CDE Detailed Report | NINDS Common Data Elements

Disease: Sport Related Concussion
Sub-Domain: History of Disease/Injury Event
CRF: Injury Report

Displaying 51 - 82 of 82

CDE ID	CDE Name	Variable Name	Definition	Short Description	Question Text	Permissible Values	Description	Data Type	Disease Specific Instructions	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 caDSR
C55475	Injury report immediate indicator	InjRptImmedInd	Indicator of whether the injury was reported by the injured party immediately upon occurrence	Indicator of whether the injury was reported by the injured party immediately upon occurrence	Did athlete immediately report the injury?	No;Yes	No;Yes	Alphanumeric		Adult;Pediatric	Supplemental	1.00	2017-05-11 16:05:32.0	Injury Report	History of Disease/Injury Event	Disease/Injury Related Events		Single Pre-Defined Value Selected
C55496	Injury onset participant involvment category	InjOnstPtcptInvlvmntCat	Category of onset speed of the suspected injury and involvment of other participants in the activity in which the subject/participant incurred the suspected injury	Category of onset speed of the suspected injury and involvment of other participants in the activity in which the subject/participant incurred the suspected injury	Injury involved:	Gradual onset/overuse;Sudden onset and contact with another participant;Sudden onset and no contact with another participant;Unknown	Gradual onset/overuse;Sudden onset and contact with another participant;Sudden onset and no contact with another participant;Unknown	Alphanumeric		Adult;Pediatric	Supplemental	1.00	2017-05-12 10:36:03.0	Injury Report	History of Disease/Injury Event	Disease/Injury Related Events		Single Pre-Defined Value Selected
C55573	Pain intensity visual analogue scale value	PainIntnstyVslAnalogSclVal	Value indicated by the subject/participant for his or her pain intensity using a visual analogue scale	Value indicated by the subject/participant for his or her pain intensity using a visual analogue scale	Pain assessment			Numeric Values		Adult;Pediatric	Supplemental	1.00	2017-05-12 16:23:04.0	Injury Report	History of Disease/Injury Event	Disease/Injury Related Events		Free-Form Entry	0	10
C19197	Injury time	InjuryTime	Time of injury	Time of injury	Time of Injury (24 hour clock)			Date or Date & Time	Record the date/time according to the ISO 8601, the International Standard for the representation of dates and times (http://www.iso.org/iso/home.html). The date/time should be recorded to the level of granularity known (e.g., year, year and month, complete date plus hours and minutes, etc.).	Adult;Pediatric	Supplemental	1.00	2014-06-02 16:13:18.0	Injury Report	History of Disease/Injury Event	Disease/Injury Related Events		Free-Form Entry
C55517	Symptom duration value	SymptmDuratnVal	Value for the duration of the symptom(s) being documented	Value for the duration of the symptom(s) being documented	How long did symptoms last after injury/impact?			Numeric Values		Adult;Pediatric	Supplemental	1.00	2017-05-12 12:33:35.0	Injury Report	History of Disease/Injury Event	Disease/Injury Related Events		Free-Form Entry	0
C55463	Injury data reliability category	InjDataReliablCat	Category of reliability for the injury data being reported	Category of reliability for the injury data being reported	Reliability of injury data	Verified;Estimated;Unknown	Verified;Estimated;Unknown	Alphanumeric		Adult;Pediatric	Supplemental	3.00	2013-07-20 10:21:25.65	Injury Report	History of Disease/Injury Event	Disease/Injury Related Events		Single Pre-Defined Value Selected
