CDE Detailed Report
Disease: Traumatic Brain Injury
Subdomain Name: Demographics
CRF: FITBIR Demographics Form
Displaying 1 - 50 of 123
Subdomain Name: Demographics
CRF: FITBIR Demographics Form
Displaying 1 - 50 of 123
| 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| C21979 | Sport college primary participation type | SportCollegePrimaryPartTyp | The primary sport the participant/subject played in college | The primary sport the participant/subject played in colleg | What was the primary sport the subject played in college? | Ice Hockey;Diving;Golf;Soccer;Water polo;Equestrian;Football;Lacrosse;Ice Skating;Skiing;Basketball;Baseball;Gymnastics;Swimming;Boxing;Rifle;Bowling;Field Event;Field Hockey;Softball;Volleyball;Figure skating;Rowing;Cross Country / Track;Tennis;Other, specify;Wrestling;Fencing | Ice Hockey;Diving;Golf;Soccer;Water polo;Equestrian;Football;Lacrosse;Ice Skating;Skiing;Basketball;Baseball;Gymnastics;Swimming;Boxing;Rifle;Bowling;Field Event;Field Hockey;Softball;Volleyball;Figure skating;Rowing;Cross Country / Track;Tennis;Other, specify;Wrestling;Fencing | Alphanumeric | Adult | Supplemental | 1.00 | 2016-06-06 18:24:16.0 | FITBIR Demographics Form | Demographics | Participant Characteristics |
Single Pre-Defined Value Selected |
||||||||||
| C00214 | Living with persons count | PrsnCohabitCt | Count of other people with whom the participant/subject currently lives, cohabits, or stays | Count of other people with whom the participant/subject currently lives, cohabits, or stays | What is the count of other people with whom the subject currently lives, cohabits, or stays? | Numeric Values |
Include everyone who is living or staying here for more than 2 months. Include participant/subject if they are living here for more than 2 months. Include anyone else staying here who does not have another place to stay even if they are here for 2 months or less. Do not include anyone who is living somewhere else for more than 2 months, such as college student living away or someone in the Armed Forces on deployment. Answer should be recorded as a 2 digit number (i.e., one should be recorded as 01, ten should be recorded as 10). Participant/subject should NOT be included. |
American Community Survey questionnaire. U.S. Department of Commerce, U.S. Census Bureau. http://www.census.gov/acs/www/Downloads/questionnaires/2012/Quest12.pdf | Adult;Pediatric | Supplemental | 3.00 | 2013-07-25 08:54:08.2 | FITBIR Demographics Form | Demographics | Participant Characteristics |
Free-Form Entry |
0 | 99 | ||||||||
| C22700 | Parent job classification category | ParentJobclassCat | Category that classifies work performed by the participant's/subject's parent, guardian, or caregiver | Category that classifies work performed by the participant's/subject's parent, guardian, or caregive | What is the parent, guardian, or caregiver's job classification? | Agricultural or fishery worker;Armed forces occupation;Clerk;Craft and related trades workers;Elementary occupations;Legislator, or senior official, or manager;Plant and machine operators and assemblers;Professional;Professional referral;Service or sales worker;Technicians and associate professionals;Not applicable;Unknown;Other, specify | Agricultural or fishery worker;Armed forces occupation (officers, service personnel);Clerk;Craft and related trades workers (e.g. motor mechanic, printer, tool and die makers, electrician);Elementary occupations (laborer, porter, unskilled workers);Legislator, or senior official, or manager;Plant and machine operators and assemblers;Professional;Professional referral;Service or sales worker;Technicians and associate professionals (typically requiring a Bachelor degree or equivilent);Not applicable;Unknown;Other, specify | Alphanumeric | Adult;Pediatric | Supplemental | 3.00 | 2013-07-20 10:21:25.65 | FITBIR Demographics Form | Demographics | Participant Characteristics |
Single Pre-Defined Value Selected |
||||||||||
| C21759 | Primary other person shared living adult patient text | SesPrimAdultOTH | Primary person living with adult patient | Primary person living with adult patient | Other, specify | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2016-06-02 13:29:06.0 | FITBIR Demographics Form | Demographics | Participant Characteristics | 256 |
Free-Form Entry |
|||||||||||
| C00005 | Birth country name | BirthCntryName | Name for country where the participant was born | Name for country where the participant was born | What is the subject's birth country name? | Alphanumeric |
Text for participant/subject's birth country. It may be easier to record the full name of the country and code the data later in Birth country ISO code using the ISO 3166-1 alpha-2 codes. |
Adult;Pediatric | Supplemental | 3.1 | 10/16/2024 8:51:20 AM | FITBIR Demographics Form | Demographics | Participant Characteristics | 255 |
Free-Form Entry |
||||||||||
| C21990 | Sport professional primary participation type | SportProfessionlPrimryPlaydTyp | The primary sport the participant/subject played professionally | The primary sport the participant/subject played professionall | What was the primary professional sport the subject played? | Ice Hockey;Diving;Golf;Soccer;Water polo;Equestrian;Football;Lacrosse;Ice Skating;Skiing;Basketball;Baseball;Gymnastics;Swimming;Boxing;Rifle;Bowling;Field Event;Field Hockey;Softball;Volleyball;Figure skating;Rowing;Cross Country / Track;Tennis;Other, specify;Wrestling;Fencing | Ice Hockey;Diving;Golf;Soccer;Water polo;Equestrian;Football;Lacrosse;Ice Skating;Skiing;Basketball;Baseball;Gymnastics;Swimming;Boxing;Rifle;Bowling;Field Event;Field Hockey;Softball;Volleyball;Figure skating;Rowing;Cross Country / Track;Tennis;Other, specify;Wrestling;Fencing | Alphanumeric | Adult | Supplemental | 1.00 | 2016-06-06 18:36:16.0 | FITBIR Demographics Form | Demographics | Participant Characteristics |
