CDE Detailed Report

Disease: Sport Related Concussion
Sub-Domain: Post-Concussive / Mild TBI-Related Symptoms
CRF: Immediate Post-Concussion Assessment and Cognitive Testing (imPACT)

Displaying 1 - 50 of 109
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 / Guideline) Sub Domain Name Domain Name Size Input Restrictions Min Value Max Value Measurement Type External Id Loinc External Id Snomed External Id caDSR External Id CDISC
C21380 Immediate Post-Concussion Assessment Testing (ImPACT) - Epilepsy seizure treatment administered indicator ImPACTTreatEpilepSeizInd Indicator of whether the subject was treated for epilepsy/seizures, as part of the Immediate Post-Concussion Assessment Testing (ImPACT). Indicator of whether the subject was treated for epilepsy/seizures, as part of the Immediate Post-Concussion Assessment Testing (ImPACT). Treatment for epilepsy/seizures: No;Yes No;Yes Alphanumeric Iverson GL, Lovell MR, Collins MW. Validity of ImPACT for measuring processing speed<br />following sports-related concussion. J Clin Exper Neuropsychol. 2005;27(6):683&#8211;699. Adult;Pediatric Core 1.00 2015-07-20 11:52:01.0 Immediate Post-Concussion Assessment and Cognitive Testing (imPACT) Post-Concussive / Mild TBI-Related Symptoms Outcomes and End Points

Single Pre-Defined Value Selected

C21412 Immediate Post-Concussion Assessment Testing (ImPACT), the Post -Concussion Symptom Scale (PCSS) - Dizziness score ImPACTPCSSDizzinessScore The subject's current dizziness rating score, as part of the Immediate Post-Concussion Assessment Testing (ImPACT), the Post -Concussion Symptom Scale (PCSS). The subject's current dizziness rating score, as part of the Immediate Post-Concussion Assessment Testing (ImPACT), the Post -Concussion Symptom Scale (PCSS). Dizziness 1;2;3;4;5;6;0 Minor;Minor;Moderate;Moderate;Severe;Severe;Not experiencing this symptom Numeric Values Iverson GL, Lovell MR, Collins MW. Validity of ImPACT for measuring processing speed<br />following sports-related concussion. J Clin Exper Neuropsychol. 2005;27(6):683&#8211;699. Adult;Pediatric Core 1.00 2015-07-20 11:52:01.0 Immediate Post-Concussion Assessment and Cognitive Testing (imPACT) Post-Concussive / Mild TBI-Related Symptoms Outcomes and End Points

Single Pre-Defined Value Selected

C21444 Immediate Post-Concussion Assessment Testing (ImPACT) - Design memory total correct percentage value ImPACTDesignMemTotCorrPercVal The total percent correct on the design memory module, as part of the Immediate Post-Concussion Assessment Testing (ImPACT). The total percent correct on the design memory module, as part of the Immediate Post-Concussion Assessment Testing (ImPACT). Total percent correct Numeric Values Iverson GL, Lovell MR, Collins MW. Validity of ImPACT for measuring processing speed<br />following sports-related concussion. J Clin Exper Neuropsychol. 2005;27(6):683&#8211;699. Adult;Pediatric Core 1.00 2015-07-20 11:52:01.0 Immediate Post-Concussion Assessment and Cognitive Testing (imPACT) Post-Concussive / Mild TBI-Related Symptoms Outcomes and End Points

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C21391 Immediate Post-Concussion Assessment Testing (ImPACT) - Verbal memory composite percentage value ImPACTVerbMemCompPercVal The percentile of the subject's verbal memory composite score (if available), as part of the Immediate Post-Concussion Assessment Testing (ImPACT). The percentile of the subject's verbal memory composite score (if available), as part of the Immediate Post-Concussion Assessment Testing (ImPACT). Memory composite (verbal) Numeric Values Iverson GL, Lovell MR, Collins MW. Validity of ImPACT for measuring processing speed<br />following sports-related concussion. J Clin Exper Neuropsychol. 2005;27(6):683&#8211;699. Adult;Pediatric Core 1.00 2015-07-20 11:52:01.0 Immediate Post-Concussion Assessment and Cognitive Testing (imPACT) Post-Concussive / Mild TBI-Related Symptoms Outcomes and End Points

