CDE Detailed Report
Disease: Sport Related Concussion
Subdomain Name: History of Disease%2FInjury Event
CRF: Injury Report
Displaying 1 - 50 of 82
Subdomain Name: History of Disease%2FInjury Event
CRF: Injury Report
Displaying 1 - 50 of 82
| 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| C54336 | Acute Concussion Evaluation (ACE) - Impact location anatomic site | ACEImpactLocationAnatSite | Anatomic site of impact injury as related to the Acute Concussion Evaluation (ACE) | Anatomic site of impact injury as related to the Acute Concussion Evaluation (ACE | Location of impact | Frontal;Indirect Force;Left Parietal;Left Temporal;Neck;Occipital;Right Parietal;Right Temporal | Frontal;Indirect Force;Left Parietal;Left Temporal;Neck;Occipital;Right Parietal;Right Temporal | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2017-02-27 20:16:54.0 | Injury Report | History of Disease%2FInjury Event | Disease%2FInjury Related Events |
Multiple Pre-Defined Values Selected |
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| C55507 | Dizziness vertigo duration range | DizznsVrtgoDuratnRng | Range of time within which the duration of the subject/participant's dizziness or vertigo falls | Range of time within which the duration of the subject/participant's dizziness or vertigo fall | Dizziness duration | Less than 1 hour;1-24 hours;>24 hours | Less than 1 hour;1-24 hours;>24 hours | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2017-05-12 12:10:01.0 | Injury Report | History of Disease%2FInjury Event | Disease%2FInjury Related Events |
Single Pre-Defined Value Selected |
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| C55540 | Neck sore uninjured indicator | NeckSoreUninjurdInd | Indicator of whether the subject/participant's neck is sore but otherwise uninjured | Indicator of whether the subject/participant's neck is sore but otherwise uninjured | Neck sore but not injured | No;Yes | No;Yes | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2017-05-12 13:31:57.0 | Injury Report | History of Disease%2FInjury Event | Disease%2FInjury Related Events |
Single Pre-Defined Value Selected |
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| C01055 | Post traumatic amnesia duration range | PstTraumAmnsDurRang | The range of duration of post-traumatic amnesia the participant/subject experienced | The range of duration of post-traumatic amnesia the participant/subject experienced | Post traumatic amnesia duration | >24 hours;<1 hour;1-24 hours | >24 hours;<1 hour;1-24 hours | Alphanumeric | Adult;Pediatric | Supplemental | 3.10 | 2017-05-12 12:30:51.0 | Injury Report | History of Disease%2FInjury Event | Disease%2FInjury Related Events |
Single Pre-Defined Value Selected |
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| C55472 | Remove participation activity indicator | RmvPrtcptnActvtyInd | Indicator of whether subject/participant was removed from participation in the activity in which he or she incurred the condition or injury being documented | Indicator of whether subject/participant was removed from participation in the activity in which he or she incurred the condition or injury being documented | Was athlete taken out of game? | No;Yes | No;Yes | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2017-05-11 13:54:14.0 | Injury Report | History of Disease%2FInjury Event | Disease%2FInjury Related Events |
Single Pre-Defined Value Selected |
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| C55569 | Educational assistance supplemental formal indicator | EduAsstncSupplFormlInd | Indicator of whether the subject/participant has ever received formal supplemental educational assistance, such as an Individualized Education Program (IEP) | Indicator of whether the subject/participant has ever received formal supplemental educational assistance, such as an Individualized Education Program (IEP) | Have you ever had an IEP (Individualized Education Program) or extra support for studies? | Yes;No;Unknown | Yes;No;Unknown | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2017-05-12 16:08:25.0 | Injury Report | History of Disease%2FInjury Event | Disease%2FInjury Related Events |
Single Pre-Defined Value Selected |
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| C13523 | Dizziness or vertigo indicator | DizzinessVertigoInd | Indicator of whether the participant/subject experienced dizziness or vertigo | Indicator of whether the participant/subject experienced dizziness or vertig | Dizziness | Yes;No | Yes;No | Alphanumeric | Adult;Pediatric | Supplemental | 3.00 | 2013-06-21 00:00:00.0 | Injury Report | History of Disease%2FInjury Event | Disease%2FInjury Related Events |
Single Pre-Defined Value Selected |
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| C55485 | Injury activity circumstance type | InjActvtyCrcmstncTyp | Type of circumstances of the activity during which the suspected injury was incurred | Type of circumstances of the activity during which the suspected injury was incurred | Injury occurred during | Training;Other;Game;Practice;Dryland/fitness | Training;Other;Game;Practice;Dryland/fitness | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2017-05-11 16:53:27.0 | Injury Report | History of Disease%2FInjury Event | Disease%2FInjury Related Events |
Single Pre-Defined Value Selected |
