CDE Detailed Report

Disease: Traumatic Brain Injury
Subdomain Name: 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 / 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
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

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

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

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

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

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 categori 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 3.00 2013-07-25 08:54:08.2 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

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

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

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

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

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

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
CSV