CDE Detailed Report

Disease: Sport-Related Concussion
Subdomain Name: Post-Concussive / Mild TBI-Related Symptoms
CRF: Sport Concussion Assessment Tool - 3rd Edition for children ages 5 to 12 (Child-SCAT3)

Displaying 1 - 26 of 26
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
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 Age Numeric Values 1. this tool has been developed by a group of international experts at the 4th international Consensus meeting on Concussion in Sport held in Zurich, Switzerland<br />in november 2012. the full details of the conference outcomes and the authors of<br />the tool are published in the BJSm injury prevention and Health protection, 2013,<br />Volume 47, issue 5. the outcome paper will also be simultaneously co-published in<br />other leading biomedical journals with the copyright held by the Concussion in Sport<br />Group, to allow unrestricted distribution, providing no alterations are made.<br />2. mcCrory p et al., Consensus Statement on Concussion in Sport &#8211; the 3rd international Conference on Concussion in Sport held in Zurich, november 2008. British<br />Journal of Sports medicine 2009; 43: i76-89.<br />3. maddocks, Dl; Dicker, GD; Saling, mm. the assessment of orientation following<br />concussion in athletes. Clinical Journal of Sport medicine. 1995; 5(1): 32&#8211;3.<br />4. mcCrea m. Standardized mental status testing of acute concussion. Clinical Journal of Sport medicine. 2001; 11: 176&#8211;181.<br />5. Guskiewicz Km. Assessment of postural stability following sport-related concussion. Current Sports medicine reports. 2003; 2: 24&#8211;30.<br />6. Schneiders, A.G., Sullivan, S.J., Gray, A., Hammond-tooke, G.&mcCrory, p.<br />normative values for 16-37 year old subjects for three clinical measures of motor<br />performance used in the assessment of sports concussions. Journal of Science and<br />medicine in Sport. 2010; 13(2): 196&#8211;201.<br />7. Schneiders, A.G., Sullivan, S.J., Kvarnstrom. J.K., olsson, m., Yden. t.&marshall,<br />S.W. the effect of footwear and sports-surface on dynamic neurological screening in sport-related concussion. Journal of Science and medicine in Sport. 2010;<br />13(4): 382&#8211;386<br />8. Ayr, l.K., Yeates, K.o., taylor, H.G.,&Brown, m. Dimensions of post-concussive<br />symptoms in children with mild traumatic brain injuries. Journal of the international<br />neuropsychological Society. 2009; 15:19&#8211;30. Pediatric Supplemental 3.10 2024-02-29 15:47:28.0 Sport Concussion Assessment Tool - 3rd Edition for children ages 5 to 12 (Child-SCAT3) Post-Concussive / Mild TBI-Related Symptoms Outcomes and End Points

Free-Form Entry

0 1800 month
C51670 School name SchoolName The name of the school that the subject currently attends, if applicable The name of the school that the subject currently attends, if applicabl Sport/team/school Alphanumeric 1. this tool has been developed by a group of international experts at the 4th international Consensus meeting on Concussion in Sport held in Zurich, Switzerland<br />in november 2012. the full details of the conference outcomes and the authors of<br />the tool are published in the BJSm injury prevention and Health protection, 2013,<br />Volume 47, issue 5. the outcome paper will also be simultaneously co-published in<br />other leading biomedical journals with the copyright held by the Concussion in Sport<br />Group, to allow unrestricted distribution, providing no alterations are made.<br />2. mcCrory p et al., Consensus Statement on Concussion in Sport &#8211; the 3rd international Conference on Concussion in Sport held in Zurich, november 2008. British<br />Journal of Sports medicine 2009; 43: i76-89.<br />3. maddocks, Dl; Dicker, GD; Saling, mm. the assessment of orientation following<br />concussion in athletes. Clinical Journal of Sport medicine. 1995; 5(1): 32&#8211;3.<br />4. mcCrea m. Standardized mental status testing of acute concussion. Clinical Journal of Sport medicine. 2001; 11: 176&#8211;181.<br />5. Guskiewicz Km. Assessment of postural stability following sport-related concussion. Current Sports medicine reports. 2003; 2: 24&#8211;30.<br />6. Schneiders, A.G., Sullivan, S.J., Gray, A., Hammond-tooke, G.&mcCrory, p.<br />normative values for 16-37 year old subjects for three clinical measures of motor<br />performance used in the assessment of sports concussions. Journal of Science and<br />medicine in Sport. 2010; 13(2): 196&#8211;201.<br />7. Schneiders, A.G., Sullivan, S.J., Kvarnstrom. J.K., olsson, m., Yden. t.&marshall,<br />S.W. the effect of footwear and sports-surface on dynamic neurological screening in sport-related concussion. Journal of Science and medicine in Sport. 2010;<br />13(4): 382&#8211;386<br />8. Ayr, l.K., Yeates, K.o., taylor, H.G.,&Brown, m. Dimensions of post-concussive<br />symptoms in children with mild traumatic brain injuries. Journal of the international<br />neuropsychological Society. 2009; 15:19&#8211;30. Pediatric Supplemental 1.00 2016-12-12 00:00:00.0 Sport Concussion Assessment Tool - 3rd Edition for children ages 5 to 12 (Child-SCAT3) Post-Concussive / Mild TBI-Related Symptoms Outcomes and End Points 255

Free-Form Entry

C52443 Sport Concussion Assessment Tool (SCAT) - Past concussion count SCAT3PastConcussCt The count of how many times the subject believes he/she has had a concussion, as part of the Sport Concussion Assessment Tool (SCAT3) The count of how many times the subject believes he/she has had a concussion, as part of the Sport Concussion Assessment Tool (SCAT3 How many concussions has the child had in the past? Numeric Values 1. this tool has been developed by a group of international experts at the 4th international Consensus meeting on Concussion in Sport held in Zurich, Switzerland<br />in november 2012. the full details of the conference outcomes and the authors of<br />the tool are published in the BJSm injury prevention and Health protection, 2013,<br />Volume 47, issue 5. the outcome paper will also be simultaneously co-published in<br />other leading biomedical journals with the copyright held by the Concussion in Sport<br />Group, to allow unrestricted distribution, providing no alterations are made.<br />2. mcCrory p et al., Consensus Statement on Concussion in Sport &#8211; the 3rd international Conference on Concussion in Sport held in Zurich, november 2008. British<br />Journal of Sports medicine 2009; 43: i76-89.<br />3. maddocks, Dl; Dicker, GD; Saling, mm. the assessment of orientation following<br />concussion in athletes. Clinical Journal of Sport medicine. 1995; 5(1): 32&#8211;3.<br />4. mcCrea m. Standardized mental status testing of acute concussion. Clinical Journal of Sport medicine. 2001; 11: 176&#8211;181.<br />5. Guskiewicz Km. Assessment of postural stability following sport-related concussion. Current Sports medicine reports. 2003; 2: 24&#8211;30.<br />6. Schneiders, A.G., Sullivan, S.J., Gray, A., Hammond-tooke, G.&mcCrory, p.<br />normative values for 16-37 year old subjects for three clinical measures of motor<br />performance used in the assessment of sports concussions. Journal of Science and<br />medicine in Sport. 2010; 13(2): 196&#8211;201.<br />7. Schneiders, A.G., Sullivan, S.J., Kvarnstrom. J.K., olsson, m., Yden. t.&marshall,<br />S.W. the effect of footwear and sports-surface on dynamic neurological screening in sport-related concussion. Journal of Science and medicine in Sport. 2010;<br />13(4): 382&#8211;386<br />8. Ayr, l.K., Yeates, K.o., taylor, H.G.,&Brown, m. Dimensions of post-concussive<br />symptoms in children with mild traumatic brain injuries. Journal of the international<br />neuropsychological Society. 2009; 15:19&#8211;30. Pediatric Supplemental 1.00 2017-01-18 15:05:43.0 Sport Concussion Assessment Tool - 3rd Edition for children ages 5 to 12 (Child-SCAT3) Post-Concussive / Mild TBI-Related Symptoms Outcomes and End Points

