CDE Detailed Report

Disease: Traumatic Brain Injury
Sub-Domain: Demographics
CRF: FITBIR Demographics Form

Displaying 101 - 123 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 / 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
C00206 Family income supported persons count FamilyIncmeSupprtPersCt Count of all people, including the participant/subject, who are supported by the household gross annual income reported Count of all people, including the participant/subject, who are supported by the household gross annual income reported What is the number of people supported by the above income? Numeric Values

Add date stamp for when assessed. Recommend collection at least on date of TBI and perhaps after all initial medical treatment.

 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

 1 99
C12605 Caregiver primary type CaregvrPrimryType Type of relationship that the person who serves as the participant/subject's primary caregiver has with the participant/subject Type of relationship that the person who serves as the participant/subject's primary caregiver has with ther participant/subject Who is the primary person living with the subject? Alone;Child;Group living situation, boarding house;Homeless;Military barracks;Other;Other patients (in hospital/nursing home);Other residents;Other, specify;Parent or legal guardian;Personal care attendant;Roommates/friends;Self;Sibling;Spouse or partner;Unable to obtain information Alone;Child;Group living situation, boarding house;Homeless;Military barracks;Other;Other patients (in hospital/nursing home);Other residents;Other, specify;Parent or legal guardian;Personal care attendant;Roommates/friends;Self;Sibling;Spouse or partner;Unable to obtain information Alphanumeric Adult;Pediatric Supplemental 3.00 2013-07-24 11:38:01.2 FITBIR Demographics Form Demographics Participant Characteristics

Multiple Pre-Defined Values Selected
C21804 Job classification current other text JobClassNowOTH The free-text field related to Job classification-now specifying other text The free-text field related to Job classification-now specifying other tex Other, specify Alphanumeric Adult;Pediatric Supplemental 1.00 2016-06-03 11:17:16.0 FITBIR Demographics Form Demographics Participant Characteristics 4000

Free-Form Entry
C21987 Sport recreational other participation text SportRecreationlOtherPlaydTxt Which other sport(s) the participant/subject played recreationally Which other sport(s) the participant played/subject recreationally Which other recreational sports did the subject play? Alphanumeric Adult;Pediatric Supplemental 1.00 2016-06-06 18:33:20.0 FITBIR Demographics Form Demographics Participant Characteristics 4000

Free-Form Entry
C18614 Education primary caregiver year count EduPrimCaregiverYrCt Number of years of education of the primary caregiver (age 5 and beyond) Number of years of education of the primary caregiver (age 5 and beyond How many years of education does the parent, guardian, or caregiver have? Numeric Values

In order to apply to international setting, this data element was made to supplement C00013

 Adult;Pediatric Supplemental 3.00 2013-10-07 00:00:00.0 FITBIR Demographics Form Demographics Participant Characteristics

Free-Form Entry

 0 30 year
C21816 Sport elementary school other participation text ElementarySchoolSportOthrPlayd The free-text field to specify which other sports the participant/subject played in elementary school The free-text field to specify which other sports the participant/subject played in elementary school Which other sports did the subject play in elementary school? Alphanumeric

The free-text field to specify which other sports the participant played in elementary school

 Adult;Pediatric Supplemental 1.00 2016-06-03 11:59:33.0 FITBIR Demographics Form Demographics Participant Characteristics 4000

Free-Form Entry
C00025 Language primary text LangPrimryTxt Text for the language the participant/subject speaks most often Text for the language the participant/subject speaks most often What is the subject's primary language (use ISO code)? eng;spa;sgn;chi;fre;ger;Other, specify English;Spanish;Sign Languages;Chinese languages;French;German;Other, specify Alphanumeric

Choose one. It may be easier to record the full name of the language using Language primary text and code the data later using the ISO 639-2 alpha-3 codes.

Data Sharing Instructions: 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

Single Pre-Defined Value Selected
C22687 Marital or partner status other text MartlPartnerStatusOTH The free-text field related to Marital or partner status specifying other text. Status of participant/subjects current domestic relationships The free-text field related to Marital or partner status specifying other text. Status of participant/subjects current domestic relationship Other, specify Alphanumeric Adult;Pediatric Supplemental 1.00 2016-08-01 13:44:07.0 FITBIR Demographics Form Demographics Participant Characteristics 4000

Free-Form Entry
C22698 Parent occupation primary status ParentOccupationPrimaryStatus The status indicating the participant's/subject's parent, guardian, or caregiver's current primary occupational status The status indicating the participant's/subject's parent, guardian, or caregiver's current primary occupational statu What is the parent's, guardian's, or caregiver's current primary occupational status? Homemaker;Other, specify;Paid work;Retired;Retired;Student;Unemployed;Unknown;Unpaid work Homemaker;Other, specify;Paid work (employed/self-employed, including military);Retired (disability pension);Retired (non-disability);Student (including on the job training);Unemployed (none of the above);Unknown;Unpaid work (volunteer) Alphanumeric Adult Supplemental 1.00 2014-06-06 08:50:45.0 FITBIR Demographics Form Demographics Participant Characteristics