Single Pre-Defined Value Selected |
||||||||||
| C15989 | Unemployed reason | UnemplymntRsn | Participant's/subject's reason for unemployment | Participant's/subject's reason for unemployment | What is the subject's reason for being unemployed? | Alphanumeric |
Specify the reason for unemployment |
Adult;Pediatric | Supplemental | 3.00 | 2013-07-16 14:01:43.01 | FITBIR Demographics Form | Demographics | Participant Characteristics | 255 |
Free-Form Entry |
||||||||||
| C21807 | Military occupational status | MilMOS | Military occupational status of participant/subject | Military occupational status of participant/subject | What is the military occupational status of the subject? | Non-combat;Combat;Other, specify | Non-combat;Combat;Other, specify | Alphanumeric |
Military occupational status of participant |
Adult;Pediatric | Supplemental | 1.00 | 2016-06-03 11:21:24.0 | FITBIR Demographics Form | Demographics | Participant Characteristics |
Single Pre-Defined Value Selected |
|||||||||
| C21819 | Sport junior high primary participation text | JuniorHighPrimrySportPlayedTxt | The indicator related to which sports participant/subject played in junior high school | The indicator related to which sports participant/subject played in junior high school | What was the primary sport the subject played in junior high school? | Alphanumeric |
The indicator related to which sports subject played in junior high school |
Adult;Pediatric | Supplemental | 1.00 | 2016-06-03 12:47:49.0 | FITBIR Demographics Form | Demographics | Participant Characteristics | 4000 |
Free-Form Entry |
||||||||||
| C00028 | Language spoken fluent ISO code | LangSpokeFluentISOCode | Code (ISO 639-2)for each language that the participant/subject speaks fluently | Code (ISO 639-2)for each language that the participant/subject speaks fluently | What are the ISO codes for each language the subject can speak fluently? The ISO codes represent the international codes for different countries. | English (eng);German (ger);Other specify;Chinese languages (Chi);fre;sgn;Spanish (spa) | English (eng);German (ger);Other specify;Chinese languages (Chi);French;Sign Languages;Spanish (spa) | Alphanumeric |
Choose all that apply. It may be easier to record the full name of the language and code the data later using the ISO 639-2 codes. The language data should be coded using the ISO 639-2 codes prior to aggregation or sharing. |
ISO 639-2 language codes (http://www.loc.gov/standards/iso639-2/php/code_list.php) | Adult;Pediatric | Supplemental | 3.00 | 2013-07-20 10:21:25.65 | FITBIR Demographics Form | Demographics | Participant Characteristics |
Multiple Pre-Defined Values Selected |
||||||||
| C22690 | Parent Ethnicity USA category | ParentEthnUSACat | Category of ethnicity the parent, guardian, or caregiver most closely identifies with | Category of ethnicity the parent, guardian, or caregiver most closely identifies with | What is the parent's, guardian's, or caregiver's ethnicity? | Hispanic or Latino;Not Hispanic or Latino;Unknown;Not reported;Other, specify | A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race. The term 'Spanish origin' can also be used in addition to 'Hispanic or Latino.';A person not meeting the definition for Hispanic or Latino.;Could not be determined or unsure;Not reported;Other, specify | Alphanumeric |
Choose one. Response is obtained by report of the participant/subject or caretaker. If more detailed characterizations of ethnicity are collected to enhance data quality and consistency, it is recommended that they be "collapsible" up to the two categories for reportable ethnicity, as needed for reporting to FDA under its guidance. Other regulatory bodies may expect the reporting of ethnicity values which more appropriately reflect the population of their areas (e.g., Japanese ancestry for MHLW reporting to Japan). These may be collected as an extension to the suggested code list. The NIH Guidelines on Inclusion of Women and Minorities as Subjects in Clinical Research: The Office of Management and Budget Directive No. 15 defines the minimum standard of basic racial and ethnic categories. (http://grants.nih.gov/grants/funding/women_min/guidelines_update.htm) Collection of Race and Ethnicity Data in Clinical Trials (FDA, September 2005 - http://www.fda.gov/RegulatoryInformation/Guidances/ucm126340.htm) |
Adult;Pediatric | Core | 3.00 | 2013-08-28 16:08:00.453 | FITBIR Demographics Form | Demographics | Participant Characteristics |
Single Pre-Defined Value Selected |
2192217 | ||||||||
| C18739 | Military USA service branch other text | MilUSAServBrnchOTH | The free-text field related to 'Military USA service branch type' specifying other text. Branch of service in the U.S. military, not including the Commissioned Corps | The free-text field related to 'Military USA service branch type' specifying other text. Branch of service in the U.S. military, not including the Commissioned Corps | Other, specify | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2014-05-27 13:34:46.0 | FITBIR Demographics Form | Demographics | Participant Characteristics | 4000 |
