CDE Detailed Report

Disease: Sport Related Concussion
Sub-Domain: Cognitive Assessment
CRF: Acute Concussion Evaluation (ACE)

Displaying 51 - 59 of 59
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
C54334 Acute Concussion Evaluation (ACE) - Evidence direct blow head indicator ACEEvidnceDirctBlowHeadInd Indicator whether injury is due to a blow to the head as related to the Acute Concussion Evaluation (ACE) Indicator whether injury is due to a blow to the head as related to the Acute Concussion Evaluation (ACE Is there evidence of a forcible blow to the head (direct or indirect)? No;Yes;Unknown No;Yes;Unknown Alphanumeric Centers for the Disease Control and Prevention. Heads Up: Brain Injury in Your Practice Tool Kit, 2006. Adult;Pediatric Supplemental 1.00 2017-02-27 20:02:13.0 Acute Concussion Evaluation (ACE) Cognitive Assessment Outcomes and End Points

Single Pre-Defined Value Selected

C54366 Acute Concussion Evaluation (ACE) - Risk factors protracted recovery multiple concussion force reinjury indicator ACERskFcPtrcRcvMltCncFrcRnjInd Indicator of whether multiple concussions occur with less force caused reinjury is a risk factor that may protract the subject/participant recovery process since injury as related to the Acute Concussion Evaluation (ACE) Indicator of whether multiple concussions occur with less force caused reinjury is a risk factor that may protract the subject/participant recovery process since injury as related to the Acute Concussion Evaluation (ACE If multiple concussions, less force caused reinjury? No;Yes No;Yes Alphanumeric

Assess the number and date(s) of prior concussions, duration of symptoms for each injury, and whether less biomechanical force resulted in re-injury.

Centers for the Disease Control and Prevention. Heads Up: Brain Injury in Your Practice Tool Kit, 2006. Adult;Pediatric Supplemental 1.00 2017-02-27 20:22:56.0 Acute Concussion Evaluation (ACE) Cognitive Assessment Outcomes and End Points

Multiple Pre-Defined Values Selected

C54390 Acute Concussion Evaluation (ACE) - Diagnosis (ICD) concussion type ACEDiagnosisIcdConcussionTyp Type of ICD diagnosis of concussion as related to the Acute Concussion Evaluation (ACE) Type of ICD diagnosis of concussion as related to the Acute Concussion Evaluation (ACE Diagnosis (ICD) No diagnosis;850.0 Concussion without Loss of Consciousness (LOC);850.1 Concussion with Loss of Consciousness (LOC);850.9 Concussion (Unspecified);Other (854) No diagnosis;850.0 Concussion without Loss of Consciousness (LOC);850.1 Concussion with Loss of Consciousness (LOC);850.9 Concussion (Unspecified);Other (854) Alphanumeric

The following ICD diagnostic codes may be applicable.
850.0 (Concussion with no loss of consciousness) – Positive injury description with evidence of forcible direct/indirect blow to the head (A1a); plus evidence of active symptoms (B) of any type and number related to the trauma (Total Symptom Score >0); no evidence of LOC (A5), skull fracture or intracranial injury (A1b).
850.1 (Concussion, with brief loss of consciousness 0); positive evidence of LOC (A5), skull fracture or intracranial injury (A1b).
850.9 (Concussion, unspecified) – Positive injury description with evidence of forcible direct/indirect blow to the head (A1a); plus evidence of active symptoms (B) of any type and number related to the trauma (Total Symptom Score >0); unclear/unknown injury details; unclear evidence of LOC (A5), no skull fracture or intracranial injury.
Other diagnosis – If patient presents with a positive injury description and associated symptoms, but additional evidence of intracranial injury (A1b) such as from neuroimaging, a moderate TBI and diagnostic category of 854 (Intracranial injury) should be considered.

Centers for the Disease Control and Prevention. Heads Up: Brain Injury in Your Practice Tool Kit, 2006. Adult;Pediatric Supplemental 1.00 2017-02-27 20:22:56.0 Acute Concussion Evaluation (ACE) Cognitive Assessment Outcomes and End Points

Multiple Pre-Defined Values Selected

C54345 Acute Concussion Evaluation (ACE) - Loss of consciousness duration ACELossConsciousnessDur Duration of the subject/participant's loss of consciousness as related to the Acute Concussion Evaluation (ACE) Duration of the subject/participant's loss of consciousness as related to the Acute Concussion Evaluation (ACE Loss of consciousness duration Numeric Values Centers for the Disease Control and Prevention. Heads Up: Brain Injury in Your Practice Tool Kit, 2006. Adult;Pediatric Supplemental 1.00 2017-02-27 20:29:51.0 Acute Concussion Evaluation (ACE) Cognitive Assessment Outcomes and End Points

