoms before your injury. Next, we would like to know if these symptoms have changed after your injury. Please rate the symptom at two points in time- Before the Injury/Pre-Injury and Currently.
Please answer all the items the best that you can. Do not skip any items. Circle the number to tell us how much of a problem this symptom has been for you.

Sady MD, Vaughan CG, Gioia GA. Psychometric Characteristics of the Postconcussion Symptom Inventory in Children and Adolescents. Archives of Clinical Neuropsychology. 2014;29(4):348-363. Pediatric Supplemental 1.00 2016-12-29 16:31:56.0 Post-Concussion Symptom Inventory (PCSI) Self-Report Assessment Form Pre and Post-Injury Report Ages 13-18 Post-concussive/TBI-Related Symptoms Outcomes and End Points

Single Pre-Defined Value Selected

C52720 Post-Concussion Symptom Inventory (PCSI) - Emotional factor subscale score PCSIEmotionalFactorSubsclScore Score of the emotional content-based factor subscale, as a part of the Post-Concussion Symptom Inventory (PCSI) Score of the emotional content-based factor subscale, as a part of the Post-Concussion Symptom Inventory (PCSI Emotional Factor Numeric Values

This is the sum score of the questions in the emotional content-based factor subscale (questions 9-12), calculated at two points in time- Before the Injury/Pre-Injury and Currently.

Sady MD, Vaughan CG, Gioia GA. Psychometric Characteristics of the Postconcussion Symptom Inventory in Children and Adolescents. Archives of Clinical Neuropsychology. 2014;29(4):348-363. Pediatric Supplemental 1.00 2017-01-30 10:30:19.0 Post-Concussion Symptom Inventory (PCSI) Self-Report Assessment Form Pre and Post-Injury Report Ages 13-18 Post-concussive/TBI-Related Symptoms Outcomes and End Points

Free-Form Entry

0 24
C52321 Post-Concussion Symptom Inventory (PCSI) - Dizziness scale PCSIDizzinessScl Scale to which the subject appeared or complained of dizziness, as part of the Post-Concussion Symptom Inventory (PCSI) Scale to which the subject appeared or complained of dizziness, as part of the Post-Concussion Symptom Inventory (PCSI Dizziness 0;1;2;3;4;5;6 Not a problem;1;2;Moderate problem;4;5;Severe problem Numeric Values

We would like to know if you have had any of these symptoms before your injury. Next, we would like to know if these symptoms have changed after your injury. Please rate the symptom at two points in time- Before the Injury/Pre-Injury and Currently.
Please answer all the items the best that you can. Do not skip any items. Circle the number to tell us how much of a problem this symptom has been for you.

Sady MD, Vaughan CG, Gioia GA. Psychometric Characteristics of the Postconcussion Symptom Inventory in Children and Adolescents. Archives of Clinical Neuropsychology. 2014;29(4):348-363. Pediatric Supplemental 1.00 2016-12-29 16:00:33.0 Post-Concussion Symptom Inventory (PCSI) Self-Report Assessment Form Pre and Post-Injury Report Ages 13-18 Post-concussive/TBI-Related Symptoms Outcomes and End Points

Single Pre-Defined Value Selected

C52332 Post-Concussion Symptom Inventory (PCSI) - Difficulty concentrating scale PCSIDiffConcentrateScl Scale to which the subject had difficulty concentrating, as part of the Post-Concussion Symptom Inventory (PCSI) Scale to which the subject had difficulty concentrating, as part of the Post-Concussion Symptom Inventory (PCSI Difficulty concentrating 0;1;2;3;4;5;6 Not a problem;1;2;Moderate problem;4;5;Severe problem Numeric Values

We would like to know if you have had any of these symptoms before your injury. Next, we would like to know if these symptoms have changed after your injury. Please rate the symptom at two points in time- Before the Injury/Pre-Injury and Currently.
Please answer all the items the best that you can. Do not skip any items. Circle the number to tell us how much of a problem this symptom has been for you.