Free-Form Entry |
|||||||||||
| C21980 | Sport college participation total year count | SportCollegePrimaryYrsCt | Total combined years the participant/subject played primary college sport (should be used in combination with Primary college sport played by the participant UDE) | Total combined years the participant/subject played primary college sport (should be used in combination with Primary college sport played by the participant UDE | How many years did the subject play the primary sport in college? | Numeric Values | Adult | Supplemental | 1.00 | 2016-06-06 18:25:34.0 | FITBIR Demographics Form | Demographics | Participant Characteristics |
Free-Form Entry |
1 | 50 | ||||||||||
| C00220 | Military USA rank category | MilUSARnkCat | Category that describes the participant's/subject's rank in the military | Category that describes the participant's/subject's rank in the military | What is the subject's military rank? | Company grade officer;Warrant officer;Non-commissioned officer;Other enlisted rank;Field grade officer or above | Company grade officer;Warrant officer;Non-commissioned officer (e.g., sergeant/corporal);Other enlisted rank;Field grade officer or above | Alphanumeric |
Choose one. Response is obtained by report of the participant/subject or relatives. NATO rank specifications could be used instead, but military personnel are typically unfamiliar with these ranks (i.e., they do not know their own NATO rank specification). Ranks generally reflect level of responsibility and type of activities engaged in while in theatre - information that may correlate with risk/severity/type of injury. |
Adult;Pediatric | Supplemental | 3.00 | 2013-07-20 10:21:25.65 | FITBIR Demographics Form | Demographics | Participant Characteristics |
Single Pre-Defined Value Selected |
|||||||||
| C22701 | Parent unemployed reason | ParentUnemplymntRsn | Participant's/subject's parent, guardian, or caregiver's reason for unemployment | Participant's/subject's parent, guardian, or caregiver's reason for unemployment | What is the parent, guardian, or caregiver's reason for being unemployed? | Alphanumeric |
Specify the reason for unemployment |
Adult;Pediatric | Supplemental | 3.00 | 2013-07-16 14:01:43.01 | FITBIR Demographics Form | Demographics | Participant Characteristics | 255 |
Free-Form Entry |
||||||||||
| C21794 | Living situation juvenile patient type | SesPrimChild | Living situation of juvenile patient | Living situation of juvenile patient | What is the subject's living situation? | Adoptive parents;Foster care;Other family member;Parent;Unable to obtain information;Other, specify | Adoptive parents;Foster care;Other family member;Parent;Unable to obtain information;Other, specify | Alphanumeric |
Living situation of juvenile patient |
Adult;Pediatric | Supplemental | 1.00 | 2016-06-02 15:03:52.0 | FITBIR Demographics Form | Demographics | Participant Characteristics |
Single Pre-Defined Value Selected |
|||||||||
| C00007 | Birth date | BirthDate | Date (and time, if applicable and known) the participant was born | Date (and time, if applicable and known) the participant was born | What is the subject's date of birth? | Date or Date & Time |
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, complete date plus hours and minutes, etc.). Recording date of birth will give the most detailed information required for calculation of age and is recommended as first choice. However, in some studies recording date of birth may elicit discussions on a potential violation of privacy legislation and specifically HIPAA regulations. In these cases, the calculated age should be recorded. Data Sharing Instructions: When date/time data are prepared for aggregation or sharing they should be converted to the format specified by ISO 8601, YYYY-MM-DDThh:mm:ss. |
ISO 8601 - http: //www.iso.org/iso/iso_catalogue.htm Management and prognosis of severe traumatic brain injury: Age. J Neurotrauma. 2000;17: 573-581.<br />Mushkudiani NA, Engel DC, Steyerberg EW, et al. Prognostic value of demographic characteristics in traumatic brain injury: results from the IMPACT study. J Neurotrauma. Feb 2007;24(2): 259-69. <br />Pediatric-specific reference(s): Anderson V, Catroppa C, Morse S, Haritou F, Rosenfeld J (2005) Functional plasticity or vulnerability after early brain injury. Pediatric 116: 1374-1382 | Adult;Pediatric | Core | 3.1 | 10/16/2024 8:51:14 AM | FITBIR Demographics Form | Demographics | Participant Characteristics |
Free-Form Entry |
793 | |||||||||
| C21991 | Sport professional participation total year count | SportProfessPrimPartTtlYrsCt | Total combined years the participant/subject played primary professional sport (should be used in combination with Primary professional sport played by the participant/subject CDE) | Total combined years the participant/subject played primary professional sport (should be used in combination with Primary professional sport played by the participant/subject CDE) | What is the total number of years the subject played the primary professional sports? | Numeric Values |
Use in combination with Primary professional sport played by the participant UDE. |
Adult | Supplemental | 1.00 | 2016-06-06 18:37:01.0 | FITBIR Demographics Form | Demographics | Participant Characteristics |
Free-Form Entry |
1 | 50 | |||||||||