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| 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 | Sport at time of injury | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2017-02-27 20:29:51.0 | Injury Report | History of Disease%2FInjury Event | Disease%2FInjury Related Events | 255 |
Free-Form Entry |
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| C55508 | Amnesia retrograde duration range | AmnsiaRtrogrdDuratnRng | Range of time within which the duration of the subject/participant's retrograde amnesia falls | Range of time within which the duration of the subject/participant's retrograde amnesia falls | Retrograde amnesia duration | Less than 1 hour;1-24 hours;>24 hours | Less than 1 hour;1-24 hours;>24 hours | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2017-05-12 12:17:20.0 | Injury Report | History of Disease%2FInjury Event | Disease%2FInjury Related Events |
Single Pre-Defined Value Selected |
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| C55541 | Concussion prior current year text | ConcusnPriorCurrYrTxt | The free-text field for documenting prior concussions suffered by the subject/participant during the current year | The free-text field for documenting prior concussions suffered by the subject/participant during the current year | Repeat concussion this year | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2017-05-12 13:35:06.0 | Injury Report | History of Disease%2FInjury Event | Disease%2FInjury Related Events | 4000 |
Free-Form Entry |
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| C04813 | Return work school status | RtrnWrkSchlStatus | Status of participant's/subject's return to work and/or school | Status of participant's/subject's return to work and/or school | Return to work/school | Returned to previous level;Same work or school, reduced level;Different work or school;Only in sheltered environment;Did not return to work or school;N/A;Unknown | Returned to previous level;Same work or school, reduced level;Different work or school;Only in sheltered environment;Did not return to work or school;N/A;Unknown | Alphanumeric | Adult;Pediatric | Supplemental | 3.00 | 2013-07-20 10:21:25.65 | Injury Report | History of Disease%2FInjury Event | Disease%2FInjury Related Events |
Single Pre-Defined Value Selected |
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| C55473 | Injury report delay elapsed time duration | InjRptDlyElpsdTimDur | Duration of time elapsed between occurrence of injury and initial report of injury by subject/participant if not immediately reported | Duration of time elapsed between occurrence of injury and initial report of injury by subject/participant if not immediately reported | How many minutes/hours after injury did athlete report it to someone? | Numeric Values | Adult;Pediatric | Supplemental | 1.00 | 2017-05-11 14:50:06.0 | Injury Report | History of Disease%2FInjury Event | Disease%2FInjury Related Events |
Free-Form Entry |
0 | |||||||||||
| C55570 | Educational assistance supplemental formal subject type | EduAsstncSupplFormlSbjTyp | Type of academic subject(s) for which the subjec/participant received formal supplemental educational assistance, such as an Individualized Education Program (IEP) | Type of academic subject(s) for which the subjec/participant received formal supplemental educational assistance, such as an Individualized Education Program (IEP) | What did you have an IEP in? | Reading;Writing;Math;Other | Reading;Writing;Math;Other | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2017-05-12 16:11:30.0 | Injury Report | History of Disease%2FInjury Event | Disease%2FInjury Related Events |
Multiple Pre-Defined Values Selected |
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| C17499 | Special education indicator | SpecialEduInd | Indicator as to whether the participant/subject has or had special education | Indicator as to whether the participant/subject has or had special education | Does your child have a history of Special Education? For example, have you had any special classes or accommodations in school? | Yes;No;Unknown | Yes;No;Unknown | Alphanumeric | Adult;Pediatric | Supplemental | 3.00 | 2013-07-15 16:08:48.687 | Injury Report | History of Disease%2FInjury Event | Disease%2FInjury Related Events |
Single Pre-Defined Value Selected |
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| C55486 | Equipment protective worn injury incur type | EqpmntPrtctvWrnInjryIncrTyp | Type of protective equipment being worn by the subject/participant when he or she incurred the suspected injury | Type of protective equipment being worn by the subject/participant when he or she incurred the suspected injury | At the time of injury, was any protective equipment worn? | Helmet;Mouthguard;Brace;Tape;Other | Helmet;Mouthguard;Brace;Tape;Other | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2017-05-11 16:57:20.0 | Injury Report | History of Disease%2FInjury Event | Disease%2FInjury Related Events |
Multiple Pre-Defined Values Selected |
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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 | Retrograde amnesia | No;Yes | No;Yes | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2017-02-27 20:29:51.0 | Injury Report | History of Disease%2FInjury Event | Disease%2FInjury Related Events |
Single Pre-Defined Value Selected |
