CDE Detailed Report

Disease: Sport Related Concussion
Sub-Domain: General Health History
CRF: Concussion History

Displaying 1 - 9 of 9
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
C52399 Concussion diagnosis ConcussionDiagnos Diagnosis of whether or not the subject has a concussion Diagnosis of whether or not the subject has a concussion The concussion was diagnosed or undiagnosed Diagnosed;Undiagnosed Diagnosed;Undiagnosed Alphanumeric Adult Supplemental 1.00 2017-01-18 09:15:18.0 Concussion History General Health History Participant History and Family History

Single Pre-Defined Value Selected

C52400 Injury date InjuryDate The date the subject received his or her injury The date the subject received his or her injury Approxiamate date of injury (mm/yyyy) Date or Date & Time Adult Supplemental 1.00 2017-01-18 09:25:29.0 Concussion History General Health History Participant History and Family History

Free-Form Entry

C52401 Injury age value InjAgeVal The value of the subject's age at the time he/she was injured The value of the subject's age at the time he/she was injured Age at time of injury Numeric Values Adult Supplemental 1.00 2017-01-18 09:34:35.0 Concussion History General Health History Participant History and Family History

Free-Form Entry

year
C52403 Unconsciousness time value UnconsciousTimeVal Value representing the amount of time, in seconds, that the subject was unconscious. Value representing the amount of time, in seconds, that the subject was unconscious. How long were you unconscious (seconds)? Numeric Values Adult Supplemental 1.00 2017-01-18 09:42:29.0 Concussion History General Health History Participant History and Family History

Free-Form Entry

seconds
C52404 Difficulty remembering before after injury indicator DiffRemeBefAfterInjInd The indicator relating to whether or not the subject has difficulty remembering things before or after his or her injury. The indicator relating to whether or not the subject has difficulty remembering things before or after his or her injury. Did/do you have difficulty remembering things before or after the injury? No;Yes No;Yes Alphanumeric Adult Supplemental 1.00 2017-01-18 10:01:42.0 Concussion History General Health History Participant History and Family History

Single Pre-Defined Value Selected

C52405 Minutes not remember value MinutesNotRememberVal The value of how many minutes the subject does not remember. The value of how many minutes the subject does not remember. How many minutes do you not remember? Numeric Values Adult Supplemental 1.00 2017-01-18 10:02:55.0 Concussion History General Health History Participant History and Family History

Free-Form Entry

minute
C52406 Day symptom experience count DaySymptmExpCt The count of the number of days the subject experience symptoms related to his or her injury The count of the number of days the subject experience symptoms related to his or her injury How many days did you experience symptoms related to the injury? Numeric Values Adult Supplemental 1.00 2017-01-18 10:03:45.0 Concussion History General Health History Participant History and Family History

Free-Form Entry

day
C01052 Loss of consciousness indicator LOCInd The indicator for whether the participant/subject experienced any period of loss of consciousness (LOC). The indicator for whether the participant/subject experienced any period of loss of consciousness (LOC). Did you lose consciousness (i.e. knocked out/blacked out)? Yes;No Yes;No Alphanumeric Adult Supplemental 3.00 2013-07-20 10:21:25.65 Concussion History General Health History Participant History and Family History

Single Pre-Defined Value Selected

C52398 Injury mechanism type InjuryMechTyp The type of mechanism leading to the subject's injury The type of mechanism leading to the subject's injury Mechanism Blow to head or neck;Sport/recreation;Fight or being hit;Explosion/blast;Other;Fall;Motor vehicle crash—pedestrian/bicyclist;Motor vehicle crash—occupant Blow to head or neck;Sport/recreation;Fight or being hit;Explosion/blast;Other;Fall;Motor vehicle crash—pedestrian/bicyclist;Motor vehicle crash—occupant Alphanumeric

Mechanism Prompts:
Blow to the head or neck: Have you ever been hospitalized or treated in an emergency room following an injury to your head or neck? Think about any childhood injuries you remember or were told about.
Car / vehicle accident: Have you ever injured your head or neck in a car accident or from some other moving vehicle accident (e.g. motorcycle, ATV)?
Sport / recreation: Have you ever been hit in the head or fallen on your head while participating in an organized sport or recreational activity, including on the playground?
Fall: Have you ever injured from falling?
Fight or being hit: Have you ever injured your head or neck in a fight, from being hit by someone/something, or from being shaken violently?
Explosion / Blast: Have you ever been nearby when an explosion or a blast occurred? If you served in the military, think about any combat- or training-related incidents.

Adult Supplemental 1.10 2017-05-12 11:35:57.0 Concussion History General Health History Participant History and Family History

Multiple Pre-Defined Values Selected

CSV