| C15993 | Dependent children number | DpndntChildNum | Number of dependent children | Number of dependent children | What is the total number of dependents children the subject has? | Numeric Values |
Number of dependent children for a participant/subject |
Adult;Pediatric | Supplemental | 3.00 | 2013-07-16 14:01:43.01 | FITBIR Demographics Form | Demographics | Participant Characteristics |
Free-Form Entry |
|||||||||||
| C21808 | Military occupational status other text | MilMOSOTH | Military occupational status of participant/subject other text | Military occupational status of participant/subject other text | Other, specify | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2016-06-03 11:23:15.0 | FITBIR Demographics Form | Demographics | Participant Characteristics | 4000 |
Free-Form Entry |
|||||||||||
| C21820 | Sport junior high participation year count | JuniorHighPrimarySprtYrsCt | The number of years participant/subject played sport(s) in junior high school | The number of years participant/subject played sport(s) in junior high school | How many years did the subject play the primary sport in junior high school? | 1;2;3;4;5;6 | 1;2;3;4;5;6 | Numeric Values |
The number of years subject played sport(s) in junior high school |
Adult;Pediatric | Supplemental | 1.00 | 2016-06-03 12:48:46.0 | FITBIR Demographics Form | Demographics | Participant Characteristics |
Single Pre-Defined Value Selected |
|||||||||
| C00029 | Language written fluent ISO code | LangWrtnFlntlyTxtISOCode | Code (ISO 639-2) for each language that the participant/subject writes fluently | Code (ISO 639-2) for each language that the participant/subject writes fluently | What are the ISO codes for each language the subject can write fluently? | Alphanumeric |
Enter all that apply |
ISO 639-2 language codes (http://www.loc.gov/standards/iso639-2/php/code_list.php) | Adult;Pediatric | Supplemental | 3.00 | 2013-07-20 10:21:25.65 | FITBIR Demographics Form | Demographics | Participant Characteristics | 255 |
Free-Form Entry |
|||||||||
| C22691 | Parent birth country ISO code | ParentBirthCntryISOCode | Code (ISO 3166-1 alpha-2 code) for country where the participant's/subject's parent, guardian, or caregiver was born | Code (ISO 3166-1 alpha-2 code) for country where the participant's/subject's parent, guardian, or caregiver was bor | What is the parent's, guardian's, or caregiver's birth country ISO code? | AU;CA;MX;GB;US | AUSTRALIA;CANADA;MEXICO;UNITED KINGDOM;UNITED STATES | Alphanumeric |
Choose one. It may be easier to record the full name of the country and code the data later using the ISO 3166-1 alpha-2 codes. Code (ISO 3166-1 alpha-2 code) for country where the participant/subject was born |
Adult;Pediatric | Supplemental | 3.00 | 2013-07-24 21:00:23.88 | FITBIR Demographics Form | Demographics | Participant Characteristics |
Single Pre-Defined Value Selected |
|||||||||
| C18747 | Residence other text | ResdncOTH | The free-text field related to 'Residence type' specifying other text. Type of residence where the participant/subject is currently living | The free-text field related to 'Residence type' specifying other text. Type of residence where the participant/subject is currently living | Other, specify | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2014-05-27 13:34:46.0 | FITBIR Demographics Form | Demographics | Participant Characteristics | 4000 |
Free-Form Entry |
|||||||||||
| C21981 | Sport college primary participation other text | SportCollegePrimarPartOTH | Other sports the participant/subject played in college. A complimentary CDE for Primary college sport played by the participant/subject | Other sports the participant/subject played in college. A complimentary CDE for Primary college sport played by the participant/subjec | Other, specify | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2016-06-06 18:26:32.0 | FITBIR Demographics Form | Demographics | Participant Characteristics | 4000 |
Free-Form Entry |
|||||||||||
| C00222 | Job classification category | JobclassCat | Category that classifies work performed by participant/subject | Category that classifies work performed by participant/subjec | What is the subject's current job classification? | Agricultural or fishery worker;Armed forces occupation;Clerk;Craft and related trades workers;Elementary occupations;Legislator, or senior official, or manager;Plant and machine operators and assemblers;Professional;Professional referral;Service or sales worker;Technicians and associate professionals;Not applicable;Unknown;Other, specify | Agricultural or fishery worker;Armed forces occupation (officers, service personnel);Clerk;Craft and related trades workers (e.g. motor mechanic, printer, tool and die makers, electrician);Elementary occupations (laborer, porter, unskilled workers);Legislator, or senior official, or manager;Plant and machine operators and assemblers;Professional;Professional referral;Service or sales worker;Technicians and associate professionals (typically requiring a Bachelor degree or equivilent);Not applicable;Unknown;Other, specify | Alphanumeric |
For detailed definitions go to: http://www.who.int/healthinfo/survey/whsshortversionguide.pdf |
Adult;Pediatric | Supplemental | 3.00 | 2013-07-20 10:21:25.65 | FITBIR Demographics Form | Demographics | Participant Characteristics |
Single Pre-Defined Value Selected |
|||||||||
