CDE Detailed Report
Disease: system
Subdomain Name: Cognitive Assessment
CRF: system
Displaying 51 - 59 of 59
Subdomain Name: Cognitive Assessment
CRF: system
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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| C54393 | Acute Concussion Evaluation (ACE) - Follow-up action plan referral type | ACEFollowupActPlanReferralTyp | Type follow-up plan of action referral for subject/participant as related to the Acute Concussion Evaluation (ACE) | Type follow-up plan of action referral for subject/participant as related to the Acute Concussion Evaluation (ACE | Referral: | Emergency department;Neuropsychological Testing;Physician | Emergency department;Neuropsychological Testing;Physician | 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 |
|||||||||
| 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 | Centers for the Disease Control and Prevention. Heads Up: Brain Injury in Your Practice Tool Kit, 2006. | Adult;Pediatric | Supplemental | 3.00 | 2013-07-20 10:21:25.65 | Acute Concussion Evaluation (ACE) | Cognitive Assessment | Outcomes and End Points |
Free-Form Entry |
|||||||||||
| C54359 | Acute Concussion Evaluation (ACE) - Symptom check list exertion physical activity indicator | ACESymptomChkLstExrtPhysActInd | Indicator of whether subject/participant symptoms worsen with physical activity since injury as related to the Acute Concussion Evaluation (ACE) | Indicator of whether subject/participant symptoms worsen with physical activity since injury as related to the Acute Concussion Evaluation (ACE | Exertion: Do these symptoms worsen with physical activity? | Yes;No;N/A | Yes;No;N/A | 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 |
Single Pre-Defined Value Selected |
|||||||||
| C54338 | Acute Concussion Evaluation (ACE) - Injury cause type sports text | ACEInjuryCauseTypSportsTxt | Text specifying the cause of the impact injury as related to the Acute Concussion Evaluation (ACE) | Text specifying the cause of the impact injury as related to the Acute Concussion Evaluation (ACE | Sports (specify) | 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 |
||||||||||
| C54370 | Acute Concussion Evaluation (ACE) - Risk factors protracted recovery migraine headache family text | ACERskFcPtrctRcvMgrnHeadFamTxt | Text describing which family member(s) had/have migraine headache as a risk factor that may protract the subject/participant recovery process since injury as related to the Acute Concussion Evaluation (ACE) | Text describing which family member(s) had/have migraine headache as a risk factor that may protract the subject/participant recovery process since injury as related to the Acute Concussion Evaluation (ACE | Provide detail of family members with history of migraine | Alphanumeric |
Provide detail of family members with history of migraine |
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 | 100 |
Free-Form Entry |
|||||||||
| C54349 | Acute Concussion Evaluation (ACE) - Symptom check list type | ACESymptomChkLstTyp | Type of symptoms subject/participant has experienced since injury as related to the Acute Concussion Evaluation (ACE) | Type of symptoms subject/participant has experienced since injury as related to the Acute Concussion Evaluation (ACE | Since the injury, has the person experienced any of these symptoms any more than jusual today or in the past day? | Balance problems;Difficulty concentrating;Difficulty remembering;Dizziness;Drowsiness;Fatigue;Feeling mentally foggy;Feeling slowed down;Headache;Irritability;More emotional;Nausea;Nervousness;Numbness/tingling;Sadness;Sensitivity to light;Sensitivity to noise;Sleeping less than usual;Sleeping more than usual;Trouble falling asleep;Visual problems;Vomiting | Balance problems;Difficulty concentrating;Difficulty remembering;Dizziness;Drowsiness;Fatigue;Feeling mentally foggy;Feeling slowed down;Headache;Irritability;More emotional;Nausea;Nervousness;Numbness/tingling;Sadness;Sensitivity to light;Sensitivity to noise;Sleeping less than usual;Sleeping more than usual;Trouble falling asleep;Visual problems;Vomiting | Alphanumeric | Centers for the Disease Control and Prevention. Heads Up: Brain Injury in Your Practice Tool Kit, 2006. Lovell MR, Collins MW. Neuropsychological assessment of the college football player. J Head Trauma Rehabil. 1998;13(2):9-26. | 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 |
|||||||||
| C54394 | Acute Concussion Evaluation (ACE) - Follow-up action plan referral physician type | ACEFollowupActPlnReferPhyscTyp | Type follow-up plan of action referral physician for subject/participant as related to the Acute Concussion Evaluation (ACE) | Type follow-up plan of action referral physician for subject/participant as related to the Acute Concussion Evaluation (ACE | Physician: | Neurology;Neurosurgery;Other;Physiatrist;Psychiatrist;Sports Medicine | Neurology;Neurosurgery;Other;Physiatrist;Psychiatrist;Sports Medicine | 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 |
|||||||||
| 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 |
|||||||||||
| C54360 | Acute Concussion Evaluation (ACE) - Symptom check list exertion cognitive activity indicator | ACESymptomChkLstExrtCognActInd | Indicator of whether subject/participant symptoms worsen with cognitive activity since injury as related to the Acute Concussion Evaluation (ACE) | Indicator of whether subject/participant symptoms worsen with cognitive activity since injury as related to the Acute Concussion Evaluation (ACE | Exertion: Do these symptoms worsen with cognitive activity? | Yes;No;N/A | Yes;No;N/A | 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 |
Single Pre-Defined Value Selected |