Free-Form Entry

C00023 Hand preference type HandPrefTyp Hand which the participant/subject uses predominantly, not necessarily the hand he/she writes with exclusively Hand which the participant/subject uses predominantly, not necessarily the hand he/she writes with exclusivel Dominant hand Left hand;Right hand Left hand;Right hand Alphanumeric 1. this tool has been developed by a group of international experts at the 4th international Consensus meeting on Concussion in Sport held in Zurich, Switzerland<br />in november 2012. the full details of the conference outcomes and the authors of<br />the tool are published in the BJSm injury prevention and Health protection, 2013,<br />Volume 47, issue 5. the outcome paper will also be simultaneously co-published in<br />other leading biomedical journals with the copyright held by the Concussion in Sport<br />Group, to allow unrestricted distribution, providing no alterations are made.<br />2. mcCrory p et al., Consensus Statement on Concussion in Sport &#8211; the 3rd international Conference on Concussion in Sport held in Zurich, november 2008. British<br />Journal of Sports medicine 2009; 43: i76-89.<br />3. maddocks, Dl; Dicker, GD; Saling, mm. the assessment of orientation following<br />concussion in athletes. Clinical Journal of Sport medicine. 1995; 5(1): 32&#8211;3.<br />4. mcCrea m. Standardized mental status testing of acute concussion. Clinical Journal of Sport medicine. 2001; 11: 176&#8211;181.<br />5. Guskiewicz Km. Assessment of postural stability following sport-related concussion. Current Sports medicine reports. 2003; 2: 24&#8211;30.<br />6. Schneiders, A.G., Sullivan, S.J., Gray, A., Hammond-tooke, G.&mcCrory, p.<br />normative values for 16-37 year old subjects for three clinical measures of motor<br />performance used in the assessment of sports concussions. Journal of Science and<br />medicine in Sport. 2010; 13(2): 196&#8211;201.<br />7. Schneiders, A.G., Sullivan, S.J., Kvarnstrom. J.K., olsson, m., Yden. t.&marshall,<br />S.W. the effect of footwear and sports-surface on dynamic neurological screening in sport-related concussion. Journal of Science and medicine in Sport. 2010;<br />13(4): 382&#8211;386<br />8. Ayr, l.K., Yeates, K.o., taylor, H.G.,&Brown, m. Dimensions of post-concussive<br />symptoms in children with mild traumatic brain injuries. Journal of the international<br />neuropsychological Society. 2009; 15:19&#8211;30. Pediatric Supplemental 3.00 2013-07-25 08:54:08.2 Sport Concussion Assessment Tool - 3rd Edition for children ages 5 to 12 (Child-SCAT3) Post-Concussive / Mild TBI-Related Symptoms Outcomes and End Points

Single Pre-Defined Value Selected

2180147
C51671 Grade status GradeStatus The status of the subject's grade level in school, if applicable The status of the subject's grade level in school, if applicabl Current school year/grade Alphanumeric 1. this tool has been developed by a group of international experts at the 4th international Consensus meeting on Concussion in Sport held in Zurich, Switzerland<br />in november 2012. the full details of the conference outcomes and the authors of<br />the tool are published in the BJSm injury prevention and Health protection, 2013,<br />Volume 47, issue 5. the outcome paper will also be simultaneously co-published in<br />other leading biomedical journals with the copyright held by the Concussion in Sport<br />Group, to allow unrestricted distribution, providing no alterations are made.<br />2. mcCrory p et al., Consensus Statement on Concussion in Sport &#8211; the 3rd international Conference on Concussion in Sport held in Zurich, november 2008. British<br />Journal of Sports medicine 2009; 43: i76-89.<br />3. maddocks, Dl; Dicker, GD; Saling, mm. the assessment of orientation following<br />concussion in athletes. Clinical Journal of Sport medicine. 1995; 5(1): 32&#8211;3.<br />4. mcCrea m. Standardized mental status testing of acute concussion. Clinical Journal of Sport medicine. 2001; 11: 176&#8211;181.<br />5. Guskiewicz Km. Assessment of postural stability following sport-related concussion. Current Sports medicine reports. 2003; 2: 24&#8211;30.<br />6. Schneiders, A.G., Sullivan, S.J., Gray, A., Hammond-tooke, G.&mcCrory, p.<br />normative values for 16-37 year old subjects for three clinical measures of motor<br />performance used in the assessment of sports concussions. Journal of Science and<br />medicine in Sport. 2010; 13(2): 196&#8211;201.<br />7. Schneiders, A.G., Sullivan, S.J., Kvarnstrom. J.K., olsson, m., Yden. t.&marshall,<br />S.W. the effect of footwear and sports-surface on dynamic neurological screening in sport-related concussion. Journal of Science and medicine in Sport. 2010;<br />13(4): 382&#8211;386<br />8. Ayr, l.K., Yeates, K.o., taylor, H.G.,&Brown, m. Dimensions of post-concussive<br />symptoms in children with mild traumatic brain injuries. Journal of the international<br />neuropsychological Society. 2009; 15:19&#8211;30. Pediatric Supplemental 1.00 2016-12-12 00:00:00.0 Sport Concussion Assessment Tool - 3rd Edition for children ages 5 to 12 (Child-SCAT3) Post-Concussive / Mild TBI-Related Symptoms Outcomes and End Points 25

Free-Form Entry

C52444 Sport Concussion Assessment Tool - 3rd Edition (SCAT3) - Recent concussion text SCAT3RecntConcusTxt Text detailing when the subject experienced his/her most recent concussion, as part of the Sport Concussion Assessment Tool - 3rd Edition (SCAT3) Text detailing when the subject experienced his/her most recent concussion, as part of the Sport Concussion Assessment Tool - 3rd Edition (SCAT3 When was the most recent concussion? Alphanumeric 1. this tool has been developed by a group of international experts at the 4th international Consensus meeting on Concussion in Sport held in Zurich, Switzerland<br />in november 2012. the full details of the conference outcomes and the authors of<br />the tool are published in the BJSm injury prevention and Health protection, 2013,<br />Volume 47, issue 5. the outcome paper will also be simultaneously co-published in<br />other leading biomedical journals with the copyright held by the Concussion in Sport<br />Group, to allow unrestricted distribution, providing no alterations are made.<br />2. mcCrory p et al., Consensus Statement on Concussion in Sport &#8211; the 3rd international Conference on Concussion in Sport held in Zurich, november 2008. British<br />Journal of Sports medicine 2009; 43: i76-89.<br />3. maddocks, Dl; Dicker, GD; Saling, mm. the assessment of orientation following<br />concussion in athletes. Clinical Journal of Sport medicine. 1995; 5(1): 32&#8211;3.<br />4. mcCrea m. Standardized mental status testing of acute concussion. Clinical Journal of Sport medicine. 2001; 11: 176&#8211;181.<br />5. Guskiewicz Km. Assessment of postural stability following sport-related concussion. Current Sports medicine reports. 2003; 2: 24&#8211;30.<br />6. Schneiders, A.G., Sullivan, S.J., Gray, A., Hammond-tooke, G.&mcCrory, p.<br />normative values for 16-37 year old subjects for three clinical measures of motor<br />performance used in the assessment of sports concussions. Journal of Science and<br />medicine in Sport. 2010; 13(2): 196&#8211;201.<br />7. Schneiders, A.G., Sullivan, S.J., Kvarnstrom. J.K., olsson, m., Yden. t.&marshall,<br />S.W. the effect of footwear and sports-surface on dynamic neurological screening in sport-related concussion. Journal of Science and medicine in Sport. 2010;<br />13(4): 382&#8211;386<br />8. Ayr, l.K., Yeates, K.o., taylor, H.G.,&Brown, m. Dimensions of post-concussive<br />symptoms in children with mild traumatic brain injuries. Journal of the international<br />neuropsychological Society. 2009; 15:19&#8211;30. Pediatric Supplemental 1.00 2017-01-18 15:07:39.0 Sport Concussion Assessment Tool - 3rd Edition for children ages 5 to 12 (Child-SCAT3) Post-Concussive / Mild TBI-Related Symptoms Outcomes and End Points 255

Free-Form Entry

C00035 Gender type GenderTyp Self-reported gender of the participant/subject Self-reported gender of the participant/subjec Gender Alphanumeric 1. this tool has been developed by a group of international experts at the 4th international Consensus meeting on Concussion in Sport held in Zurich, Switzerland<br />in november 2012. the full details of the conference outcomes and the authors of<br />the tool are published in the BJSm injury prevention and Health protection, 2013,<br />Volume 47, issue 5. the outcome paper will also be simultaneously co-published in<br />other leading biomedical journals with the copyright held by the Concussion in Sport<br />Group, to allow unrestricted distribution, providing no alterations are made.<br />2. mcCrory p et al., Consensus Statement on Concussion in Sport - the 3rd international Conference on Concussion in Sport held in Zurich, november 2008. British<br />Journal of Sports medicine 2009; 43: i76-89.<br />3. maddocks, Dl; Dicker, GD; Saling, mm. the assessment of orientation following<br />concussion in athletes. Clinical Journal of Sport Medicine. 1995; 5(1): 32?--3.<br />4. mcCrea m. Standardized mental status testing of acute concussion. Clinical Journal of Sport medicine. 2001; 11: 176-181.<br />5. Guskiewicz Km. Assessment of postural stability following sport-related concussion. Current Sports medicine reports. 2003; 2: 24-30.<br />6. Schneiders, A.G., Sullivan, S.J., Gray, A., Hammond-tooke, G.&mcCrory, p.<br />normative values for 16-37 year old subjects for three clinical measures of motor<br />performance used in the assessment of sports concussions. Journal of Science and<br />Medicine in Sport. 2010; 13(2): 196?--201.<br />7. Schneiders, A.G., Sullivan, S.J., Kvarnstrom. J.K., olsson, m., Yden. t.&marshall,<br />S.W. The effect of footwear and sports-surface on dynamic neurological screening in sport-related concussion. Journal of Science and medicine in Sport. 2010;<br />13(4): 382?--386 Pediatric Supplemental 3.00 2013-08-28 16:08:00.453 Sport Concussion Assessment Tool - 3rd Edition for children ages 5 to 12 (Child-SCAT3) Post-Concussive / Mild TBI-Related Symptoms Outcomes and End Points