| C22706 | Military USA rank category other text | MilUSARnkCatOTH | The free-text field related to Military rank category specifying other text. Category that describes the participant's/subject's rank in the military | The free-text field related to Military rank category specifying other text. Category that describes the participant's/subject's rank in the military | Other, specify | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2016-08-22 09:14:32.0 | FITBIR Demographics Form | Demographics | Participant Characteristics | 255 |
Free-Form Entry |
|||||||||||
| C21798 | Living situation juvenile patient other text | SesPrimChildOTH | Living situation of juvenile patient other text | Living situation of juvenile patient other text | Other, specify | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2016-06-03 08:49:58.0 | FITBIR Demographics Form | Demographics | Participant Characteristics | 4000 |
Free-Form Entry |
|||||||||||
| C00008 | Age value | AgeVal | Value for participant's age, calculated as elapsed time since the birth of the participant | Value for participant's age, calculated as elapsed time since the birth of the participant | Subject's age (recorded in years) | Numeric Values |
The subject's age is typically recorded to the nearest full year completed, e.g., 11 years and 6 months should be recorded as 11 years. For subject's which are under 1 year old, use decimal points and use the following convention: record 1 month as 0.083 (1/12), 2 months as 0.166 (2/12), 3 months as 0.25 (3/12), 4 months as 0.333 (4/12), 5 months as 0.416 (5/12), 6 months as 0.5 (6/12), 7 months as 0.583 (7/12), 8 months as 0.666 (8/12), 9 months as 0.75 (9/12), 10 months as 0.833 (10/12), 11 months as 0.916 (11/12) and 12 months as 1 year. |
Adult;Pediatric | Supplemental | 3.10 | 2024-02-29 15:47:28.0 | FITBIR Demographics Form | Demographics | Participant Characteristics |
Free-Form Entry |
0 | 1800 | month | ||||||||
| C21992 | Sport professional primary participation other text | SportProfessionalPartOTH | Other sports the participant played professionally. A complimentary element for Primary professional sport played by the participant | Other sports the participant played professionally. A complimentary element for Primary professional sport played by the participan | Other, specify | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2016-06-06 18:38:26.0 | FITBIR Demographics Form | Demographics | Participant Characteristics | 4000 |
Free-Form Entry |
|||||||||||
| C15994 | Dependent children living in household number | DpndntChildLvngHshldNum | Number of dependent children living in household | Number of dependent children living in household | What is the number of dependent children living in the subject's household? | Numeric Values | Adult;Pediatric | Supplemental | 3.00 | 2013-07-16 14:01:43.01 | FITBIR Demographics Form | Demographics | Participant Characteristics |
Free-Form Entry |
||||||||||||
| C21809 | Military deployment location | MilDeploy | Region or country to where participant/subject was deployed | Region or country to where participant/subject was deployed | Where was the subject deployed? | Iraq;Afghanistan;Africa;Germany;None;Other, specify | Iraq;Afghanistan;Africa;Germany;None;Other, specify | Alphanumeric |
Region or country the military patient was deployed |
Adult;Pediatric | Supplemental | 1.00 | 2016-06-03 11:24:57.0 | FITBIR Demographics Form | Demographics | Participant Characteristics |
Multiple Pre-Defined Values Selected |
|||||||||
| C21821 | Sport junior high other participation text | JuniorHighSportOtherplayedTxt | The free-text field to specify which other sports participant/subject played in junior high school | The free-text field to specify which other sports participant/subject played in junior high school | Which other sports did the subject play in junior high school? | Alphanumeric |
The free-text field to specify which other sports subject played in junior high school |
Adult;Pediatric | Supplemental | 1.00 | 2016-06-03 12:51:28.0 | FITBIR Demographics Form | Demographics | Participant Characteristics | 4000 |
Free-Form Entry |
||||||||||
| C00030 | Race USA category | RaceUSACat | The patient's self declared racial origination, independent of ethnic origination, using OMB approved categories | The patient's self declared racial origination, independent of ethnic origination, using OMB approved categories | What is the subject's racial background (as defined by OMB)? | American Indian or Alaska Native;Asian;Black or African-American;Native Hawaiian or Other Pacific Islander;White;Unknown;Not Reported | A person having origins in any of the original peoples of North and South America (including Central America), and who maintains tribal affiliation or community attachment.;A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.;A person having origins in any of the black racial groups of Africa. Terms such as 'Haitian' can be used in addition to 'Black or African American.';A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.;A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.;Could not be determined or unsure;Not provided or unavailable | Alphanumeric |