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| C55511 | Amnesia event lacuna indicator | AmnsiaEvntLacunaInd | Indicator of whether the subject/participant experienced lacunar amnesia of the suspected injury event | Indicator of whether the subject/participant experienced lacunar amnesia of the suspected injury event | Amnesia of event | No;Yes | No;Yes | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2017-05-12 12:20:44.0 | Injury Report | History of Disease%2FInjury Event | Disease%2FInjury Related Events |
Single Pre-Defined Value Selected |
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| C55542 | Injury external cause ICD-10 code | InjExtrnlCausICD10Code | Code from the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) for the external cause of the suspected injury | Code from the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) for the external cause of the suspected injury | Injury ICD external cause code | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2017-05-12 13:42:56.0 | Injury Report | History of Disease%2FInjury Event | Disease%2FInjury Related Events | 10 |
Free-Form Entry |
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| C05403 | Injury date time estimation type | InjDateTimeEstTyp | The type as related to the point in time estimated as injury date and time | The type as related to the point in time estimated as injury date and time | If injury data is ESTIMATED, injury data type (point in time) | Time that the participant/subject became symptomatic;Time of first trauma activation;Time of presentation to emergency department | Time that the participant/subject became symptomatic;Time of first trauma activation;Time of presentation to emergency department | Alphanumeric | Adult;Pediatric | Supplemental | 3.00 | 2013-07-20 10:21:25.65 | Injury Report | History of Disease%2FInjury Event | Disease%2FInjury Related Events |
Single Pre-Defined Value Selected |
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| C55474 | Injury report delay elapsed time unit of measure | InjRptDlyElpsdTimUOM | Unit of measure related to 'Injury report delay elapsed time duration' for recording the units of the elapsed time between the occurrence and reporting of the injury that was recorded | Unit of measure related to 'Injury report delay elapsed time duration' for recording the units of the elapsed time between the occurrence and reporting of the injury that was recorded | How many minutes/hours after injury did the athlete report it to someone? | Hour;Minute | Hour;Minute | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2017-05-11 14:55:12.0 | Injury Report | History of Disease%2FInjury Event | Disease%2FInjury Related Events |
Single Pre-Defined Value Selected |
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| C55571 | Academic performance high school category | AcadPerfrmncHiSchlCat | Category of the subject/participant's overall academic performance in high school | Category of the subject/participant's overall academic performance in high school | What type of student were/are you in high school? | Below Average;Average;Above Average | Below Average;Average;Above Average | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2017-05-12 16:17:04.0 | Injury Report | History of Disease%2FInjury Event | Disease%2FInjury Related Events |
Single Pre-Defined Value Selected |
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| C18397 | Influence alcohol likelihood type | InfAlcLkhdTyp | Indicator for the likelihood the subject was under the influence of alcohol | Indicator for the likelihood the subject was under the influence of alcoho | Likelihood participant under influence of alcohol | None;Suspected;Confrimed;Unknown | None;Suspected;Confrimed;Unknown | Alphanumeric | Adult;Pediatric | Supplemental | 3.00 | 2013-07-20 10:21:25.65 | Injury Report | History of Disease%2FInjury Event | Disease%2FInjury Related Events |
Single Pre-Defined Value Selected |
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| C55487 | Injury incur activity role text | InjryIncurActvtyRolTxt | The free-text field for specifying the subject/participant's role in the activity in which he or she incurred the suspected injury | The free-text field for specifying the subject/participant's role in the activity in which he or she incurred the suspected injury | Position at time of injury | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2017-05-11 17:08:21.0 | Injury Report | History of Disease%2FInjury Event | Disease%2FInjury Related Events | 255 |
Free-Form Entry |
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| C55512 | Amnesia event lacuna duration range | AmnsiaEvntLacunaDuratnRng | Range of time within which the duration of the subject/participant's lacunar amnesia of the suspected injury event falls | Range of time within which the duration of the subject/participant's lacunar amnesia of the suspected injury event falls | Amnesia of event: duration | Less than 1 hour;1-24 hours;>24 hours | Less than 1 hour;1-24 hours;>24 hours | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2017-05-12 12:17:20.0 | Injury Report | History of Disease%2FInjury Event | Disease%2FInjury Related Events |
Single Pre-Defined Value Selected |