Single Pre-Defined Value Selected
C19287 Income basic needs status IncomeBasicNeedsStatus The status of how the household currently manages to meet basic needs as defined by food, shelter and clothing The status of how the household currently manages to meet basic needs as defined by food, shelter and clothin Does the subject's income meet the subject's household's basic needs? Very well;Very poorly;Unknown;Refused to answer;Rather well;Rather poorly;Adequately (neither well nor poorly) Very well;Very poorly;Unknown;Refused to answer;Rather well;Rather poorly;Adequately (neither well nor poorly) Alphanumeric Adult Supplemental 1.00 2014-06-06 11:03:24.0 FITBIR Demographics Form Demographics Participant Characteristics

Single Pre-Defined Value Selected
C21977 Sport high school other participation total year count SportHighSchoolOtherYrsCt Total combined number of years participant/subject played other sport(s) in high school Total combined number of years participant/subject played other sport(s) in high school How many total combined years did the subject play other sports in high school? Numeric Values Adult;Pediatric Supplemental 1.00 2016-06-06 18:12:55.0 FITBIR Demographics Form Demographics Participant Characteristics

Free-Form Entry

 0
C00207 Marital or partner status MartlPartnerStatus Status of participant/subject's current domestic relationship, whether marital or partnered Status of participant/subject's current domestic relationship, whether marital or partnered What is the subject'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

 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
C14123 Country of residence name CntryResdnceName Country where the participant/subject currently lives Country where the participant/subject currently live What is the subject's current country of residence name? Alphanumeric

This CDE should be used in combination with Country of residence ISO code CDE when there is no ISO code available for the country name. 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.

 Adult;Pediatric Supplemental 3.00 2013-06-21 00:00:00.0 FITBIR Demographics Form Demographics Participant Characteristics 255

Free-Form Entry
C21805 Caregiver primary extended type CaregvPrimryExtendType Type of relationship between the person who acts as the primary caregiver for the participant/subject and the participant/subject Type of relationship between the person who acts as the primary caregiver for the participant/subject and the participant/subject What is the relationship between the person who acts as the primary caregiver for the subject and the subject? Adoptive father;Adoptive mother;Adoptive parents;Biological father;Biological father - not a primary caregiver;Biological mother;Biological mother - not a primary caregiver;Biological parents;Child;Grandfather;Grandmother;Home aide;Legal guardian;Long-term care/nursing facility staff;Parent;Relative;Self;Sibling;Spouse or partner;Stepfather;Stepmother;Stepparent;Unknown;Other, specify Adoptive father;Adoptive mother;Adoptive parents;Biological father;Biological father - not a primary caregiver;Biological mother;Biological mother - not a primary caregiver;Biological parents;Child;Grandfather;Grandmother;Home aide;Legal guardian;Long-term care/nursing facility staff;Parent;Relative;Self;Sibling;Spouse or partner;Stepfather;Stepmother;Stepparent;Unknown;Other, specify Alphanumeric

Type of relationship between the person who acts as the primary caregiver for the participant/subject and the participant/subject

 Adult;Pediatric Supplemental 1.00 2016-06-03 11:18:55.0 FITBIR Demographics Form Demographics Participant Characteristics

Multiple Pre-Defined Values Selected
C21988 Sport recreational other participation year count SportRecreationlOtherYrsCt Total number of years participant/subject played other sport(s) recreationally Total number of years participant/subject played other sport(s) recreationally How many total combined years did the subject play other recreational sports? Numeric Values Adult;Pediatric Supplemental 1.00 2016-06-06 18:34:23.0 FITBIR Demographics Form Demographics Participant Characteristics

Free-Form Entry

 0
C18658 Employment expanded status EmplmtExpndStatus Status of participant/subject's current employment (expanded list) Status of participant/subject's current employment (expanded list) What is the status of the subject's current employment? Working full time;Working 20-34 hrs/week, at least minimum wage;Working less than 20 hrs/week, at least minimum wage;Temporary/odd jobs/less than minimum wage jobs;Special employment;Sick leave or maternity leave;Unemployed;Other, specify;Not in paid workforce;Unable to obtain information;Unknown Working full time (35 hrs or more/week, at least minimum wage);Working 20-34 hrs/week, at least minimum wage;Working less than 20 hrs/week, at least minimum wage;Temporary/odd jobs/less than minimum wage jobs;Special employment (sheltered workshop, supportive employment, job coach);Sick leave or maternity leave;Unemployed;Other, specify;Not in paid workforce (including child, retired, student, homemaker, disabled pre-injury);Unable to obtain information;Unknown Alphanumeric

Prior TBI studies utilized the Employment Status data element for data capture

Choose one.