Single Pre-Defined Value Selected

2200604
C52423 Sport Concussion Assessment Tool (SCAT) - Loss consciousness indicator SCATLossConcsnInd Indicator of whether or not the individual reports loss of consciousness , as part of the Sport Concussion Assessment Tool (SCAT) Indicator of whether or not the individual reports loss of consciousness , as part of the Sport Concussion Assessment Tool (SCAT) Any loss of consciousness? No;Yes No;Yes Alphanumeric 1. this tool has been developed by a group of international experts at the 4th international Consensus meeting on Concussion in Sport held in Zurich, Switzerland<br />in november 2012. the full details of the conference outcomes and the authors of<br />the tool are published in the BJSm injury prevention and Health protection, 2013,<br />Volume 47, issue 5. the outcome paper will also be simultaneously co-published in<br />other leading biomedical journals with the copyright held by the Concussion in Sport<br />Group, to allow unrestricted distribution, providing no alterations are made.<br />2. mcCrory p et al., Consensus Statement on Concussion in Sport &#8211; the 3rd international Conference on Concussion in Sport held in Zurich, november 2008. British<br />Journal of Sports medicine 2009; 43: i76-89.<br />3. maddocks, Dl; Dicker, GD; Saling, mm. the assessment of orientation following<br />concussion in athletes. Clinical Journal of Sport medicine. 1995; 5(1): 32&#8211;3.<br />4. mcCrea m. Standardized mental status testing of acute concussion. Clinical Journal of Sport medicine. 2001; 11: 176&#8211;181.<br />5. Guskiewicz Km. Assessment of postural stability following sport-related concussion. Current Sports medicine reports. 2003; 2: 24&#8211;30.<br />6. Schneiders, A.G., Sullivan, S.J., Gray, A., Hammond-tooke, G.&mcCrory, p.<br />normative values for 16-37 year old subjects for three clinical measures of motor<br />performance used in the assessment of sports concussions. Journal of Science and<br />medicine in Sport. 2010; 13(2): 196&#8211;201.<br />7. Schneiders, A.G., Sullivan, S.J., Kvarnstrom. J.K., olsson, m., Yden. t.&marshall,<br />S.W. the effect of footwear and sports-surface on dynamic neurological screening in sport-related concussion. Journal of Science and medicine in Sport. 2010;<br />13(4): 382&#8211;386<br />8. Ayr, l.K., Yeates, K.o., taylor, H.G.,&Brown, m. Dimensions of post-concussive<br />symptoms in children with mild traumatic brain injuries. Journal of the international<br />neuropsychological Society. 2009; 15:19&#8211;30. Pediatric Supplemental 3.00 2013-07-20 10:21:25.65 Sport Concussion Assessment Tool - 3rd Edition for children ages 5 to 12 (Child-SCAT3) Post-Concussive / Mild TBI-Related Symptoms Outcomes and End Points

Single Pre-Defined Value Selected

C52445 Sport COncusion Assessment Tool - 3rd Edition (SCAT3) - Recent concussion recovery text SCAT3RecntConcusRcvTxt Text detailing how long it too for the subject to recover from his/her most recent concussion, as part of the Sport Concussion Assessment Tool - 3rd Edition (SCAT3) Text detailing how long it too for the subject to recover from his/her most recent concussion, as part of the Sport Concussion Assessment Tool - 3rd Edition (SCAT3 How long was the recovery from the most recent concussion? Alphanumeric 1. this tool has been developed by a group of international experts at the 4th international Consensus meeting on Concussion in Sport held in Zurich, Switzerland<br />in november 2012. the full details of the conference outcomes and the authors of<br />the tool are published in the BJSm injury prevention and Health protection, 2013,<br />Volume 47, issue 5. the outcome paper will also be simultaneously co-published in<br />other leading biomedical journals with the copyright held by the Concussion in Sport<br />Group, to allow unrestricted distribution, providing no alterations are made.<br />2. mcCrory p et al., Consensus Statement on Concussion in Sport &#8211; the 3rd international Conference on Concussion in Sport held in Zurich, november 2008. British<br />Journal of Sports medicine 2009; 43: i76-89.<br />3. maddocks, Dl; Dicker, GD; Saling, mm. the assessment of orientation following<br />concussion in athletes. Clinical Journal of Sport medicine. 1995; 5(1): 32&#8211;3.<br />4. mcCrea m. Standardized mental status testing of acute concussion. Clinical Journal of Sport medicine. 2001; 11: 176&#8211;181.<br />5. Guskiewicz Km. Assessment of postural stability following sport-related concussion. Current Sports medicine reports. 2003; 2: 24&#8211;30.<br />6. Schneiders, A.G., Sullivan, S.J., Gray, A., Hammond-tooke, G.&mcCrory, p.<br />normative values for 16-37 year old subjects for three clinical measures of motor<br />performance used in the assessment of sports concussions. Journal of Science and<br />medicine in Sport. 2010; 13(2): 196&#8211;201.<br />7. Schneiders, A.G., Sullivan, S.J., Kvarnstrom. J.K., olsson, m., Yden. t.&marshall,<br />S.W. the effect of footwear and sports-surface on dynamic neurological screening in sport-related concussion. Journal of Science and medicine in Sport. 2010;<br />13(4): 382&#8211;386<br />8. Ayr, l.K., Yeates, K.o., taylor, H.G.,&Brown, m. Dimensions of post-concussive<br />symptoms in children with mild traumatic brain injuries. Journal of the international<br />neuropsychological Society. 2009; 15:19&#8211;30. Pediatric Supplemental 1.00 2017-01-18 15:07:39.0 Sport Concussion Assessment Tool - 3rd Edition for children ages 5 to 12 (Child-SCAT3) Post-Concussive / Mild TBI-Related Symptoms Outcomes and End Points 255

Free-Form Entry

C01017 Pediatric Glasgow Coma Scale (PGCS) - total score PGCSTotalScore Score for the participant's total Pediatric Glasgow Coma Scale (PGCS) score of the 3 tests, eye, motor, and verbal responses. A score of less than 9 would indicate that that participant is in a severe coma while a score of greater than 9 is a mild or no coma at all Score for the participant's total Pediatric Glasgow Coma Scale (PGCS) score of the 3 tests, eye, motor, and verbal responses. A score of less than 9 would indicate that that participant is in a severe coma while a score of greater than 9 is a mild or no coma at al Total score 3;4;5;6;7;8;9;10;11;12;13;14;15;Untestable;Unknown 3;4;5;6;7;8;9;10;11;12;13;14;15;Untestable;Unknown Alphanumeric 1. this tool has been developed by a group of international experts at the 4th international Consensus meeting on Concussion in Sport held in Zurich, Switzerland<br />in november 2012. the full details of the conference outcomes and the authors of<br />the tool are published in the BJSm injury prevention and Health protection, 2013,<br />Volume 47, issue 5. the outcome paper will also be simultaneously co-published in<br />other leading biomedical journals with the copyright held by the Concussion in Sport<br />Group, to allow unrestricted distribution, providing no alterations are made.<br />2. mcCrory p et al., Consensus Statement on Concussion in Sport &#8211; the 3rd international Conference on Concussion in Sport held in Zurich, november 2008. British<br />Journal of Sports medicine 2009; 43: i76-89.<br />3. maddocks, Dl; Dicker, GD; Saling, mm. the assessment of orientation following<br />concussion in athletes. Clinical Journal of Sport medicine. 1995; 5(1): 32&#8211;3.<br />4. mcCrea m. Standardized mental status testing of acute concussion. Clinical Journal of Sport medicine. 2001; 11: 176&#8211;181.<br />5. Guskiewicz Km. Assessment of postural stability following sport-related concussion. Current Sports medicine reports. 2003; 2: 24&#8211;30.<br />6. Schneiders, A.G., Sullivan, S.J., Gray, A., Hammond-tooke, G.&mcCrory, p.<br />normative values for 16-37 year old subjects for three clinical measures of motor<br />performance used in the assessment of sports concussions. Journal of Science and<br />medicine in Sport. 2010; 13(2): 196&#8211;201.<br />7. Schneiders, A.G., Sullivan, S.J., Kvarnstrom. J.K., olsson, m., Yden. t.&marshall,<br />S.W. the effect of footwear and sports-surface on dynamic neurological screening in sport-related concussion. Journal of Science and medicine in Sport. 2010;<br />13(4): 382&#8211;386<br />8. Ayr, l.K., Yeates, K.o., taylor, H.G.,&Brown, m. Dimensions of post-concussive<br />symptoms in children with mild traumatic brain injuries. Journal of the international<br />neuropsychological Society. 2009; 15:19&#8211;30. Pediatric Supplemental 3.00 2013-07-20 10:21:25.65 Sport Concussion Assessment Tool - 3rd Edition for children ages 5 to 12 (Child-SCAT3) Post-Concussive / Mild TBI-Related Symptoms Outcomes and End Points