Sady MD, Vaughan CG, Gioia GA. Psychometric Characteristics of the Postconcussion Symptom Inventory in Children and Adolescents. Archives of Clinical Neuropsychology. 2014;29(4):348-363. Pediatric Supplemental 1.00 2016-12-29 16:34:44.0 Post-Concussion Symptom Inventory (PCSI) Self-Report Assessment Form Pre and Post-Injury Report Ages 13-18 Post-concussive/TBI-Related Symptoms Outcomes and End Points

Single Pre-Defined Value Selected

C52721 Post-Concussion Symptom Inventory (PCSI) - Cognitive factor subscale score PCSICognitiveFactorSubsclScore Score of the cognitive content-based factor subscale, as a part of the Post-Concussion Symptom Inventory (PCSI) Score of the cognitive content-based factor subscale, as a part of the Post-Concussion Symptom Inventory (PCSI Cognitive Factor Numeric Values

This is the sum score of the questions in the cognitive content-based factor subscale (questions 13-16,18,20), calculated at two points in time- Before the Injury/Pre-Injury and Currently.

Sady MD, Vaughan CG, Gioia GA. Psychometric Characteristics of the Postconcussion Symptom Inventory in Children and Adolescents. Archives of Clinical Neuropsychology. 2014;29(4):348-363. Pediatric Supplemental 1.00 2017-01-30 10:30:19.0 Post-Concussion Symptom Inventory (PCSI) Self-Report Assessment Form Pre and Post-Injury Report Ages 13-18 Post-concussive/TBI-Related Symptoms Outcomes and End Points

Free-Form Entry

0 36
C52322 Post-Concussion Symptom Inventory (PCSI) - Fatigue scale PCSIFatigueScl Scale to which the subject has fatigue, as part of the Post-Concussion Symptom Inventory (PCSI) Scale to which the subject has fatigue, as part of the Post-Concussion Symptom Inventory (PCSI Fatigue 0;1;2;3;4;5;6 Not a problem;1;2;Moderate problem;4;5;Severe problem Numeric Values

We would like to know if you have had any of these symptoms before your injury. Next, we would like to know if these symptoms have changed after your injury. Please rate the symptom at two points in time- Before the Injury/Pre-Injury and Currently.
Please answer all the items the best that you can. Do not skip any items. Circle the number to tell us how much of a problem this symptom has been for you.

Sady MD, Vaughan CG, Gioia GA. Psychometric Characteristics of the Postconcussion Symptom Inventory in Children and Adolescents. Archives of Clinical Neuropsychology. 2014;29(4):348-363. Pediatric Supplemental 1.00 2016-12-29 16:02:54.0 Post-Concussion Symptom Inventory (PCSI) Self-Report Assessment Form Pre and Post-Injury Report Ages 13-18 Post-concussive/TBI-Related Symptoms Outcomes and End Points

Single Pre-Defined Value Selected

C52333 Post-Concussion Symptom Inventory (PCSI) - Difficult remembering scale PCSIDiffRememberScl Scale to which the subject had difficulty remembering, as part of the Post-Concussion Symptom Inventory (PCSI) Scale to which the subject had difficulty remembering, as part of the Post-Concussion Symptom Inventory (PCSI Difficulty remembering 0;1;2;3;4;5;6 Not a problem;1;2;Moderate problem;4;5;Severe problem Numeric Values

We would like to know if you have had any of these symptoms before your injury. Next, we would like to know if these symptoms have changed after your injury. Please rate the symptom at two points in time- Before the Injury/Pre-Injury and Currently.
Please answer all the items the best that you can. Do not skip any items. Circle the number to tell us how much of a problem this symptom has been for you.

Sady MD, Vaughan CG, Gioia GA. Psychometric Characteristics of the Postconcussion Symptom Inventory in Children and Adolescents. Archives of Clinical Neuropsychology. 2014;29(4):348-363. Pediatric Supplemental 1.00 2016-12-29 16:39:34.0 Post-Concussion Symptom Inventory (PCSI) Self-Report Assessment Form Pre and Post-Injury Report Ages 13-18 Post-concussive/TBI-Related Symptoms Outcomes and End Points

Single Pre-Defined Value Selected

C54072 Post-Concussion Symptom Inventory (PCSI) - Change value PCSIChangeVal Value related to change in score, as part of the Post-Concussion Symptom Inventory (PCSI) Value related to change in score, as part of the Post-Concussion Symptom Inventory (PCSI Change Numeric Values

Change in value is calculated for total score as well as each factor subscale score.