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C21423 Immediate Post-Concussion Assessment Testing (ImPACT), the Post -Concussion Symptom Scale (PCSS) - Emotional greater than normal score ImPACTPCSSFeelEmotionalScore The subject's current feeling more emotional rating score, as part of the Immediate Post-Concussion Assessment Testing (ImPACT), the Post -Concussion Symptom Scale (PCSS). The subject's current feeling more emotional rating score, as part of the Immediate Post-Concussion Assessment Testing (ImPACT), the Post -Concussion Symptom Scale (PCSS). Feeling more emotional 1;2;3;4;5;6;0 Minor;Minor;Moderate;Moderate;Severe;Severe;Not experiencing this symptom Numeric Values Iverson GL, Lovell MR, Collins MW. Validity of ImPACT for measuring processing speed<br />following sports-related concussion. J Clin Exper Neuropsychol. 2005;27(6):683&#8211;699. Adult;Pediatric Core 1.00 2015-07-20 11:52:01.0 Immediate Post-Concussion Assessment and Cognitive Testing (imPACT) Post-Concussive / Mild TBI-Related Symptoms Outcomes and End Points

Single Pre-Defined Value Selected

C00005 Birth country name BirthCntryName Name for country where the participant/subject was born Name for country where the participant/subject was born Native country/region Alphanumeric Iverson GL, Lovell MR, Collins MW. Validity of ImPACT for measuring processing speed<br />following sports-related concussion. J Clin Exper Neuropsychol. 2005;27(6):683&#8211;699. Adult;Pediatric Core 3.00 2013-07-24 21:00:23.88 Immediate Post-Concussion Assessment and Cognitive Testing (imPACT) Post-Concussive / Mild TBI-Related Symptoms Outcomes and End Points 255

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C21455 Immediate Post-Concussion Assessment Testing (ImPACT) - Color match average correct reaction time duration ImPACTColorMatchAvgCorrRTDur The average correct reaction time duration on the color match module, as part of the Immediate Post-Concussion Assessment Testing (ImPACT). The average correct reaction time duration on the color match module, as part of the Immediate Post-Concussion Assessment Testing (ImPACT). Avg. correct RT Numeric Values Iverson GL, Lovell MR, Collins MW. Validity of ImPACT for measuring processing speed<br />following sports-related concussion. J Clin Exper Neuropsychol. 2005;27(6):683&#8211;699. Adult;Pediatric Core 1.00 2015-07-20 11:52:01.0 Immediate Post-Concussion Assessment and Cognitive Testing (imPACT) Post-Concussive / Mild TBI-Related Symptoms Outcomes and End Points

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C21525 Language secondary ISO code LangSecondaryCode Code (ISO 639-2) for the language the participant/subject speaks second-most often Code (ISO 639-2) for the language the participant/subject speaks second-most often Secondary language ISO code Alphanumeric Iverson GL, Lovell MR, Collins MW. Validity of ImPACT for measuring processing speed<br />following sports-related concussion. J Clin Exper Neuropsychol. 2005;27(6):683&#8211;699. Adult;Pediatric Core 3.00 2013-07-20 10:21:25.65 Immediate Post-Concussion Assessment and Cognitive Testing (imPACT) Post-Concussive / Mild TBI-Related Symptoms Outcomes and End Points 255

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C21402 Immediate Post-Concussion Assessment Testing (ImPACT) - Impulse control composite score ImPACTImplseCntrlCompScore Impulse control composite score, as part of the Immediate Post-Concussion Assessment Testing (ImPACT). Impulse control composite score, as part of the Immediate Post-Concussion Assessment Testing (ImPACT). Impulse control composite Numeric Values Iverson GL, Lovell MR, Collins MW. Validity of ImPACT for measuring processing speed<br />following sports-related concussion. J Clin Exper Neuropsychol. 2005;27(6):683&#8211;699. Adult;Pediatric Core 1.00 2015-07-20 11:52:01.0 Immediate Post-Concussion Assessment and Cognitive Testing (imPACT) Post-Concussive / Mild TBI-Related Symptoms Outcomes and End Points