Single Pre-Defined Value Selected

C52424 Sport Concussion Assessment Tool (SCAT) - Loss consciousness time duration SCATLossConcsnTmDur Duration of incidents where the subject reports losing consciousness, as part of the Sport Concussion Assessment Tool (SCAT) Duration of incidents where the subject reports losing consciousness, as part of the Sport Concussion Assessment Tool (SCAT "If so, how long?" Numeric Values 1. this tool has been developed by a group of international experts at the 4th international Consensus meeting on Concussion in Sport held in Zurich, Switzerland<br />in november 2012. the full details of the conference outcomes and the authors of<br />the tool are published in the BJSm injury prevention and Health protection, 2013,<br />Volume 47, issue 5. the outcome paper will also be simultaneously co-published in<br />other leading biomedical journals with the copyright held by the Concussion in Sport<br />Group, to allow unrestricted distribution, providing no alterations are made.<br />2. mcCrory p et al., Consensus Statement on Concussion in Sport &#8211; the 3rd international Conference on Concussion in Sport held in Zurich, november 2008. British<br />Journal of Sports medicine 2009; 43: i76-89.<br />3. maddocks, Dl; Dicker, GD; Saling, mm. the assessment of orientation following<br />concussion in athletes. Clinical Journal of Sport medicine. 1995; 5(1): 32&#8211;3.<br />4. mcCrea m. Standardized mental status testing of acute concussion. Clinical Journal of Sport medicine. 2001; 11: 176&#8211;181.<br />5. Guskiewicz Km. Assessment of postural stability following sport-related concussion. Current Sports medicine reports. 2003; 2: 24&#8211;30.<br />6. Schneiders, A.G., Sullivan, S.J., Gray, A., Hammond-tooke, G.&mcCrory, p.<br />normative values for 16-37 year old subjects for three clinical measures of motor<br />performance used in the assessment of sports concussions. Journal of Science and<br />medicine in Sport. 2010; 13(2): 196&#8211;201.<br />7. Schneiders, A.G., Sullivan, S.J., Kvarnstrom. J.K., olsson, m., Yden. t.&marshall,<br />S.W. the effect of footwear and sports-surface on dynamic neurological screening in sport-related concussion. Journal of Science and medicine in Sport. 2010;<br />13(4): 382&#8211;386<br />8. Ayr, l.K., Yeates, K.o., taylor, H.G.,&Brown, m. Dimensions of post-concussive<br />symptoms in children with mild traumatic brain injuries. Journal of the international<br />neuropsychological Society. 2009; 15:19&#8211;30. Pediatric Supplemental 3.00 2013-07-20 10:21:25.65 Sport Concussion Assessment Tool - 3rd Edition for children ages 5 to 12 (Child-SCAT3) Post-Concussive / Mild TBI-Related Symptoms Outcomes and End Points

Free-Form Entry

C52528 Sport Concussion Assessment Tool - 3rd Edition (SCAT3) - Mechanism of injury text SCAT3MechInjTxt Text describing the mechanism of the subject's injury (i.e., what happened), as part of the Sport Concussion Assessment Tool - 3rd Edition (SCAT3) Text describing the mechanism of the subject's injury (i.e., what happened), as part of the Sport Concussion Assessment Tool - 3rd Edition (SCAT3 Mechanism of Injury ("tell me what happened"?) Alphanumeric 1. this tool has been developed by a group of international experts at the 4th international Consensus meeting on Concussion in Sport held in Zurich, Switzerland<br />in november 2012. the full details of the conference outcomes and the authors of<br />the tool are published in the BJSm injury prevention and Health protection, 2013,<br />Volume 47, issue 5. the outcome paper will also be simultaneously co-published in<br />other leading biomedical journals with the copyright held by the Concussion in Sport<br />Group, to allow unrestricted distribution, providing no alterations are made.<br />2. mcCrory p et al., Consensus Statement on Concussion in Sport &#8211; the 3rd international Conference on Concussion in Sport held in Zurich, november 2008. British<br />Journal of Sports medicine 2009; 43: i76-89.<br />3. maddocks, Dl; Dicker, GD; Saling, mm. the assessment of orientation following<br />concussion in athletes. Clinical Journal of Sport medicine. 1995; 5(1): 32&#8211;3.<br />4. mcCrea m. Standardized mental status testing of acute concussion. Clinical Journal of Sport medicine. 2001; 11: 176&#8211;181.<br />5. Guskiewicz Km. Assessment of postural stability following sport-related concussion. Current Sports medicine reports. 2003; 2: 24&#8211;30.<br />6. Schneiders, A.G., Sullivan, S.J., Gray, A., Hammond-tooke, G.&mcCrory, p.<br />normative values for 16-37 year old subjects for three clinical measures of motor<br />performance used in the assessment of sports concussions. Journal of Science and<br />medicine in Sport. 2010; 13(2): 196&#8211;201.<br />7. Schneiders, A.G., Sullivan, S.J., Kvarnstrom. J.K., olsson, m., Yden. t.&marshall,<br />S.W. the effect of footwear and sports-surface on dynamic neurological screening in sport-related concussion. Journal of Science and medicine in Sport. 2010;<br />13(4): 382&#8211;386<br />8. Ayr, l.K., Yeates, K.o., taylor, H.G.,&Brown, m. Dimensions of post-concussive<br />symptoms in children with mild traumatic brain injuries. Journal of the international<br />neuropsychological Society. 2009; 15:19&#8211;30. Pediatric Supplemental 1.00 2017-01-19 08:45:04.0 Sport Concussion Assessment Tool - 3rd Edition for children ages 5 to 12 (Child-SCAT3) Post-Concussive / Mild TBI-Related Symptoms Outcomes and End Points 4000

Free-Form Entry

C01020 Pediatric Glasgow Coma Scale (PGCS) - eye response score PGCSEyeRespnsScore Score for the participant's eye response according to the Pediatric Glasgow Coma Scale (PGCS) if the participant is under the age of 18 Score for the participant's eye response according to the Pediatric Glasgow Coma Scale (PGCS) if the participant is under the age of 1 Best eye response 1;2;3;4;Untestable;Unknown No eye opening;Eye opening to pain;Eye opening to speech;Eyes open spontaneously;Untestable;Unknown Alphanumeric 1. this tool has been developed by a group of international experts at the 4th international Consensus meeting on Concussion in Sport held in Zurich, Switzerland<br />in november 2012. the full details of the conference outcomes and the authors of<br />the tool are published in the BJSm injury prevention and Health protection, 2013,<br />Volume 47, issue 5. the outcome paper will also be simultaneously co-published in<br />other leading biomedical journals with the copyright held by the Concussion in Sport<br />Group, to allow unrestricted distribution, providing no alterations are made.<br />2. mcCrory p et al., Consensus Statement on Concussion in Sport &#8211; the 3rd international Conference on Concussion in Sport held in Zurich, november 2008. British<br />Journal of Sports medicine 2009; 43: i76-89.<br />3. maddocks, Dl; Dicker, GD; Saling, mm. the assessment of orientation following<br />concussion in athletes. Clinical Journal of Sport medicine. 1995; 5(1): 32&#8211;3.<br />4. mcCrea m. Standardized mental status testing of acute concussion. Clinical Journal of Sport medicine. 2001; 11: 176&#8211;181.<br />5. Guskiewicz Km. Assessment of postural stability following sport-related concussion. Current Sports medicine reports. 2003; 2: 24&#8211;30.<br />6. Schneiders, A.G., Sullivan, S.J., Gray, A., Hammond-tooke, G.&mcCrory, p.<br />normative values for 16-37 year old subjects for three clinical measures of motor<br />performance used in the assessment of sports concussions. Journal of Science and<br />medicine in Sport. 2010; 13(2): 196&#8211;201.<br />7. Schneiders, A.G., Sullivan, S.J., Kvarnstrom. J.K., olsson, m., Yden. t.&marshall,<br />S.W. the effect of footwear and sports-surface on dynamic neurological screening in sport-related concussion. Journal of Science and medicine in Sport. 2010;<br />13(4): 382&#8211;386<br />8. Ayr, l.K., Yeates, K.o., taylor, H.G.,&Brown, m. Dimensions of post-concussive<br />symptoms in children with mild traumatic brain injuries. Journal of the international<br />neuropsychological Society. 2009; 15:19&#8211;30. Pediatric Supplemental 3.00 2013-07-20 10:21:25.65 Sport Concussion Assessment Tool - 3rd Edition for children ages 5 to 12 (Child-SCAT3) Post-Concussive / Mild TBI-Related Symptoms Outcomes and End Points