Sady MD, Vaughan CG, Gioia GA. Psychometric Characteristics of the Postconcussion Symptom Inventory in Children and Adolescents. Archives of Clinical Neuropsychology. 2014;29(4):348-363. Pediatric Supplemental 1.00 2017-02-13 11:44:59.0 Post-Concussion Symptom Inventory (PCSI) Self-Report Assessment Form Pre and Post-Injury Report Ages 13-18 Post-concussive/TBI-Related Symptoms Outcomes and End Points

Free-Form Entry

C52323 Post-Concussion Symptom Inventory (PCSI) - Drowsiness scale PCSIDrowsinessScl Scale to which the subject experiences drowsiness, as part of the Post-Concussion Symptom Inventory (PCSI) Scale to which the subject experiences drowsiness, as part of the Post-Concussion Symptom Inventory (PCSI Drowsiness 0;1;2;3;4;5;6 Not a problem;1;2;Moderate problem;4;5;Severe problem Numeric Values

We would like to know if you have had any of these symptoms before your injury. Next, we would like to know if these symptoms have changed after your injury. Please rate the symptom at two points in time- Before the Injury/Pre-Injury and Currently.
Please answer all the items the best that you can. Do not skip any items. Circle the number to tell us how much of a problem this symptom has been for you.

Sady MD, Vaughan CG, Gioia GA. Psychometric Characteristics of the Postconcussion Symptom Inventory in Children and Adolescents. Archives of Clinical Neuropsychology. 2014;29(4):348-363. Pediatric Supplemental 1.00 2016-12-29 16:06:47.0 Post-Concussion Symptom Inventory (PCSI) Self-Report Assessment Form Pre and Post-Injury Report Ages 13-18 Post-concussive/TBI-Related Symptoms Outcomes and End Points

Single Pre-Defined Value Selected

C52334 Post-Concussion Symptom Inventory (PCSI) - Visual problems scale PCSIVisualProbScl Scale to which the subject expressed visual problems (blurry, double vision), as part of the Post-Concussion Symptom Inventory (PCSI) Scale to which the subject expressed visual problems (blurry, double vision), as part of the Post-Concussion Symptom Inventory (PCSI Visual Problems(double vision, blurring) 0;1;2;3;4;5;6 Not a problem;1;2;Moderate problem;4;5;Severe problem Numeric Values

We would like to know if you have had any of these symptoms before your injury. Next, we would like to know if these symptoms have changed after your injury. Please rate the symptom at two points in time- Before the Injury/Pre-Injury and Currently.
Please answer all the items the best that you can. Do not skip any items. Circle the number to tell us how much of a problem this symptom has been for you.

Sady MD, Vaughan CG, Gioia GA. Psychometric Characteristics of the Postconcussion Symptom Inventory in Children and Adolescents. Archives of Clinical Neuropsychology. 2014;29(4):348-363. Pediatric Supplemental 1.00 2016-12-29 16:42:39.0 Post-Concussion Symptom Inventory (PCSI) Self-Report Assessment Form Pre and Post-Injury Report Ages 13-18 Post-concussive/TBI-Related Symptoms Outcomes and End Points

Single Pre-Defined Value Selected

C52324 Post-Concussion Symptom Inventory (PCSI) - Sensitive to light scale PCSISensitiveToLightScl Scale to which the subject was sensitive to light, as part of the Post-Concussion Symptom Inventory (PCSI) Scale to which the subject was sensitive to light, as part of the Post-Concussion Symptom Inventory (PCSI Sensitivity to light 0;1;2;3;4;5;6 Not a problem;1;2;Moderate problem;4;5;Severe problem Numeric Values

We would like to know if you have had any of these symptoms before your injury. Next, we would like to know if these symptoms have changed after your injury. Please rate the symptom at two points in time- Before the Injury/Pre-Injury and Currently.
Please answer all the items the best that you can. Do not skip any items. Circle the number to tell us how much of a problem this symptom has been for you.

