CDE Detailed Report
Disease: Sport-Related Concussion
Subdomain Name: Cognitive Assessment
CRF: Acute Concussion Evaluation (ACE)
Displaying 51 - 59 of 59
Subdomain Name: 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 / 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| C17409 | Visit date | VisitDate | Date of interview or visit (actually the date when data in the form were captured) | Date of interview or visit | Date: | Date or Date & Time | Centers for the Disease Control and Prevention. Heads Up: Brain Injury in Your Practice Tool Kit, 2006. | Adult;Pediatric | Supplemental | 3.00 | 2013-06-21 00:00:00.0 | Acute Concussion Evaluation (ACE) | Cognitive Assessment | Outcomes and End Points |
Free-Form Entry |
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| C54371 | Acute Concussion Evaluation (ACE) - Risk factors protracted recovery developmental history type | ACERskFacProtrctRcvDevlopHxTyp | Type of developmental history as a risk factor that may protract the subject/participant recovery process since injury as related to the Acute Concussion Evaluation (ACE) | Type of developmental history as a risk factor that may protract the subject/participant recovery process since injury as related to the Acute Concussion Evaluation (ACE | Developmental History | Attention Deficit Hyperactivity Disorder (ADHD);Learning disability;Other developmental disorder | Attention Deficit Hyperactivity Disorder (ADHD);Learning disability;Other developmental disorder | 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 |
Single Pre-Defined Value Selected |
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| C54339 | Acute Concussion Evaluation (ACE) - Injury cause type other text | ACEInjuryCauseTypOthrTxt | Text specifying another cause of the impact injury as related to the Acute Concussion Evaluation (ACE) | Text specifying another cause of the impact injury as related to the Acute Concussion Evaluation (ACE | Other | 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 20:29:51.0 | Acute Concussion Evaluation (ACE) | Cognitive Assessment | Outcomes and End Points | 255 |
Free-Form Entry |
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| C54350 | Acute Concussion Evaluation (ACE) - Symptom check list physical indicator | ACESymptomChkLstPhysInd | Indicator of whether subject/participant has experienced physical symptoms since injury as related to the Acute Concussion Evaluation (ACE) | Indicator of whether subject/participant has experienced physical symptoms since injury as related to the Acute Concussion Evaluation (ACE | PHYSICAL (0-10) | 0;1 | 0=No;1=Yes | 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 |
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| C54395 | Acute Concussion Evaluation (ACE) - Follow-up action plan referral physician type other text | ACEFlowupActPlnReferPhysTypOTH | Test of other type follow-up plan of action referral physician for subject/participant as related to the Acute Concussion Evaluation (ACE) | Test of other type follow-up plan of action referral physician for subject/participant as related to the Acute Concussion Evaluation (ACE | Other | 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 | 255 |
Free-Form Entry |
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| C54361 | Acute Concussion Evaluation (ACE) - Symptom check list overall rating status | ACESympChkLstOverallRateStat | Status of how different the subject/participant is acting from usual self after injury as related to the Acute Concussion Evaluation (ACE) | Status of how different the subject/participant is acting from usual self after injury as related to the Acute Concussion Evaluation (ACE | Overall Rating: How different is the person acting compared to his/her usual self? | 0;1;2;3;4;5;6 | 0 - Normal;1;2;3;4;5;6 - Very Different | Alphanumeric |
Circle "0" (Normal) to "6" (Very Different) |
Centers for the Disease Control and Prevention. Heads Up: Brain Injury in Your Practice Tool Kit, 2006. | Adult;Pediatric | Supplemental | 1.00 | 2017-02-28 12:25:41.0 | Acute Concussion Evaluation (ACE) | Cognitive Assessment | Outcomes and End Points |
Multiple Pre-Defined Values Selected |
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| C19247 | Subject ID | SubIDNam | Subject identification ID | Subject identification ID | ID/MR# | Alphanumeric | Centers for the Disease Control and Prevention. Heads Up: Brain Injury in Your Practice Tool Kit, 2006. | Adult;Pediatric | Supplemental | 1.00 | 2014-06-05 13:10:49.0 | Acute Concussion Evaluation (ACE) | Cognitive Assessment | Outcomes and End Points | 255 |
Free-Form Entry |
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| C54372 | Acute Concussion Evaluation (ACE) - Risk factors protracted recovery other developmental disorder other text | ACERskFacPrtrctRcvOthDevlDsOTH | Text describing other developmental disorder as a risk factor that may protract the subject/participant recovery process since injury as related to the Acute Concussion Evaluation (ACE) | Text describing other developmental disorder as a risk factor that may protract the subject/participant recovery process since injury as related to the Acute Concussion Evaluation (ACE | Other developmental disorder | Alphanumeric |
Specify the other developmental disorder. |
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 | 255 |
Free-Form Entry |
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| C54340 | Acute Concussion Evaluation (ACE) - Amnesia before no memory events indicator | ACEAmnesiaBfNoMemEvntsInd | Indicator of whether subject/participant had no memory of events before (retrograde) amnesia as related to the Acute Concussion Evaluation (ACE) | Indicator of whether subject/participant had no memory of events before (retrograde) amnesia as related to the Acute Concussion Evaluation (ACE | Amnesia Before (Retrograde) Are there any events just BEFORE th einjury that you/person has no memory of (even brief)? | No;Yes | No;Yes | Alphanumeric |
Even seconds to minutes of memory loss can be predictive of outcome. Recent research has indicated that amnesia may be up to 4-10 times more predictive of symptoms and cognitive deficits following concussion than is LOC (less than 1 minute). |
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 |