Single Pre-Defined Value Selected

C52425 Sport Concussion Assessment Tool (SCAT) - Balance motor incoordination indicator SCATBalMotorIncoordInd The indicator relating to whether or not the subject has balance or motor incoordination, as part of the Sport Concussion Assessment Tool (SCAT) The indicator relating to whether or not the subject has balance or motor incoordination, as part of the Sport Concussion Assessment Tool (SCAT Balance or motor incoordination (stumbles, slow/laboured movements,etc.)? Y;N Yes;No Alphanumeric 1. this tool has been developed by a group of international experts at the 4th international Consensus meeting on Concussion in Sport held in Zurich, Switzerland<br />in november 2012. the full details of the conference outcomes and the authors of<br />the tool are published in the BJSm injury prevention and Health protection, 2013,<br />Volume 47, issue 5. the outcome paper will also be simultaneously co-published in<br />other leading biomedical journals with the copyright held by the Concussion in Sport<br />Group, to allow unrestricted distribution, providing no alterations are made.<br />2. mcCrory p et al., Consensus Statement on Concussion in Sport &#8211; the 3rd international Conference on Concussion in Sport held in Zurich, november 2008. British<br />Journal of Sports medicine 2009; 43: i76-89.<br />3. maddocks, Dl; Dicker, GD; Saling, mm. the assessment of orientation following<br />concussion in athletes. Clinical Journal of Sport medicine. 1995; 5(1): 32&#8211;3.<br />4. mcCrea m. Standardized mental status testing of acute concussion. Clinical Journal of Sport medicine. 2001; 11: 176&#8211;181.<br />5. Guskiewicz Km. Assessment of postural stability following sport-related concussion. Current Sports medicine reports. 2003; 2: 24&#8211;30.<br />6. Schneiders, A.G., Sullivan, S.J., Gray, A., Hammond-tooke, G.&mcCrory, p.<br />normative values for 16-37 year old subjects for three clinical measures of motor<br />performance used in the assessment of sports concussions. Journal of Science and<br />medicine in Sport. 2010; 13(2): 196&#8211;201.<br />7. Schneiders, A.G., Sullivan, S.J., Kvarnstrom. J.K., olsson, m., Yden. t.&marshall,<br />S.W. the effect of footwear and sports-surface on dynamic neurological screening in sport-related concussion. Journal of Science and medicine in Sport. 2010;<br />13(4): 382&#8211;386<br />8. Ayr, l.K., Yeates, K.o., taylor, H.G.,&Brown, m. Dimensions of post-concussive<br />symptoms in children with mild traumatic brain injuries. Journal of the international<br />neuropsychological Society. 2009; 15:19&#8211;30. Pediatric Supplemental 1.00 2017-01-18 14:14:31.0 Sport Concussion Assessment Tool - 3rd Edition for children ages 5 to 12 (Child-SCAT3) Post-Concussive / Mild TBI-Related Symptoms Outcomes and End Points

Single Pre-Defined Value Selected

C01021 Pediatric Glasgow Coma Scale (PGCS) - motor response score PGCSMotorRespnsScore Score for the participant's motor response according to the Pediatric Glasgow Coma Scale (PGCS) if the participant is under the age of 18 Score for the participant's motor response according to the Pediatric Glasgow Coma Scale (PGCS) if the participant is under the age of 1 Best motor response 1;2;3;4;5;6;Untestable;Unknown No motor response;Extension to pain;Flexion to pain;Withdrawal from pain;Localizing pain;Obeys commands;Untestable;Unknown Alphanumeric 1. this tool has been developed by a group of international experts at the 4th international Consensus meeting on Concussion in Sport held in Zurich, Switzerland<br />in november 2012. the full details of the conference outcomes and the authors of<br />the tool are published in the BJSm injury prevention and Health protection, 2013,<br />Volume 47, issue 5. the outcome paper will also be simultaneously co-published in<br />other leading biomedical journals with the copyright held by the Concussion in Sport<br />Group, to allow unrestricted distribution, providing no alterations are made.<br />2. mcCrory p et al., Consensus Statement on Concussion in Sport &#8211; the 3rd international Conference on Concussion in Sport held in Zurich, november 2008. British<br />Journal of Sports medicine 2009; 43: i76-89.<br />3. maddocks, Dl; Dicker, GD; Saling, mm. the assessment of orientation following<br />concussion in athletes. Clinical Journal of Sport medicine. 1995; 5(1): 32&#8211;3.<br />4. mcCrea m. Standardized mental status testing of acute concussion. Clinical Journal of Sport medicine. 2001; 11: 176&#8211;181.<br />5. Guskiewicz Km. Assessment of postural stability following sport-related concussion. Current Sports medicine reports. 2003; 2: 24&#8211;30.<br />6. Schneiders, A.G., Sullivan, S.J., Gray, A., Hammond-tooke, G.&mcCrory, p.<br />normative values for 16-37 year old subjects for three clinical measures of motor<br />performance used in the assessment of sports concussions. Journal of Science and<br />medicine in Sport. 2010; 13(2): 196&#8211;201.<br />7. Schneiders, A.G., Sullivan, S.J., Kvarnstrom. J.K., olsson, m., Yden. t.&marshall,<br />S.W. the effect of footwear and sports-surface on dynamic neurological screening in sport-related concussion. Journal of Science and medicine in Sport. 2010;<br />13(4): 382&#8211;386<br />8. Ayr, l.K., Yeates, K.o., taylor, H.G.,&Brown, m. Dimensions of post-concussive<br />symptoms in children with mild traumatic brain injuries. Journal of the international<br />neuropsychological Society. 2009; 15:19&#8211;30. Pediatric Supplemental 3.00 2013-07-20 10:21:25.65 Sport Concussion Assessment Tool - 3rd Edition for children ages 5 to 12 (Child-SCAT3) Post-Concussive / Mild TBI-Related Symptoms Outcomes and End Points

Single Pre-Defined Value Selected

C52426 Sport Concussion Assessment Tool - 3rd Edition (SCAT3) - Disorientation confusion indicator SCAT3DisorientConfusInd The indicator relating to whether or not the subject has any disorientation or confusion, as part of the Sport Concussion Assessment Tool - 3rd Edition (SCAT3) The indicator relating to whether or not the subject has any disorientation or confusion, as part of the Sport Concussion Assessment Tool - 3rd Edition (SCAT3 Disorientation or confusion (inability to respond appropriately to questions)? Y;N Yes;No Alphanumeric 1. this tool has been developed by a group of international experts at the 4th international Consensus meeting on Concussion in Sport held in Zurich, Switzerland<br />in november 2012. the full details of the conference outcomes and the authors of<br />the tool are published in the BJSm injury prevention and Health protection, 2013,<br />Volume 47, issue 5. the outcome paper will also be simultaneously co-published in<br />other leading biomedical journals with the copyright held by the Concussion in Sport<br />Group, to allow unrestricted distribution, providing no alterations are made.<br />2. mcCrory p et al., Consensus Statement on Concussion in Sport &#8211; the 3rd international Conference on Concussion in Sport held in Zurich, november 2008. British<br />Journal of Sports medicine 2009; 43: i76-89.<br />3. maddocks, Dl; Dicker, GD; Saling, mm. the assessment of orientation following<br />concussion in athletes. Clinical Journal of Sport medicine. 1995; 5(1): 32&#8211;3.<br />4. mcCrea m. Standardized mental status testing of acute concussion. Clinical Journal of Sport medicine. 2001; 11: 176&#8211;181.<br />5. Guskiewicz Km. Assessment of postural stability following sport-related concussion. Current Sports medicine reports. 2003; 2: 24&#8211;30.<br />6. Schneiders, A.G., Sullivan, S.J., Gray, A., Hammond-tooke, G.&mcCrory, p.<br />normative values for 16-37 year old subjects for three clinical measures of motor<br />performance used in the assessment of sports concussions. Journal of Science and<br />medicine in Sport. 2010; 13(2): 196&#8211;201.<br />7. Schneiders, A.G., Sullivan, S.J., Kvarnstrom. J.K., olsson, m., Yden. t.&marshall,<br />S.W. the effect of footwear and sports-surface on dynamic neurological screening in sport-related concussion. Journal of Science and medicine in Sport. 2010;<br />13(4): 382&#8211;386<br />8. Ayr, l.K., Yeates, K.o., taylor, H.G.,&Brown, m. Dimensions of post-concussive<br />symptoms in children with mild traumatic brain injuries. Journal of the international<br />neuropsychological Society. 2009; 15:19&#8211;30. Pediatric Supplemental 1.00 2017-01-18 14:14:31.0 Sport Concussion Assessment Tool - 3rd Edition for children ages 5 to 12 (Child-SCAT3) Post-Concussive / Mild TBI-Related Symptoms Outcomes and End Points