C55558	Education current level USA type	EduCurrLvlUSATyp	Current grade or level of school in which participant/subject is enrolled	Current grade or level of school in which participant/subject is enrolled	Please indicate the grade that your child is currently enrolled in:	1st Grade;2nd Grade;3rd Grade;4th Grade;5th Grade;6th Grade;7th Grade;8th Grade;9th Grade;10th Grade;11th Grade;12th Grade;Kindergarten;Not currently enrolled;Other, specify	1st Grade;2nd Grade;3rd Grade;4th Grade;5th Grade;6th Grade;7th Grade;8th Grade;9th Grade;10th Grade;11th Grade;12th Grade;Kindergarten;Not currently enrolled;Other, specify	Alphanumeric		Pediatric	Supplemental	3.00	2013-07-25 08:54:08.2	Injury Report	History of Disease/Injury Event	Disease/Injury Related Events		Single Pre-Defined Value Selected				3134878
C05406	Hospital first treat arrival date time	HospFirstTreatArrDateTime	Date (and time, if applicable and known) of arrival at the first hospital, if the participant/subject was transferred to the study center from another hospital	Date (and time, if applicable and known) of arrival at the first hospital, if the participant/subject was transferred to the study center from another hospital	Date treated at hospital; Time treated at hospital			Date or Date & Time	Record the date/time according to the ISO 8601, the International Standard for the representation of dates and times (http://www.iso.org/iso/home.html). The date/time should be recorded to the level of granularity known (e.g., year, year and month, complete date plus hours and minutes, etc.).	Adult;Pediatric	Supplemental	3.00	2013-07-20 10:21:25.65	Injury Report	History of Disease/Injury Event	Disease/Injury Related Events		Free-Form Entry
C55477	Participation continue activity post injury indicator	PtcptnCntnuActvtyPostInjyInd	Indicator of whether the injured party continued to participate in the activity in which he or she received the suspected injury, after the occurrence of the suspected injury	Indicator of whether the injured party continued to participate in the activity in which he or she received the suspected injury, after the occurrence of the suspected injur	Did athlete continue participation after suspected injury event?	No;Yes	No;Yes	Alphanumeric		Adult;Pediatric	Supplemental	1.00	2017-05-11 16:08:03.0	Injury Report	History of Disease/Injury Event	Disease/Injury Related Events		Single Pre-Defined Value Selected
C55497	Injury cause activity behavior text	InjCausActvtyBehvrTxt	The free-text field for describing the activity behavior or action that caused the suspected injury	The free-text field for describing the activity behavior or action that caused the suspected injury	Cause of injury (will depend on sport) – body check, tackle, intentional player contact (elbowing, roughing, cross-check, dueling for header, etc)			Alphanumeric		Adult;Pediatric	Supplemental	1.00	2017-05-12 10:42:48.0	Injury Report	History of Disease/Injury Event	Disease/Injury Related Events	255	Free-Form Entry
C22622	Wong-Baker FACES - Pain rating scale	WongBakerFacesPainRatingScale	This scale uses faces and corresponding numbers to indicate the amount of pain the subject feels	This scale uses faces and corresponding numbers to indicate the amount of pain the subject feel	Pain assessment	0;10;2;4;6;8	No Hurt;Hurts Worst;Hurts Little Bit;Hurts Little More;Hurts Even More;Hurts Whole Lot	Numeric Values		Pediatric	Supplemental	1.00	2016-07-13 13:21:18.0	Injury Report	History of Disease/Injury Event	Disease/Injury Related Events		Single Pre-Defined Value Selected
C55518	Symptom duration unit of measure	SymptmDuratnUOM	Unit of measure related to 'Symptom duration value'	Unit of measure related to 'Symptom duration value'	How long did symptoms last after injury/impact?	Days;Hours;minutes	Days;Hours;minutes	Alphanumeric		Adult;Pediatric	Supplemental	1.00	2017-05-12 12:35:09.0	Injury Report	History of Disease/Injury Event	Disease/Injury Related Events		Single Pre-Defined Value Selected
C55464	Assessment clinical perform occupation type	AssmntClnclPrfrmOccptnTyp	Type of occupation of the person performing the clinical assessment	Type of occupation of the person performing the clinical assessment	Who was the clinical assessment completed by?	Medical doctor;Athletic trainer;Coach;Physician's Assistant;Physical therapist;Other	Medical doctor;Athletic trainer;Coach;Physician's Assistant;Physical therapist;Other	Alphanumeric		Adult;Pediatric	Supplemental	1.00	2017-05-11 12:34:42.0	Injury Report	History of Disease/Injury Event	Disease/Injury Related Events		Single Pre-Defined Value Selected