Choose all that apply. Response is obtained by report of the participant/subject or caretaker. Collecting information on race may not be allowed in some countries for concerns related to discrimination. In other countries, however, these concerns are considered a reason for recording race in order to guarantee equal access to care. Investigators receiving funding from the US National Institutes of Health (NIH) are required to report the number of subjects enrolled on an annual basis using the racial categories listed. The NIH Guidelines on Inclusion of Women and Minorities as Subjects in Clinical Research: The Office of Management and Budget (OMB) Directive No. 15 defines the minimum standard of basic racial and ethnic categories. (http://grants.nih.gov/grants/funding/women_min/guidelines_update.htm) |
The NIH Guidelines on Inclusion of Women and Minorities as Subjects in Clinical Research: The Office of Management and Budget (OMB) Directive No. 15 defines the minimum standard of basic racial and ethnic categories. (http://grants.nih.gov/grants/funding/women_min/guidelines_update.htm) Collection of Race and Ethnicity Data in Clinical Trials (FDA, September 2005 - http://www.fda.gov/RegulatoryInformation/Guidances/ucm126340.htm) Jorde LB and Wooding SP. Genetic variation, classification and "race". Nature Genetics. 2004;36(11):S28-S33. Bhopal R and Donaldson L. White, European, Western, Caucasian, or What? Inappropriate labeling in Research on Race, Ethnicity, and Health. Amer J of Publ Health. 1998;88:1303-1307. | Adult;Pediatric | Core | 3.1 | 10/16/2024 8:51:18 AM | FITBIR Demographics Form | Demographics | Participant Characteristics |
Multiple Pre-Defined Values Selected |
2192199 | |||||||
| C22692 | Parent birth country name | ParentBirthCntryName | Name for country where the parent, guardian, or caregiver was born | Name for country where the parent, guardian, or caregiver was born | What is the parent's, guardian's, or caregiver's birth country name? | Alphanumeric |
Choose one. It may be easier to record the full name of the country and code the data later using the ISO 3166-1 alpha-2 codes. Code (ISO 3166-1 alpha-2 code) for country where the participant/subject was born |
Adult;Pediatric | Supplemental | 3.00 | 2013-07-24 21:00:23.88 | FITBIR Demographics Form | Demographics | Participant Characteristics | 255 |
Free-Form Entry |
||||||||||
| C18821 | School placement other text | SchoolPlacementOTH | The free-text field related to 'School placement type' specifying other text. The description of the type of education the participant/subject receives with details of being with or without assistance | The free-text field related to 'School placement type' specifying other text. The description of the type of education the participant/subject receives with details of being with or without assistanc | Other, specify | Alphanumeric | Adult;Pediatric | Supplemental | 3.00 | 2013-07-11 15:03:49.2 | FITBIR Demographics Form | Demographics | Participant Characteristics | 4000 |
Free-Form Entry |
|||||||||||
| C21982 | Sport college other participation text | SportCollegeOtherPlaydTxt | College sports played other than primary sport | College sports played other than primary sport | Which other sports did the subject play in college? | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2016-06-06 18:28:08.0 | FITBIR Demographics Form | Demographics | Participant Characteristics | 4000 |
Free-Form Entry |
|||||||||||
| C04814 | Residence type | ResdncTyp | Type of residence where the participant/subject is currently living | Type of residence where the participant/subject is currently living | What type of residence does the subject currently live in? | Hospital;Nursing home;Home;N/A - patient died;Other, specify;Unknown;Rehabilitation center | Hospital;Nursing home;Home;N/A - patient died;Other, specify;Unknown;Rehabilitation center | Alphanumeric | Adult;Pediatric | Supplemental | 3.00 | 2013-07-20 10:21:25.65 | FITBIR Demographics Form | Demographics | Participant Characteristics |
Single Pre-Defined Value Selected |
||||||||||
| C22707 | Education level USA type other text | EduLvlUSATypOTH | The free-text field related to Education level USA type specifying other text. The highest level of education the participant/subject received | The free-text field related to Education level USA type specifying other text. The highest level of education the participant/subject receive | Other, specify | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2016-08-22 10:51:20.0 | FITBIR Demographics Form | Demographics | Participant Characteristics | 255 |
Free-Form Entry |
|||||||||||
| C21799 | Living situation before injury type | LivingSituationPreInjTyp | Living situation of the participant/subject before injury | Living situation of the participant/subject before injur | What was the subject's living situation before injury? | Homeless/lives in shelter;Lives alone;Lives in group home/assisted living;Lives with friend(s) or roommate(s) or cohabiting;Lives with spouse and/or other family member(s);Data Missing/Refused/Unknown;Other, specify | Homeless/lives in shelter;Lives alone;Lives in group home/assisted living;Lives with friend(s) or roommate(s) or cohabiting;Lives with spouse and/or other family member(s);Data Missing/Refused/Unknown;Other, specify | Alphanumeric |
Living situation of the participant/subject before injury. |
Adult;Pediatric | Supplemental | 1.00 | 2016-06-03 10:34:36.0 | FITBIR Demographics Form | Demographics | Participant Characteristics |
Single Pre-Defined Value Selected |
|||||||||