 National Health and Nutrition Examination Survey (http: //www.cdc.gov/nchs/nhanes.htm) Adult;Pediatric Supplemental 1.00 2013-07-16 14:01:43.01 FITBIR Demographics Form Demographics Participant Characteristics

Single Pre-Defined Value Selected
C21817 Sport elementary school other participation total year count ElemntrySchoolSportOtherYrsCt Total combined number of years the participant/subject played other sport(s) in elementary school Total combined number of years the participant/subject played other sport(s) in elementary school What are the total combined years the subject played the other sports in elementary school? Numeric Values

Total combined number of years the participant played other sport(s) in elementary school

 Adult;Pediatric Supplemental 1.00 2016-06-03 12:00:40.0 FITBIR Demographics Form Demographics Participant Characteristics

Free-Form Entry

 0 100
C00026 Language spoken Fluent text LangSpokeFluentTxt Text for each language that the participant/subject speaks fluently Text for each language that the participant/subject speaks fluently Please list each language the subject can speak fluently: Alphanumeric

Text for all languages participant/subject speaks fluently. 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 255

Free-Form Entry
C22688 Parent Race USA Category ParentRaceUSACat The participant's/subject's parent self declared racial origination, independent of ethnic origination, using OMB approved categories The participant's/subject's parent self declared racial origination, independent of ethnic origination, using OMB approved categorie What is the parent, guardian, or caregiver's race, based on the OBM race standards? 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

The participant's/subject's parent self declared racial origination, independent of ethnic origination, using OMB approved categories.

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.

 Adult;Pediatric Core 3.00 2013-07-25 08:54:08.2 FITBIR Demographics Form Demographics Participant Characteristics

Multiple Pre-Defined Values Selected

 2192199
C22699 Parent employment expanded status ParentEmplmtExpndStatus Status of the participant's/subject's parent, guardian, or caregiver's current employment Status of the participant's/subject's parent, guardian, or caregiver's current employment What is the status of the parent's, guardian's, or caregiver's current employment? Working full time;Working 20-34 hrs/week, at least minimum wage;Working less than 20 hrs/week, at least minimum wage;Temporary/odd jobs/less than minimum wage jobs;Special employment;Sick leave or maternity leave;Unemployed;Other, specify;Not in paid workforce;Unable to obtain information;Unknown Working full time (35 hrs or more/week, at least minimum wage);Working 20-34 hrs/week, at least minimum wage;Working less than 20 hrs/week, at least minimum wage;Temporary/odd jobs/less than minimum wage jobs;Special employment (sheltered workshop, supportive employment, job coach);Sick leave or maternity leave;Unemployed;Other, specify;Not in paid workforce (including child, retired, student, homemaker, disabled pre-injury);Unable to obtain information;Unknown Alphanumeric Adult;Pediatric Supplemental 1.00 2013-07-16 14:01:43.01 FITBIR Demographics Form Demographics Participant Characteristics

Single Pre-Defined Value Selected
C21114 Visit post baseline day count VisitPostBaselineDayCt The number of days since baseline visit The number of days since baseline visi The number of days since baseline Numeric Values

Enter the number of days passed since the baseline visit

 Adult;Pediatric Supplemental 1.00 2015-06-12 14:49:48.0 FITBIR Demographics Form Demographics Participant Characteristics

Free-Form Entry

 day
C21978 Sport college participation indicator SportCollegePartInd Indicator whether the participant/subject played sports in college Indicator whether the participant/subject played sports in colleg Did the subject participate in sports in college? Yes;No;Unknown Yes;No;Unknown Alphanumeric Adult Supplemental 1.00 2016-06-06 18:13:59.0 FITBIR Demographics Form Demographics Participant Characteristics

Single Pre-Defined Value Selected
C00208 Military USA service branch type MilUSAServBrnchTyp Branch of service in the U.S. military, not including the Commissioned Corps Branch of service in the U.S. military, not including the Commissioned Corps Which branch of service in the U.S. Military is the subject involved? Air force;Army;Marine Corps;Navy;Coast Guard;Other, specify;Air Force Reserve;Army Reserve;Coast Guard Reserves;Navy Reserves;Marine Corps Reserves;Air National Guard;Army National Guard Air force;Army;Marine Corps;Navy;Coast Guard;Other, specify;Air Force Reserve;Army Reserve;Coast Guard Reserves;Navy Reserves;Marine Corps Reserves;Air National Guard;Army National Guard Alphanumeric

Choose one. Response is obtained by report of the participant/subject or relatives.

 Adult;Pediatric Supplemental 3.00 2013-07-20 10:21:25.65 FITBIR Demographics Form Demographics Participant Characteristics

Single Pre-Defined Value Selected
CSV