Sady MD, Vaughan CG, Gioia GA. Psychometric Characteristics of the Postconcussion Symptom Inventory in Children and Adolescents. Archives of Clinical Neuropsychology. 2014;29(4):348-363. Pediatric Supplemental 1.00 2016-12-29 16:09:09.0 Post-Concussion Symptom Inventory (PCSI) Self-Report Assessment Form Pre and Post-Injury Report Ages 13-18 Post-concussive/TBI-Related Symptoms Outcomes and End Points

Single Pre-Defined Value Selected

C52335 Post-Concussion Symptom Inventory (PCSI) - Get confused with directions or tasks scale PCSIConfuWthDirctnsScl Scale to which the subject expressed getting confused with directions or tasks, as part of the Post-Concussion Symptom Inventory (PCSI) Scale to which the subject expressed getting confused with directions or tasks, as part of the Post-Concussion Symptom Inventory (PCSI Get confused with directions or tasks 0;1;2;3;4;5;6 Not a problem;1;2;Moderate problem;4;5;Severe problem Numeric Values

We would like to know if you have had any of these symptoms before your injury. Next, we would like to know if these symptoms have changed after your injury. Please rate the symptom at two points in time- Before the Injury/Pre-Injury and Currently.
Please answer all the items the best that you can. Do not skip any items. Circle the number to tell us how much of a problem this symptom has been for you.

Sady MD, Vaughan CG, Gioia GA. Psychometric Characteristics of the Postconcussion Symptom Inventory in Children and Adolescents. Archives of Clinical Neuropsychology. 2014;29(4):348-363. Pediatric Supplemental 1.00 2016-12-29 16:45:34.0 Post-Concussion Symptom Inventory (PCSI) Self-Report Assessment Form Pre and Post-Injury Report Ages 13-18 Post-concussive/TBI-Related Symptoms Outcomes and End Points

Single Pre-Defined Value Selected

C00007 Birth date BirthDate Date (and time, if applicable and known) the participant/subject was born Date (and time, if applicable and known) the participant/subject was born Birthdate: Date or Date & Time Sady MD, Vaughan CG, Gioia GA. Psychometric Characteristics of the Postconcussion Symptom Inventory in Children and Adolescents. Archives of Clinical Neuropsychology. 2014;29(4):348-363. Pediatric Supplemental 3.00 2013-07-25 08:54:08.2 Post-Concussion Symptom Inventory (PCSI) Self-Report Assessment Form Pre and Post-Injury Report Ages 13-18 Post-concussive/TBI-Related Symptoms Outcomes and End Points

Free-Form Entry

793
C52325 Post-Concussion Symptom Inventory (PCSI) - Sensitive to noise scale PCSISensitiveToNoiseScl Scale to which the subject was sensitive to noise, as part of the Post-Concussion Symptom Inventory (PCSI) Scale to which the subject was sensitive to noise, as part of the Post-Concussion Symptom Inventory (PCSI Sensitivity to noise 0;1;2;3;4;5;6 Not a problem;1;2;Moderate problem;4;5;Severe problem Numeric Values

We would like to know if you have had any of these symptoms before your injury. Next, we would like to know if these symptoms have changed after your injury. Please rate the symptom at two points in time- Before the Injury/Pre-Injury and Currently.
Please answer all the items the best that you can. Do not skip any items. Circle the number to tell us how much of a problem this symptom has been for you.

Sady MD, Vaughan CG, Gioia GA. Psychometric Characteristics of the Postconcussion Symptom Inventory in Children and Adolescents. Archives of Clinical Neuropsychology. 2014;29(4):348-363. Pediatric Supplemental 1.00 2016-12-29 16:11:30.0 Post-Concussion Symptom Inventory (PCSI) Self-Report Assessment Form Pre and Post-Injury Report Ages 13-18 Post-concussive/TBI-Related Symptoms Outcomes and End Points

Single Pre-Defined Value Selected

CSV