CDE Detailed Report

Disease: Sport Related Concussion
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
C54341 Acute Concussion Evaluation (ACE) - Amnesia before no memory events duration ACEAmnesiaBfNoMemEvntsDur Duration of subject's/participant's length of amnesia before injury as related to the Acute Concussion Evaluation (ACE) Duration of subject's/participant's length of amnesia before injury as related to the Acute Concussion Evaluation (ACE Amnesia Before (Retrograde) 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

C54352 Acute Concussion Evaluation (ACE) - Symptom check list cognitive indicator ACESymptomChkLstCogntvInd Indicator of whether subject/participant has experienced cognitive symptoms since injury as related to the Acute Concussion Evaluation (ACE) Indicator of whether subject/participant has experienced cognitive symptoms since injury as related to the Acute Concussion Evaluation (ACE COGNITIVE (4) 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

C54331 Acute Concussion Evaluation (ACE) - Person obtaining report type ACEPersonObtRprtTyp The type indicating who the report was obtained by, as part of the Acute Concussion Evaluation (ACE) The type indicating who the report was obtained by, as part of the Acute Concussion Evaluation (ACE) Reporter: Patient;Parent;Spouse;Other Patient;Parent;Spouse;Other Alphanumeric Centers for the Disease Control and Prevention. Heads Up: Brain Injury in Your Practice Tool Kit, 2006. Adult;Pediatric Supplemental 1.00 2016-12-05 10:04:25.0 Acute Concussion Evaluation (ACE) Cognitive Assessment Outcomes and End Points

Single Pre-Defined Value Selected

C54363 Acute Concussion Evaluation (ACE) - Risk factors protracted recovery concussion history indicator ACERiskFacProtrctRecvConcHxTyp Indicator of whether concussion 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 concussion history is a risk factor that may protract the subject/participant recovery process since injury as related to the Acute Concussion Evaluation (ACE Concussion History? 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

C54377 Acute Concussion Evaluation (ACE) - Risk factors protracted recovery other psychiatric disorder other text ACERskFacPrtrctRcvPsycDsordOTH Text for other psychiatric disorder as a risk factor that may protract the subject/participant recovery process since injury as related to the Acute Concussion Evaluation (ACE) Text for other psychiatric disorder as a risk factor that may protract the subject/participant recovery process since injury as related to the Acute Concussion Evaluation (ACE Other psychiatric disorder Alphanumeric

Specify other psychiatric 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 100

Free-Form Entry

C54342 Acute Concussion Evaluation (ACE) - Amnesia after no memory events indicator ACEAmnesiaAftrNoMemEvntsInd Indicator of whether subject/participant had no memory of events after (anterograde) amnesia as related to the Acute Concussion Evaluation (ACE) Indicator of whether subject/participant had no memory of events after (anterograde) amnesia as related to the Acute Concussion Evaluation (ACE Amnesia After (Anterograde) Are there any events just AFTER the injury 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

C54353 Acute Concussion Evaluation (ACE) - Symptom check list cognitive total count ACESymptomChkLstCogntvTotCt Total count of cognitive symptoms subject/participant has experienced since injury as related to the Acute Concussion Evaluation (ACE) Total count of cognitive symptoms subject/participant has experienced since injury as related to the Acute Concussion Evaluation (ACE COGNITIVE Total (0-4) Numeric Values

Sum total number of symptoms present per area, and sum all four areas into a Total Symptom Score (score range 0–22)(Note: most sleep symptoms are only applicable after a night has passed since the 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 20:29:51.0 Acute Concussion Evaluation (ACE) Cognitive Assessment Outcomes and End Points

Free-Form Entry

0 4
C54332 Person obtaining report other text PersonObtRprtOtherText Text specifying another means of obtaining the report Text specifying another means of obtaining the report Other Alphanumeric Centers for the Disease Control and Prevention. Heads Up: Brain Injury in Your Practice Tool Kit, 2006. Adult;Pediatric Supplemental 1.00 2016-12-05 10:11:55.0 Acute Concussion Evaluation (ACE) Cognitive Assessment Outcomes and End Points 255

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C54364 Acute Concussion Evaluation (ACE) - Risk factors protracted recovery concussion history previous value ACERskFacPrtrctRcvCncHxPrevVal Value of the number of previous concussions as a risk factor that may protract the subject/participant recovery process since injury as related to the Acute Concussion Evaluation (ACE) Value of the number of previous concussions as a risk factor that may protract the subject/participant recovery process since injury as related to the Acute Concussion Evaluation (ACE Previous # 1;2;3;4;5;6+ 1;2;3;4;5;6+ Numeric Values

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

Single Pre-Defined Value Selected

CSV