Single Pre-Defined Value Selected

C01022 Pediatric Glasgow Coma Scale (PGCS) - verbal response score PGCSVerbalRespnsScore Score for the participant's verbal response according to the Pediatric Glasgow Coma Scale (PGCS) if the participant is under the age of 18 Score for the participant's verbal response according to the Pediatric Glasgow Coma Scale (PGCS) if the participant is under the age of 1 Best verbal response 1;2;3;4;5;Untestable;Unknown No vocal response;Inconsolable, agitated;Inconsistently consolable, moaning;Cries, but is consolable, inappropriate interactions;Smiles, oriented to sounds, follows objects, interacts;Untestable;Unknown Alphanumeric 1. this tool has been developed by a group of international experts at the 4th international Consensus meeting on Concussion in Sport held in Zurich, Switzerland<br />in november 2012. the full details of the conference outcomes and the authors of<br />the tool are published in the BJSm injury prevention and Health protection, 2013,<br />Volume 47, issue 5. the outcome paper will also be simultaneously co-published in<br />other leading biomedical journals with the copyright held by the Concussion in Sport<br />Group, to allow unrestricted distribution, providing no alterations are made.<br />2. mcCrory p et al., Consensus Statement on Concussion in Sport &#8211; the 3rd international Conference on Concussion in Sport held in Zurich, november 2008. British<br />Journal of Sports medicine 2009; 43: i76-89.<br />3. maddocks, Dl; Dicker, GD; Saling, mm. the assessment of orientation following<br />concussion in athletes. Clinical Journal of Sport medicine. 1995; 5(1): 32&#8211;3.<br />4. mcCrea m. Standardized mental status testing of acute concussion. Clinical Journal of Sport medicine. 2001; 11: 176&#8211;181.<br />5. Guskiewicz Km. Assessment of postural stability following sport-related concussion. Current Sports medicine reports. 2003; 2: 24&#8211;30.<br />6. Schneiders, A.G., Sullivan, S.J., Gray, A., Hammond-tooke, G.&mcCrory, p.<br />normative values for 16-37 year old subjects for three clinical measures of motor<br />performance used in the assessment of sports concussions. Journal of Science and<br />medicine in Sport. 2010; 13(2): 196&#8211;201.<br />7. Schneiders, A.G., Sullivan, S.J., Kvarnstrom. J.K., olsson, m., Yden. t.&marshall,<br />S.W. the effect of footwear and sports-surface on dynamic neurological screening in sport-related concussion. Journal of Science and medicine in Sport. 2010;<br />13(4): 382&#8211;386<br />8. Ayr, l.K., Yeates, K.o., taylor, H.G.,&Brown, m. Dimensions of post-concussive<br />symptoms in children with mild traumatic brain injuries. Journal of the international<br />neuropsychological Society. 2009; 15:19&#8211;30. Pediatric Supplemental 3.00 2013-07-20 10:21:25.65 Sport Concussion Assessment Tool - 3rd Edition for children ages 5 to 12 (Child-SCAT3) Post-Concussive / Mild TBI-Related Symptoms Outcomes and End Points

Single Pre-Defined Value Selected

C52427 Sport Concussion Assessment Tool - 3rd Edition (SCAT3) - Memory loss indicator SCAT3MemLossInd The indicator relating to whether or not the subject has loss his or her memory due to his or her injury, as part of the Sport Concussion Assessment Tool - 3rd Edition (SCAT3) The indicator relating to whether or not the subject has loss his or her memory due to his or her injury, as part of the Sport Concussion Assessment Tool - 3rd Edition (SCAT3 Loss of memory: Y;N Yes;No Alphanumeric 1. this tool has been developed by a group of international experts at the 4th international Consensus meeting on Concussion in Sport held in Zurich, Switzerland<br />in november 2012. the full details of the conference outcomes and the authors of<br />the tool are published in the BJSm injury prevention and Health protection, 2013,<br />Volume 47, issue 5. the outcome paper will also be simultaneously co-published in<br />other leading biomedical journals with the copyright held by the Concussion in Sport<br />Group, to allow unrestricted distribution, providing no alterations are made.<br />2. mcCrory p et al., Consensus Statement on Concussion in Sport &#8211; the 3rd international Conference on Concussion in Sport held in Zurich, november 2008. British<br />Journal of Sports medicine 2009; 43: i76-89.<br />3. maddocks, Dl; Dicker, GD; Saling, mm. the assessment of orientation following<br />concussion in athletes. Clinical Journal of Sport medicine. 1995; 5(1): 32&#8211;3.<br />4. mcCrea m. Standardized mental status testing of acute concussion. Clinical Journal of Sport medicine. 2001; 11: 176&#8211;181.<br />5. Guskiewicz Km. Assessment of postural stability following sport-related concussion. Current Sports medicine reports. 2003; 2: 24&#8211;30.<br />6. Schneiders, A.G., Sullivan, S.J., Gray, A., Hammond-tooke, G.&mcCrory, p.<br />normative values for 16-37 year old subjects for three clinical measures of motor<br />performance used in the assessment of sports concussions. Journal of Science and<br />medicine in Sport. 2010; 13(2): 196&#8211;201.<br />7. Schneiders, A.G., Sullivan, S.J., Kvarnstrom. J.K., olsson, m., Yden. t.&marshall,<br />S.W. the effect of footwear and sports-surface on dynamic neurological screening in sport-related concussion. Journal of Science and medicine in Sport. 2010;<br />13(4): 382&#8211;386<br />8. Ayr, l.K., Yeates, K.o., taylor, H.G.,&Brown, m. Dimensions of post-concussive<br />symptoms in children with mild traumatic brain injuries. Journal of the international<br />neuropsychological Society. 2009; 15:19&#8211;30. Pediatric Supplemental 1.00 2017-01-18 14:23:09.0 Sport Concussion Assessment Tool - 3rd Edition for children ages 5 to 12 (Child-SCAT3) Post-Concussive / Mild TBI-Related Symptoms Outcomes and End Points

Single Pre-Defined Value Selected

C05400 Injury date time InjDateTime Date (and time, if applicable and known) of injury Date (and time, if applicable and known) of injury Date/Time of Injury Date or Date & Time 1. this tool has been developed by a group of international experts at the 4th international Consensus meeting on Concussion in Sport held in Zurich, Switzerland<br />in november 2012. the full details of the conference outcomes and the authors of<br />the tool are published in the BJSm injury prevention and Health protection, 2013,<br />Volume 47, issue 5. the outcome paper will also be simultaneously co-published in<br />other leading biomedical journals with the copyright held by the Concussion in Sport<br />Group, to allow unrestricted distribution, providing no alterations are made.<br />2. mcCrory p et al., Consensus Statement on Concussion in Sport &#8211; the 3rd international Conference on Concussion in Sport held in Zurich, november 2008. British<br />Journal of Sports medicine 2009; 43: i76-89.<br />3. maddocks, Dl; Dicker, GD; Saling, mm. the assessment of orientation following<br />concussion in athletes. Clinical Journal of Sport medicine. 1995; 5(1): 32&#8211;3.<br />4. mcCrea m. Standardized mental status testing of acute concussion. Clinical Journal of Sport medicine. 2001; 11: 176&#8211;181.<br />5. Guskiewicz Km. Assessment of postural stability following sport-related concussion. Current Sports medicine reports. 2003; 2: 24&#8211;30.<br />6. Schneiders, A.G., Sullivan, S.J., Gray, A., Hammond-tooke, G.&mcCrory, p.<br />normative values for 16-37 year old subjects for three clinical measures of motor<br />performance used in the assessment of sports concussions. Journal of Science and<br />medicine in Sport. 2010; 13(2): 196&#8211;201.<br />7. Schneiders, A.G., Sullivan, S.J., Kvarnstrom. J.K., olsson, m., Yden. t.&marshall,<br />S.W. the effect of footwear and sports-surface on dynamic neurological screening in sport-related concussion. Journal of Science and medicine in Sport. 2010;<br />13(4): 382&#8211;386<br />8. Ayr, l.K., Yeates, K.o., taylor, H.G.,&Brown, m. Dimensions of post-concussive<br />symptoms in children with mild traumatic brain injuries. Journal of the international<br />neuropsychological Society. 2009; 15:19&#8211;30. Pediatric Supplemental 3.00 2013-07-20 10:21:25.65 Sport Concussion Assessment Tool - 3rd Edition for children ages 5 to 12 (Child-SCAT3) Post-Concussive / Mild TBI-Related Symptoms Outcomes and End Points