| C00012 | Education level USA type | EduLvlUSATyp | Highest grade or level of school participant/subject has completed or the highest degree received | Highest grade or level of school participant/subject has completed or the highest degree received | What best describes the highest level the subject completed in school? | Never attended/Kindergarten only;1st Grade;2nd Grade;3rd Grade;4th Grade;5th Grade;6th Grade;7th Grade;8th Grade;9th Grade;10th Grade;11th Grade;12th Grade, no diploma;High school graduate;GED or equivalent;Some college, no degree;Associate degree: occupational/technical/vocational program;Associate degree: academic program;Bachelor's degree (e.g., BA, AB, BS, BBA);Master's degree (e.g., MA, MS, MEng, MEd, MBA);Professional school degree (e.g., MD, DDS, DVM, JD);Doctoral degree (e.g., PhD, EdD);Unknown | Never attended/Kindergarten only;1st Grade;2nd Grade;3rd Grade;4th Grade;5th Grade;6th Grade;7th Grade;8th Grade;9th Grade;10th Grade;11th Grade;12th Grade, no diploma;High school graduate;GED or equivalent;Some college, no degree;Associate degree: occupational/technical/vocational program;Associate degree: academic program;Bachelor's degree (e.g., BA, AB, BS, BBA);Master's degree (e.g., MA, MS, MEng, MEd, MBA);Professional school degree (e.g., MD, DDS, DVM, JD);Doctoral degree (e.g., PhD, EdD);Unknown | Alphanumeric |
Choose the highest level attained by the participant/subject. |
National Health and Nutrition Examination Survey (NHANES); National Health Interview Survey (NHIS); PhenX Toolkit Current Educational Attainment #011001 (https: //www.phenxtoolkit.org) | Adult;Pediatric | Supplemental | 3.00 | 2013-07-25 08:54:08.2 | FITBIR Demographics Form | Demographics | Participant Characteristics |
Single Pre-Defined Value Selected |
3134878 | |||||||
| C21993 | Sport professional other participation text | SportProfessionlOtherPartTxt | Professional sports played other than primary sport | Professional sports played other than primary sport | Which other professional sports did the subject play? | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2016-06-06 18:39:11.0 | FITBIR Demographics Form | Demographics | Participant Characteristics | 4000 |
Free-Form Entry |
|||||||||||
| C15995 | Household wage earners number | HshldWgeEarnNum | Number of wage earners in household | Number of wage earners in household | How many wage earners live in the subject's household? | Numeric Values |
Refer to Household and Income. |
Adult;Pediatric | Supplemental | 3.00 | 2013-07-16 14:01:43.01 | FITBIR Demographics Form | Demographics | Participant Characteristics |
Free-Form Entry |
|||||||||||
| C21810 | Military deployment location other text | MilDeployOTH | Region or country to where participant/subject was deployed other text | Region or country to where participant/subject was deployed other text | Other, specify | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2016-06-03 11:26:09.0 | FITBIR Demographics Form | Demographics | Participant Characteristics | 4000 |
Free-Form Entry |
|||||||||||
| C21822 | Sport junior high other participation year count | JuniorHighSportOtherYrsCt | Total combined number of years participant/subject played sport(s) junior high school | Total combined number of years participant/subject played sport(s) junior high school | How many total combined years did the subject play other sports in junior high school? | Numeric Values |
Total combined number of years subject played sport(s) junior high school |
Adult;Pediatric | Supplemental | 1.00 | 2016-06-03 12:52:39.0 | FITBIR Demographics Form | Demographics | Participant Characteristics |
Free-Form Entry |
0 | 100 | |||||||||
| C00031 | Race expanded category | RaceCat | Category of race(s) or region(s) the participant/subject most closely identifies with | Category of race(s) or region(s) the participant/subject most closely identifies with | What is the subject's racial background (expanded categories)? | Not reported;Other;Unknown;Black African American;Black African;Black Afro Caribbean;South/Central American Indian;North American Indian;Alaskan Native;Inuit;South Asian;Far Eastern Asian;Western Asian;White North American;White South American;White European;White Middle Eastern;White African;White Australian;Hawaiian;Pacific Islander;American Indian or Alaska Native;Caucasian;Asian-West;Asian-East;African-North | Not reported;Other;Unknown;Black African American (for OMB purposes, this value is considered to be part of Black or African-American);Black African (for OMB purposes, this value is considered to be part of Black or African-American);Black Afro Caribbean (for OMB purposes, this value is considered to be part of Black or African-American);South/Central American Indian (for OMB purposes, this value is considered to be part of American Indian or Alaska Native);North American Indian (for OMB purposes, this value is considered to be part of American Indian or Alaska Native);Alaskan Native (for OMB purposes, this value is considered to be part of American Indian or Alaska Native);Inuit (for OMB purposes, this value is considered to be part of American Indian or Alaska Native);South Asian (Indian subcontinent) (for OMB purposes, this value is considered to be part of Asian);Far Eastern Asian (e.g., China, Japan, Korea, etc.) (for OMB purposes, this value is considered to be part of Asian);Western Asian (e.g., Pakistan, Iraq, Iran) (for OMB purposes, this value is considered to be part of Asian);White North American (for OMB purposes, this value is considered to be part of White);White South American (for OMB purposes, this