C55559	Education current level USA text	EduCurrLvlUSAOTH	The free-text field related to 'Education current level USA type' specifying other text	The free-text field related to 'Education current level USA type' specifying other text	Please indicate the grade that your child is currently enrolled in: other, specify:			Alphanumeric		Pediatric	Supplemental	1.00	2017-05-12 15:31:40.0	Injury Report	History of Disease/Injury Event	Disease/Injury Related Events	255	Free-Form Entry
C05408	Hospital admission date and time	HospitlAdmissDateTime	Date (and time, if applicable and known) the participant/subject was admitted to the hospital	Date (and time, if applicable and known) the participant/subject was admitted to the hospital	Hospital admission date; Hospital admission time			Date or Date & Time	Record the date/time according to the ISO 8601, the International Standard for the representation of dates and times (http://www.iso.org/iso/home.html). The date/time should be recorded to the level of granularity known (e.g., year, year and month, complete date plus hours and minutes, etc.).	Adult;Pediatric	Supplemental	3.00	2013-07-25 08:54:08.2	Injury Report	History of Disease/Injury Event	Disease/Injury Related Events		Free-Form Entry
C55479	Participation continue activity post injury duration text	PrtcptnCntnActvPstInjDurtnTxt	Text specifying the duration for which the subject/participant continued to participate in the activity in which he or she incurred the suspected injury, after incurring the suspected injury	Text specifying the duration for which the subject/participant continued to participate in the activity in which he or she incurred the suspected injury, after incurring the suspected injur	If so, for how long?			Alphanumeric		Adult;Pediatric	Supplemental	1.00	2017-05-11 16:14:45.0	Injury Report	History of Disease/Injury Event	Disease/Injury Related Events	50	Free-Form Entry
C55498	Participant activity penalize indicator	PtcpntActvtyPnlzInd	Indicator of whether a participant in the activity in which the subject/participant incurred the suspected injury was penalized for conduct directly related to the injury event	Indicator of whether a participant in the activity in which the subject/participant incurred the suspected injury was penalized for conduct directly related to the injury event	Was a penalty called directly related to the injury event	No;Yes	No;Yes	Alphanumeric		Adult;Pediatric	Supplemental	1.00	2017-05-12 11:37:05.0	Injury Report	History of Disease/Injury Event	Disease/Injury Related Events		Single Pre-Defined Value Selected
C22804	Pain present eleven point intensity scale	PainPrsnt11IntensityScl	Scale for the participant's current pain intensity based on an a scale of 0-10	Scale for the participant's current pain intensity based on an a scale of 0-1	Pain assessment	0;1;10;2;3;4;5;6;7;8;9	0;1;10;2;3;4;5;6;7;8;9	Alphanumeric		Adult;Pediatric	Supplemental	3.00	2013-07-17 09:26:36.973	Injury Report	History of Disease/Injury Event	Disease/Injury Related Events		Single Pre-Defined Value Selected
C55527	Headache Impact Test 6 baseline score	HIT6BaselineScore	Score obtained from a baseline administration of the Headache Impact Test-6 (HIT-6)	Score obtained from a baseline administration of the Headache Impact Test-6 (HIT-6)	Baseline Headache Impact Test-6 (HIT-6)			Numeric Values		Adult;Pediatric	Supplemental	1.00	2017-05-12 12:58:31.0	Injury Report	History of Disease/Injury Event	Disease/Injury Related Events		Free-Form Entry	36	78