Free-Form Entry

C52428 Sport Concussion Assessment Tool (SCAT) - Memory loss duration SCAT3MemLossDur The duration of how long the subject lost his or her memory due to his or her injury, as part of the Sport Concussion Assessment Tool - 3rd Edition (SCAT3) The duration of how long the subject lost his or her memory due to his or her injury, as part of the Sport Concussion Assessment Tool - 3rd Edition (SCAT3 "If so, how long?" Numeric Values 1. this tool has been developed by a group of international experts at the 4th international Consensus meeting on Concussion in Sport held in Zurich, Switzerland<br />in november 2012. the full details of the conference outcomes and the authors of<br />the tool are published in the BJSm injury prevention and Health protection, 2013,<br />Volume 47, issue 5. the outcome paper will also be simultaneously co-published in<br />other leading biomedical journals with the copyright held by the Concussion in Sport<br />Group, to allow unrestricted distribution, providing no alterations are made.<br />2. mcCrory p et al., Consensus Statement on Concussion in Sport &#8211; the 3rd international Conference on Concussion in Sport held in Zurich, november 2008. British<br />Journal of Sports medicine 2009; 43: i76-89.<br />3. maddocks, Dl; Dicker, GD; Saling, mm. the assessment of orientation following<br />concussion in athletes. Clinical Journal of Sport medicine. 1995; 5(1): 32&#8211;3.<br />4. mcCrea m. Standardized mental status testing of acute concussion. Clinical Journal of Sport medicine. 2001; 11: 176&#8211;181.<br />5. Guskiewicz Km. Assessment of postural stability following sport-related concussion. Current Sports medicine reports. 2003; 2: 24&#8211;30.<br />6. Schneiders, A.G., Sullivan, S.J., Gray, A., Hammond-tooke, G.&mcCrory, p.<br />normative values for 16-37 year old subjects for three clinical measures of motor<br />performance used in the assessment of sports concussions. Journal of Science and<br />medicine in Sport. 2010; 13(2): 196&#8211;201.<br />7. Schneiders, A.G., Sullivan, S.J., Kvarnstrom. J.K., olsson, m., Yden. t.&marshall,<br />S.W. the effect of footwear and sports-surface on dynamic neurological screening in sport-related concussion. Journal of Science and medicine in Sport. 2010;<br />13(4): 382&#8211;386<br />8. Ayr, l.K., Yeates, K.o., taylor, H.G.,&Brown, m. Dimensions of post-concussive<br />symptoms in children with mild traumatic brain injuries. Journal of the international<br />neuropsychological Society. 2009; 15:19&#8211;30. Pediatric Supplemental 1.00 2017-01-18 14:23:09.0 Sport Concussion Assessment Tool - 3rd Edition for children ages 5 to 12 (Child-SCAT3) Post-Concussive / Mild TBI-Related Symptoms Outcomes and End Points

Free-Form Entry

C19500 Assessment performed date AssessmentPerformedDate The date of assessment of the examination being performed The date of assessment of the examination being performed Date of Assessment Date or Date & Time 1. this tool has been developed by a group of international experts at the 4th international Consensus meeting on Concussion in Sport held in Zurich, Switzerland<br />in november 2012. the full details of the conference outcomes and the authors of<br />the tool are published in the BJSm injury prevention and Health protection, 2013,<br />Volume 47, issue 5. the outcome paper will also be simultaneously co-published in<br />other leading biomedical journals with the copyright held by the Concussion in Sport<br />Group, to allow unrestricted distribution, providing no alterations are made.<br />2. mcCrory p et al., Consensus Statement on Concussion in Sport &#8211; the 3rd international Conference on Concussion in Sport held in Zurich, november 2008. British<br />Journal of Sports medicine 2009; 43: i76-89.<br />3. maddocks, Dl; Dicker, GD; Saling, mm. the assessment of orientation following<br />concussion in athletes. Clinical Journal of Sport medicine. 1995; 5(1): 32&#8211;3.<br />4. mcCrea m. Standardized mental status testing of acute concussion. Clinical Journal of Sport medicine. 2001; 11: 176&#8211;181.<br />5. Guskiewicz Km. Assessment of postural stability following sport-related concussion. Current Sports medicine reports. 2003; 2: 24&#8211;30.<br />6. Schneiders, A.G., Sullivan, S.J., Gray, A., Hammond-tooke, G.&mcCrory, p.<br />normative values for 16-37 year old subjects for three clinical measures of motor<br />performance used in the assessment of sports concussions. Journal of Science and<br />medicine in Sport. 2010; 13(2): 196&#8211;201.<br />7. Schneiders, A.G., Sullivan, S.J., Kvarnstrom. J.K., olsson, m., Yden. t.&marshall,<br />S.W. the effect of footwear and sports-surface on dynamic neurological screening in sport-related concussion. Journal of Science and medicine in Sport. 2010;<br />13(4): 382&#8211;386<br />8. Ayr, l.K., Yeates, K.o., taylor, H.G.,&Brown, m. Dimensions of post-concussive<br />symptoms in children with mild traumatic brain injuries. Journal of the international<br />neuropsychological Society. 2009; 15:19&#8211;30. Pediatric Supplemental 1.00 2014-06-18 08:10:12.0 Sport Concussion Assessment Tool - 3rd Edition for children ages 5 to 12 (Child-SCAT3) Post-Concussive / Mild TBI-Related Symptoms Outcomes and End Points

Free-Form Entry

C52429 Sport Concussion Assessment Tool - 3rd Edition (SCAT3) - Memory loss duration text SCAT3MemLossDurTxt Text describing when the duration of how long the subject lost his or her memory due to his or her injury occurred, as part of the Sport Concussion Assessment Tool - 3rd Edition (SCAT3) Text describing when the duration of how long the subject lost his or her memory due to his or her injury occurred, as part of the Sport Concussion Assessment Tool - 3rd Edition (SCAT3 "Before or after the injury?" Alphanumeric 1. this tool has been developed by a group of international experts at the 4th international Consensus meeting on Concussion in Sport held in Zurich, Switzerland<br />in november 2012. the full details of the conference outcomes and the authors of<br />the tool are published in the BJSm injury prevention and Health protection, 2013,<br />Volume 47, issue 5. the outcome paper will also be simultaneously co-published in<br />other leading biomedical journals with the copyright held by the Concussion in Sport<br />Group, to allow unrestricted distribution, providing no alterations are made.<br />2. mcCrory p et al., Consensus Statement on Concussion in Sport &#8211; the 3rd international Conference on Concussion in Sport held in Zurich, november 2008. British<br />Journal of Sports medicine 2009; 43: i76-89.<br />3. maddocks, Dl; Dicker, GD; Saling, mm. the assessment of orientation following<br />concussion in athletes. Clinical Journal of Sport medicine. 1995; 5(1): 32&#8211;3.<br />4. mcCrea m. Standardized mental status testing of acute concussion. Clinical Journal of Sport medicine. 2001; 11: 176&#8211;181.<br />5. Guskiewicz Km. Assessment of postural stability following sport-related concussion. Current Sports medicine reports. 2003; 2: 24&#8211;30.<br />6. Schneiders, A.G., Sullivan, S.J., Gray, A., Hammond-tooke, G.&mcCrory, p.<br />normative values for 16-37 year old subjects for three clinical measures of motor<br />performance used in the assessment of sports concussions. Journal of Science and<br />medicine in Sport. 2010; 13(2): 196&#8211;201.<br />7. Schneiders, A.G., Sullivan, S.J., Kvarnstrom. J.K., olsson, m., Yden. t.&marshall,<br />S.W. the effect of footwear and sports-surface on dynamic neurological screening in sport-related concussion. Journal of Science and medicine in Sport. 2010;<br />13(4): 382&#8211;386<br />8. Ayr, l.K., Yeates, K.o., taylor, H.G.,&Brown, m. Dimensions of post-concussive<br />symptoms in children with mild traumatic brain injuries. Journal of the international<br />neuropsychological Society. 2009; 15:19&#8211;30. Pediatric Supplemental 1.00 2017-01-18 14:23:09.0 Sport Concussion Assessment Tool - 3rd Edition for children ages 5 to 12 (Child-SCAT3) Post-Concussive / Mild TBI-Related Symptoms Outcomes and End Points 255

Free-Form Entry

C21117 Subject name SubjectName Name of subject/participant Name of subject/participan Name Alphanumeric 1. this tool has been developed by a group of international experts at the 4th international Consensus meeting on Concussion in Sport held in Zurich, Switzerland<br />in november 2012. the full details of the conference outcomes and the authors of<br />the tool are published in the BJSm injury prevention and Health protection, 2013,<br />Volume 47, issue 5. the outcome paper will also be simultaneously co-published in<br />other leading biomedical journals with the copyright held by the Concussion in Sport<br />Group, to allow unrestricted distribution, providing no alterations are made.<br />2. mcCrory p et al., Consensus Statement on Concussion in Sport &#8211; the 3rd international Conference on Concussion in Sport held in Zurich, november 2008. British<br />Journal of Sports medicine 2009; 43: i76-89.<br />3. maddocks, Dl; Dicker, GD; Saling, mm. the assessment of orientation following<br />concussion in athletes. Clinical Journal of Sport medicine. 1995; 5(1): 32&#8211;3.<br />4. mcCrea m. Standardized mental status testing of acute concussion. Clinical Journal of Sport medicine. 2001; 11: 176&#8211;181.<br />5. Guskiewicz Km. Assessment of postural stability following sport-related concussion. Current Sports medicine reports. 2003; 2: 24&#8211;30.<br />6. Schneiders, A.G., Sullivan, S.J., Gray, A., Hammond-tooke, G.&mcCrory, p.<br />normative values for 16-37 year old subjects for three clinical measures of motor<br />performance used in the assessment of sports concussions. Journal of Science and<br />medicine in Sport. 2010; 13(2): 196&#8211;201.<br />7. Schneiders, A.G., Sullivan, S.J., Kvarnstrom. J.K., olsson, m., Yden. t.&marshall,<br />S.W. the effect of footwear and sports-surface on dynamic neurological screening in sport-related concussion. Journal of Science and medicine in Sport. 2010;<br />13(4): 382&#8211;386<br />8. Ayr, l.K., Yeates, K.o., taylor, H.G.,&Brown, m. Dimensions of post-concussive<br />symptoms in children with mild traumatic brain injuries. Journal of the international<br />neuropsychological Society. 2009; 15:19&#8211;30. Pediatric Supplemental 1.00 2015-06-12 15:16:39.0 Sport Concussion Assessment Tool - 3rd Edition for children ages 5 to 12 (Child-SCAT3) Post-Concussive / Mild TBI-Related Symptoms Outcomes and End Points 255