value is considered to be part of White);White European (for OMB purposes, this value is considered to be part of White);White Middle Eastern (for OMB purposes, this value is considered to be part of White);White African (for OMB purposes, this value is considered to be part of White);White Australian (for OMB purposes, this value is considered to be part of White);Hawaiian (for OMB purposes, this value is considered to be part of Native Hawaiian or Other Pacific Islander);Pacific Islander (for OMB purposes, this value is considered to be part of Native Hawaiian or Other Pacific Islander);A person having origins in any of the original peoples of North and South America (including Central America), and who maintains tribal affiliation or community attachment.;Caucasian;Asian-West;Asian-East;African-North | Alphanumeric |
Choose all that apply. Response is obtained by report of the participant/subject or caretaker. Collecting information on race may not be allowed in some countries for concerns related to discrimination. In other countries, however, these concerns are considered a reason for recording race in order to guarantee equal access to care. Investigators receiving funding from the US National Institutes of Health (NIH) are required to report the number of subject's enrolled on an annual basis using the racial categories listed. |
The NIH Guidelines on Inclusion of Women and Minorities as Subjects in Clinical Research: The Office of Management and Budget (OMB) Directive No. 15 defines the minimum standard of basic racial and ethnic categories. (http: //grants.nih.gov/grants/funding/women_min/guidelines_update.htm) Collection of Race and Ethnicity Data in Clinical Trials (FDA, September 2005 - http: //www.fda.gov/RegulatoryInformation/Guidances/ucm126340.htm) <br />Jorde LB and Wooding SP. Genetic variation, classification and race . Nature Genetics. 2004;36(11): S28-S33. Bhopal R and Donaldson L. White, European, Western, Caucasian, or What? Inappropriate labeling in Research on Race, Ethnicity, and Health. Amer J of Publ Health. 1998;88: 1303-1307. | Adult;Pediatric | Core | 3.00 | 2013-07-22 16:57:17.79 | FITBIR Demographics Form | Demographics | Participant Characteristics |
Multiple Pre-Defined Values Selected |
||||||||
| C22693 | Parent marital or partner status | ParentMartlPartnerStatus | Status of participant's/subject's parent, guardian, or caregiver's current domestic relationship, whether marital or partnered | Status of participant's/subject's parent, guardian, or caregiver's current domestic relationship, whether marital or partnered | What is the parent's, guardian's, or caregiver's marital status? | Never married;Married;Domestic partnership;Divorced;Separated;Widowed | Never married;Married;Domestic partnership;Divorced;Separated;Widowed | Alphanumeric |
STROKE: Johnson NJ, Backlund E, Sorlie PD, Loveless CA. Marital status and mortality: the national longitudinal mortality study. Ann Epidemiol. 2000;10:224-238. NCI CDE Browser Public ID = 2188083 Status of participant/subjects current domestic relationship, whether marital or partnered |
Johnson NJ, Backlund E, Sorlie PD, Loveless CA. Marital status and mortality: the national longitudinal mortality study. Ann Epidemiol. 2000;10: 224-238. | Adult;Pediatric | Supplemental | 3.00 | 2013-07-25 08:54:08.2 | FITBIR Demographics Form | Demographics | Participant Characteristics |
Single Pre-Defined Value Selected |
2188083 | |||||||
| C19036 | Education other text | EduOTH | The free-text field related to 'Education type' specifying other text. The type of education the participant/subject received | The free-text field related to 'Education type' specifying other text. The type of education the participant/subject receive | Other, specify | Alphanumeric | Adult;Pediatric | Supplemental | 3.00 | 2013-07-16 14:01:43.01 | FITBIR Demographics Form | Demographics | Participant Characteristics | 4000 |
Free-Form Entry |
|||||||||||
| C21983 | Sport college other participation total year count | SportCollegeOtherYrsCt | Total combined years the participant/subject played other college sport(s) (should be used in combination with Other sport(s) the participant played in college) | Total combined years the participant/subject played other college sport(s) (should be used in combination with Other sport(s) the participant played in college | How many total combined years did the subject play other sports in college? | Numeric Values |
Use in combination with Other sport(s) the participant played in college UDE |
Adult | Supplemental | 1.00 | 2016-06-06 18:29:02.0 | FITBIR Demographics Form | Demographics | Participant Characteristics |
Free-Form Entry |
1 | 50 | |||||||||
| C08147 | Data source | DataSource | Source of the data provided on the case report form | Source of the data provided on the case report form | Who is the source of this information in relation to the subject? | Participant/subject;Mother;Father;Sister;Brother;Son;Daughter;Family, specify relation;Friend;Physician;Chart/Medical record;Other, specify;Unknown;Spouse | Participant/subject;Mother;Father;Sister;Brother;Son;Daughter;Family, specify relation;Friend;Physician;Chart/Medical record;Other, specify;Unknown;Spouse | Alphanumeric |
Choose all that apply |
Adult;Pediatric | Supplemental | 3.00 | 2013-07-20 10:46:24.96 | FITBIR Demographics Form | Demographics | Participant Characteristics |
Multiple Pre-Defined Values Selected |