C55465	Concussion determine confidence category	CncssnDtrmnCnfdncCat	Category of the clinical assessor's confidence in his or her determination that the injury was a concussion	Category of the clinical assessor's confidence in his or her determination that the injury was a concussion	How confident was clinician that injury was a concussion?	Barely confident;Fairly confident;Not at all confident;Somewhat confident;Very confident	Barely confident;Fairly confident;Not at all confident;Somewhat confident;Very confident	Alphanumeric		Adult;Pediatric	Supplemental	1.00	2017-05-11 13:12:30.0	Injury Report	History of Disease/Injury Event	Disease/Injury Related Events		Single Pre-Defined Value Selected
C55561	Academic achievement average USA category	AcdmcAchvmntAvgUSACat	Category describing the average academic achievement of the subject/participant in relation to the typical academic achievement scale used in the USA	Category describing the average academic achievement of the subject/participant in relation to the typical academic achievement scale used in the USA	Please indicate your child's average academic achievement prior to the concussion	A & B grades;B & C grades;Below C grades;Straight A student;Straight B student	A & B grades;B & C grades;Below C grades;Straight A student;Straight B student	Alphanumeric		Pediatric	Supplemental	1.00	2017-05-12 15:34:02.0	Injury Report	History of Disease/Injury Event	Disease/Injury Related Events		Single Pre-Defined Value Selected
C05411	Injury immediate medical service receive indicator	InjImmdtMedclServRecvdInd	Indicator of whether initial medical services were received directly after injury	Indicator of whether initial medical services were received directly after injury	Were initial medical services received immediately after injury?	Yes;No;Unknown	Yes;No;Unknown	Alphanumeric		Adult;Pediatric	Supplemental	3.00	2013-07-20 10:21:25.65	Injury Report	History of Disease/Injury Event	Disease/Injury Related Events		Single Pre-Defined Value Selected
C55480	Participation continue activity post injury turn count	PrtcptnCntnuActvyPostInjTurnCt	Count of discrete turns for which the subject/participant continued to participate in the activity in which the suspected injury was received, after receiving the suspected injury	Count of discrete turns for which the subject/participant continued to participate in the activity in which the suspected injury was received, after receiving the suspected injury	For how many plays?			Numeric Values		Adult;Pediatric	Supplemental	1.00	2017-05-11 16:17:55.0	Injury Report	History of Disease/Injury Event	Disease/Injury Related Events		Free-Form Entry	0		Turns
C55499	Participant activity penalize text	PtcpntActvtyPnlzTxt	Free-text field for describing any penalty for conduct directly related to the injury event that was assessed to a participant in the activity in which the subject/participant incurred the suspected injury	Free-text field for describing any penalty for conduct directly related to the injury event that was assessed to a participant in the activity in which the subject/participant incurred the suspected injury	Was a penalty called directly related to the injury event: if yes, describe			Alphanumeric		Adult;Pediatric	Supplemental	1.00	2017-05-12 11:37:05.0	Injury Report	History of Disease/Injury Event	Disease/Injury Related Events	255	Free-Form Entry
C52398	Injury mechanism type	InjuryMechTyp	The type of mechanism leading to the subject's injury	The type of mechanism leading to the subject's injury	Mechanism of injury	Direct blow to head;Fell and hit head;Hit head on environment;Non-head injury;Contact with another participant;Impact with ground;Impact with object	Direct blow to head;Fell and hit head;Hit head on environment;Non-head injury;Contact with another participant;Impact with ground;Impact with object (i.e., ball)	Alphanumeric		Adult;Pediatric	Supplemental	1.10	2017-05-12 11:35:57.0	Injury Report	History of Disease/Injury Event	Disease/Injury Related Events		Multiple Pre-Defined Values Selected