Free-Form Entry

C52430 Sport Concussion Assessment Tool - 3rd Edition (SCAT3) - Blank vacant look indicator SCAT3BlankVacLookInd The indicator relating to whether or not the subject has a blank or vacant look on his or her face, as part of the Sport Concussion Assessment Tool - 3rd Edition (SCAT3) The indicator relating to whether or not the subject has a blank or vacant look on his or her face, as part of the Sport Concussion Assessment Tool - 3rd Edition (SCAT3 Blank or vacant look: Y;N Yes;No Alphanumeric 1. this tool has been developed by a group of international experts at the 4th international Consensus meeting on Concussion in Sport held in Zurich, Switzerland<br />in november 2012. the full details of the conference outcomes and the authors of<br />the tool are published in the BJSm injury prevention and Health protection, 2013,<br />Volume 47, issue 5. the outcome paper will also be simultaneously co-published in<br />other leading biomedical journals with the copyright held by the Concussion in Sport<br />Group, to allow unrestricted distribution, providing no alterations are made.<br />2. mcCrory p et al., Consensus Statement on Concussion in Sport &#8211; the 3rd international Conference on Concussion in Sport held in Zurich, november 2008. British<br />Journal of Sports medicine 2009; 43: i76-89.<br />3. maddocks, Dl; Dicker, GD; Saling, mm. the assessment of orientation following<br />concussion in athletes. Clinical Journal of Sport medicine. 1995; 5(1): 32&#8211;3.<br />4. mcCrea m. Standardized mental status testing of acute concussion. Clinical Journal of Sport medicine. 2001; 11: 176&#8211;181.<br />5. Guskiewicz Km. Assessment of postural stability following sport-related concussion. Current Sports medicine reports. 2003; 2: 24&#8211;30.<br />6. Schneiders, A.G., Sullivan, S.J., Gray, A., Hammond-tooke, G.&mcCrory, p.<br />normative values for 16-37 year old subjects for three clinical measures of motor<br />performance used in the assessment of sports concussions. Journal of Science and<br />medicine in Sport. 2010; 13(2): 196&#8211;201.<br />7. Schneiders, A.G., Sullivan, S.J., Kvarnstrom. J.K., olsson, m., Yden. t.&marshall,<br />S.W. the effect of footwear and sports-surface on dynamic neurological screening in sport-related concussion. Journal of Science and medicine in Sport. 2010;<br />13(4): 382&#8211;386<br />8. Ayr, l.K., Yeates, K.o., taylor, H.G.,&Brown, m. Dimensions of post-concussive<br />symptoms in children with mild traumatic brain injuries. Journal of the international<br />neuropsychological Society. 2009; 15:19&#8211;30. Pediatric Supplemental 1.00 2017-01-18 14:23:09.0 Sport Concussion Assessment Tool - 3rd Edition for children ages 5 to 12 (Child-SCAT3) Post-Concussive / Mild TBI-Related Symptoms Outcomes and End Points

Single Pre-Defined Value Selected

C50680 Examiner name ExaminerName The name of the person performing the exam The name of the person performing the exa Examiner Alphanumeric 1. this tool has been developed by a group of international experts at the 4th international Consensus meeting on Concussion in Sport held in Zurich, Switzerland<br />in november 2012. the full details of the conference outcomes and the authors of<br />the tool are published in the BJSm injury prevention and Health protection, 2013,<br />Volume 47, issue 5. the outcome paper will also be simultaneously co-published in<br />other leading biomedical journals with the copyright held by the Concussion in Sport<br />Group, to allow unrestricted distribution, providing no alterations are made.<br />2. mcCrory p et al., Consensus Statement on Concussion in Sport &#8211; the 3rd international Conference on Concussion in Sport held in Zurich, november 2008. British<br />Journal of Sports medicine 2009; 43: i76-89.<br />3. maddocks, Dl; Dicker, GD; Saling, mm. the assessment of orientation following<br />concussion in athletes. Clinical Journal of Sport medicine. 1995; 5(1): 32&#8211;3.<br />4. mcCrea m. Standardized mental status testing of acute concussion. Clinical Journal of Sport medicine. 2001; 11: 176&#8211;181.<br />5. Guskiewicz Km. Assessment of postural stability following sport-related concussion. Current Sports medicine reports. 2003; 2: 24&#8211;30.<br />6. Schneiders, A.G., Sullivan, S.J., Gray, A., Hammond-tooke, G.&mcCrory, p.<br />normative values for 16-37 year old subjects for three clinical measures of motor<br />performance used in the assessment of sports concussions. Journal of Science and<br />medicine in Sport. 2010; 13(2): 196&#8211;201.<br />7. Schneiders, A.G., Sullivan, S.J., Kvarnstrom. J.K., olsson, m., Yden. t.&marshall,<br />S.W. the effect of footwear and sports-surface on dynamic neurological screening in sport-related concussion. Journal of Science and medicine in Sport. 2010;<br />13(4): 382&#8211;386<br />8. Ayr, l.K., Yeates, K.o., taylor, H.G.,&Brown, m. Dimensions of post-concussive<br />symptoms in children with mild traumatic brain injuries. Journal of the international<br />neuropsychological Society. 2009; 15:19&#8211;30. Pediatric Supplemental 1.00 2016-12-12 00:00:00.0 Sport Concussion Assessment Tool - 3rd Edition for children ages 5 to 12 (Child-SCAT3) Post-Concussive / Mild TBI-Related Symptoms Outcomes and End Points 255

Free-Form Entry

C52431 Sport Concussion Assessment Tool - 3rd Edition (SCAT3) - Visible facial injury combination indicator SCAT3VisiFacInjComboInd The indicator relating to whether or not the subject has a visible facial injury in combination with any of the signs previously mentioned, as part of the Sport Concussion Assessment Tool - 3rd Edition (SCAT3) The indicator relating to whether or not the subject has a visible facial injury in combination with any of the signs previously mentioned, as part of the Sport Concussion Assessment Tool - 3rd Edition (SCAT3 Visible facial injury in combination with any of the above: Y;N Yes;No Alphanumeric 1. this tool has been developed by a group of international experts at the 4th international Consensus meeting on Concussion in Sport held in Zurich, Switzerland<br />in november 2012. the full details of the conference outcomes and the authors of<br />the tool are published in the BJSm injury prevention and Health protection, 2013,<br />Volume 47, issue 5. the outcome paper will also be simultaneously co-published in<br />other leading biomedical journals with the copyright held by the Concussion in Sport<br />Group, to allow unrestricted distribution, providing no alterations are made.<br />2. mcCrory p et al., Consensus Statement on Concussion in Sport &#8211; the 3rd international Conference on Concussion in Sport held in Zurich, november 2008. British<br />Journal of Sports medicine 2009; 43: i76-89.<br />3. maddocks, Dl; Dicker, GD; Saling, mm. the assessment of orientation following<br />concussion in athletes. Clinical Journal of Sport medicine. 1995; 5(1): 32&#8211;3.<br />4. mcCrea m. Standardized mental status testing of acute concussion. Clinical Journal of Sport medicine. 2001; 11: 176&#8211;181.<br />5. Guskiewicz Km. Assessment of postural stability following sport-related concussion. Current Sports medicine reports. 2003; 2: 24&#8211;30.<br />6. Schneiders, A.G., Sullivan, S.J., Gray, A., Hammond-tooke, G.&mcCrory, p.<br />normative values for 16-37 year old subjects for three clinical measures of motor<br />performance used in the assessment of sports concussions. Journal of Science and<br />medicine in Sport. 2010; 13(2): 196&#8211;201.<br />7. Schneiders, A.G., Sullivan, S.J., Kvarnstrom. J.K., olsson, m., Yden. t.&marshall,<br />S.W. the effect of footwear and sports-surface on dynamic neurological screening in sport-related concussion. Journal of Science and medicine in Sport. 2010;<br />13(4): 382&#8211;386<br />8. Ayr, l.K., Yeates, K.o., taylor, H.G.,&Brown, m. Dimensions of post-concussive<br />symptoms in children with mild traumatic brain injuries. Journal of the international<br />neuropsychological Society. 2009; 15:19&#8211;30. Pediatric Supplemental 1.00 2017-01-18 14:23:09.0 Sport Concussion Assessment Tool - 3rd Edition for children ages 5 to 12 (Child-SCAT3) Post-Concussive / Mild TBI-Related Symptoms Outcomes and End Points

Single Pre-Defined Value Selected

CSV