Free-Form Entry

C54356 Acute Concussion Evaluation (ACE) - Symptom check list sleep indicator ACESymptomChkLstSleepInd Indicator of whether subject/participant has experienced sleep symptoms since injury as related to the Acute Concussion Evaluation (ACE) Indicator of whether subject/participant has experienced sleep symptoms since injury as related to the Acute Concussion Evaluation (ACE SLEEP (4) 0;1;N/A 0=No;1=Yes;N/A Alphanumeric

Indicate presence of each symptom (0=No 1=Yes).

Centers for the Disease Control and Prevention. Heads Up: Brain Injury in Your Practice Tool Kit, 2006. Adult;Pediatric Supplemental 1.00 2017-02-27 20:29:51.0 Acute Concussion Evaluation (ACE) Cognitive Assessment Outcomes and End Points

Single Pre-Defined Value Selected

C54335 Acute Concussion Evaluation (ACE) - Evidence intracranial injury skull fracture indicator ACEEvidnceIntraCrnSkulFrctrInd Indicator whether injury is due to an intracranial skull fracture as related to f the Acute Concussion Evaluation (ACE) Indicator whether injury is due to an intracranial skull fracture as related to f the Acute Concussion Evaluation (ACE Is there eveidence of intracranial injury or skull fracture? No;Yes;Unknown No;Yes;Unknown Alphanumeric Centers for the Disease Control and Prevention. Heads Up: Brain Injury in Your Practice Tool Kit, 2006. Adult;Pediatric Supplemental 1.00 2017-02-27 20:02:13.0 Acute Concussion Evaluation (ACE) Cognitive Assessment Outcomes and End Points

Single Pre-Defined Value Selected

C54367 Acute Concussion Evaluation (ACE) - Risk factors protracted recovery headache history indicator ACERiskFacProtrctRecvHeadHxTyp Indicator of whether headache history is a risk factor that may protract the subject/participant recovery process since injury as related to the Acute Concussion Evaluation (ACE) Indicator of whether headache history is a risk factor that may protract the subject/participant recovery process since injury as related to the Acute Concussion Evaluation (ACE Headache History? No;Yes No;Yes Alphanumeric Centers for the Disease Control and Prevention. Heads Up: Brain Injury in Your Practice Tool Kit, 2006. Adult;Pediatric Supplemental 1.00 2017-02-27 20:22:56.0 Acute Concussion Evaluation (ACE) Cognitive Assessment Outcomes and End Points

Multiple Pre-Defined Values Selected

C54391 Acute Concussion Evaluation (ACE) - Follow-up action plan type ACEFollowupActionPlanTyp Type of follow-up plan of action for subject/participant as related to the Acute Concussion Evaluation (ACE) Type of follow-up plan of action for subject/participant as related to the Acute Concussion Evaluation (ACE Follow-Up Action Plan No Follow-Up Needed;Physician/Clinician Office Monitoring;Referral No Follow-Up Needed;Physician/Clinician Office Monitoring;Referral Alphanumeric Centers for the Disease Control and Prevention. Heads Up: Brain Injury in Your Practice Tool Kit, 2006. Adult;Pediatric Supplemental 1.00 2017-02-27 20:22:56.0 Acute Concussion Evaluation (ACE) Cognitive Assessment Outcomes and End Points

Multiple Pre-Defined Values Selected

C54346 Acute Concussion Evaluation (ACE) - Early signs type ACEEarlySignsTyp Type of early signs that may have been observed after subject/patient injury as related to the Acute Concussion Evaluation (ACE) Type of early signs that may have been observed after subject/patient injury as related to the Acute Concussion Evaluation (ACE EARLY SIGNS: Appears dazed or confused;Is confused about events;Answers questions slowly;Repeats questions;Forgetful (recent info) Appears dazed or confused;Is confused about events;Answers questions slowly;Repeats questions;Forgetful (recent info) Alphanumeric Centers for the Disease Control and Prevention. Heads Up: Brain Injury in Your Practice Tool Kit, 2006. Adult;Pediatric Supplemental 1.00 2017-02-27 20:22:56.0 Acute Concussion Evaluation (ACE) Cognitive Assessment Outcomes and End Points

Multiple Pre-Defined Values Selected

CSV