C55528	Headache Impact Test 6 follow-up score	HIT6FollowupScore	Score obtained from a follow-up administration of the Headache Impact Test-6 (HIT-6)	Score obtained from a follow-up administration of the Headache Impact Test-6 (HIT-6)	Follow-up Headache Impact Test-6 (HIT-6)			Numeric Values		Adult;Pediatric	Supplemental	1.00	2017-05-12 12:58:31.0	Injury Report	History of Disease/Injury Event	Disease/Injury Related Events		Free-Form Entry	36	78
C55467	First evaluation injury elapsed hour count	FrstEvalInjElpsdHrCt	Count of hours elapsed between the injury and the first evaluation	Count of hours elapsed between the injury and the first evaluation	How many hours after the injury did the first evaluation take place?			Numeric Values		Adult;Pediatric	Supplemental	1.00	2017-05-11 13:27:39.0	Injury Report	History of Disease/Injury Event	Disease/Injury Related Events		Free-Form Entry	0		Hours
C55562	Imaging prior head injury CT MRI indicator	ImgPriorHdInjCTMRIInd	Indicator of whether the subject/participant was given a CT or MRI scan for a previous head injury	Indicator of whether the subject/participant was given a CT or MRI scan for a previous head injury	Has your child had a CT or MRI for a PREVIOUS head injury?	Yes;No;Unknown	Yes;No;Unknown	Alphanumeric		Pediatric	Supplemental	1.00	2017-05-12 15:42:56.0	Injury Report	History of Disease/Injury Event	Disease/Injury Related Events		Single Pre-Defined Value Selected
C05412	Injury immediate medical service received type	InjImmdtMedServRecvdTyp	Type of initial medical services received directly after injury	Type of initial medical services received directly after injury	Medical Services received	CT/MRI;Hospitalization;Specialized therapies (speech, physical, occupational therapy);Evaluations (neurological, psychological);Medication;Education about course of symptoms;Other, specify	CT/MRI;Hospitalization;Specialized therapies (speech, physical, occupational therapy);Evaluations (neurological, psychological);Medication;Education about course of symptoms;Other, specify	Alphanumeric		Adult;Pediatric	Supplemental	3.00	2013-07-20 10:21:25.65	Injury Report	History of Disease/Injury Event	Disease/Injury Related Events		Multiple Pre-Defined Values Selected
C55481	Emergency room visit indicator	ERVisitInd	Indicator of whether the subject/participant visited an emergency room (ER) or equivalent facility	Indicator of whether the subject/participant visited an emergency room (ER) or equivalent facilit	Did athlete go to ER?	No;Yes	No;Yes	Alphanumeric		Adult;Pediatric	Supplemental	1.00	2017-05-11 16:26:22.0	Injury Report	History of Disease/Injury Event	Disease/Injury Related Events		Single Pre-Defined Value Selected
C55500	Participant activity penalize identify text	PtcpntActvtyPnlzIdntfyTxt	Free-text field for identifying the participant(s) in the activity in which the subject/participant incurred the suspected injury who was/were assessed a penalty for conduct directly related to the injury event	Free-text field for identifying the participant(s) in the activity in which the subject/participant incurred the suspected injury who was/were assessed a penalty for conduct directly related to the injury event	Who received penalty			Alphanumeric		Adult;Pediatric	Supplemental	1.00	2017-05-12 11:37:05.0	Injury Report	History of Disease/Injury Event	Disease/Injury Related Events	255	Free-Form Entry
C52400	Injury date	InjuryDate	The date the subject received his or her injury	The date the subject received his or her injury	Date Injury Occurred			Date or Date & Time	Record the date/time according to the ISO 8601, the International Standard for the representation of dates and times (http://www.iso.org/iso/home.html). The date/time should be recorded to the level of granularity known (e.g., year, year and month, complete date plus hours and minutes, etc.).	Adult;Pediatric	Supplemental	1.00	2017-01-18 09:25:29.0	Injury Report	History of Disease/Injury Event	Disease/Injury Related Events		Free-Form Entry