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| C55462 | Injury day week name | InjuryDayWeekName | Name of the day of the week on which the injury occurred | Name of the day of the week on which the injury occurred | Day of week of injury | Monday;Friday;Wednesday;Tuesday;Thursday;Sunday;Saturday | Monday;Friday;Wednesday;Tuesday;Thursday;Sunday;Saturday | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2017-05-11 11:55:34.0 | Injury Report | History of Disease%2FInjury Event | Disease%2FInjury Related Events |
Single Pre-Defined Value Selected |
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| C55543 | Days school missed count range | DaysSchoolMissedCtRng | Range in which the count of days of school missed by the subject/participant falls | Range in which the count of days of school missed by the subject/participant falls | Approximately how many days of school has the child missed? | 1-2 days;0 days;3–6 days;7 or more days | 1-2 days;0 days;3–6 days;7 or more days | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2017-05-12 13:48:24.0 | Injury Report | History of Disease%2FInjury Event | Disease%2FInjury Related Events |
Single Pre-Defined Value Selected |
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| C05404 | Symptom onset date and time | SymptmOnsetDateTime | Date (and time, if applicable and known) reported for onset of participant's/subject's symptoms | Date (and time, if applicable and known) reported for onset of participant's/subject's symptoms | Symptom onset date; Symptom onset 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%2FInjury Event | Disease%2FInjury Related Events |
Free-Form Entry |
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| 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%2FInjury Event | Disease%2FInjury Related Events |
Single Pre-Defined Value Selected |
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| 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%2FInjury Event | Disease%2FInjury 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%2FInjury Event | Disease%2FInjury Related Events |
Free-Form Entry |
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| 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%2FInjury Event | Disease%2FInjury Related Events |
Single Pre-Defined Value Selected |
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| 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%2FInjury Event | Disease%2FInjury 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%2FInjury Event | Disease%2FInjury Related Events |
Single Pre-Defined Value Selected |
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| 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%2FInjury Event | Disease%2FInjury 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%2FInjury Event | Disease%2FInjury Related Events |
Free-Form Entry |
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| 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%2FInjury Event | Disease%2FInjury Related Events |
Single Pre-Defined Value Selected |
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| 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%2FInjury Event | Disease%2FInjury Related Events |
Single Pre-Defined Value Selected |
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| 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%2FInjury Event | Disease%2FInjury Related Events | 255 |
Free-Form Entry |
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| 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%2FInjury Event | Disease%2FInjury Related Events |
Single Pre-Defined Value Selected |
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| 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%2FInjury Event | Disease%2FInjury Related Events |
Single Pre-Defined Value Selected |
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| 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%2FInjury Event | Disease%2FInjury Related Events | 255 |
Free-Form Entry |
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| 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%2FInjury Event | Disease%2FInjury Related Events |
Free-Form Entry |
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| 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%2FInjury Event | Disease%2FInjury Related Events | 50 |
Free-Form Entry |
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| 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 0-10 | Pain assessment | 0;1;10;2;3;4;5;6;7;8;9 | 0;1;10;2;3;4;5;6;7;8;9 | Numeric Values | Adult;Pediatric | Supplemental | 4.00 | 2023-05-18 16:39:30.0 | Injury Report | History of Disease%2FInjury Event | Disease%2FInjury Related Events |
Single Pre-Defined Value Selected |
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| 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%2FInjury Event | Disease%2FInjury Related Events |
Single Pre-Defined Value Selected |
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| 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%2FInjury Event | Disease%2FInjury 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%2FInjury Event | Disease%2FInjury Related Events |
Single Pre-Defined Value Selected |
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| 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%2FInjury Event | Disease%2FInjury Related Events |
Single Pre-Defined Value Selected |
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| 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%2FInjury Event | Disease%2FInjury Related Events |
Single Pre-Defined Value Selected |