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C21434 Immediate Post-Concussion Assessment Testing (ImPACT) - Word memory delay hit count ImPACTWordMemDelayHitCt The number of delayed hits on the word memory module, as part of the Immediate Post-Concussion Assessment Testing (ImPACT). The number of delayed hits on the word memory module, as part of the Immediate Post-Concussion Assessment Testing (ImPACT). Hits (delay) Numeric Values Iverson GL, Lovell MR, Collins MW. Validity of ImPACT for measuring processing speed<br />following sports-related concussion. J Clin Exper Neuropsychol. 2005;27(6):683&#8211;699. Adult;Pediatric Core 1.00 2015-07-20 11:52:01.0 Immediate Post-Concussion Assessment and Cognitive Testing (imPACT) Post-Concussive / Mild TBI-Related Symptoms Outcomes and End Points

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C21370 Immediate Post-Concussion Assessment Testing (ImPACT) - Current participation level type ImPACTCurrentPartLvlTyp Current type of level of participation in sports, as part of the Immediate Post-Concussion Assessment Testing (ImPACT). Current type of level of participation in sports, as part of the Immediate Post-Concussion Assessment Testing (ImPACT). Current level of participation Pro;Semi-Pro;Collegiate;HS;JHS Pro;Semi-Pro;Collegiate;HS;JHS Alphanumeric Iverson GL, Lovell MR, Collins MW. Validity of ImPACT for measuring processing speed<br />following sports-related concussion. J Clin Exper Neuropsychol. 2005;27(6):683&#8211;699. Adult;Pediatric Core 1.00 2015-07-20 11:52:01.0 Immediate Post-Concussion Assessment and Cognitive Testing (imPACT) Post-Concussive / Mild TBI-Related Symptoms Outcomes and End Points

Single Pre-Defined Value Selected

C21381 Immediate Post-Concussion Assessment Testing (ImPACT) - Brain surgery patient medical history indicator ImPACTHxBrainSurgInd Indicator of whether the subject has a history of brain surgery, as part of the Immediate Post-Concussion Assessment Testing (ImPACT). Indicator of whether the subject has a history of brain surgery, as part of the Immediate Post-Concussion Assessment Testing (ImPACT). History of brain surgery No;Yes No;Yes Alphanumeric Iverson GL, Lovell MR, Collins MW. Validity of ImPACT for measuring processing speed<br />following sports-related concussion. J Clin Exper Neuropsychol. 2005;27(6):683&#8211;699. Adult;Pediatric Core 1.00 2015-07-20 11:52:01.0 Immediate Post-Concussion Assessment and Cognitive Testing (imPACT) Post-Concussive / Mild TBI-Related Symptoms Outcomes and End Points

Single Pre-Defined Value Selected

C21413 Immediate Post-Concussion Assessment Testing (ImPACT), the Post -Concussion Symptom Scale (PCSS) - Fatigue score ImPACTPCSSFatigueScore The subject's current fatigue rating score, as part of the Immediate Post-Concussion Assessment Testing (ImPACT), the Post -Concussion Symptom Scale (PCSS). The subject's current fatigue rating score, as part of the Immediate Post-Concussion Assessment Testing (ImPACT), the Post -Concussion Symptom Scale (PCSS). Fatigue 1;2;3;4;5;6;0 Minor;Minor;Moderate;Moderate;Severe;Severe;Not experiencing this symptom Numeric Values Iverson GL, Lovell MR, Collins MW. Validity of ImPACT for measuring processing speed<br />following sports-related concussion. J Clin Exper Neuropsychol. 2005;27(6):683&#8211;699. Adult;Pediatric Core 1.00 2015-07-20 11:52:01.0 Immediate Post-Concussion Assessment and Cognitive Testing (imPACT) Post-Concussive / Mild TBI-Related Symptoms Outcomes and End Points

Single Pre-Defined Value Selected

C21445 Immediate Post-Concussion Assessment Testing (ImPACT) - X and O memory total correct count ImPACTXOMemTotCorrectCt The memory total correct on the X's and O's module, as part of the Immediate Post-Concussion Assessment Testing (ImPACT). The memory total correct on the X's and O's module, as part of the Immediate Post-Concussion Assessment Testing (ImPACT). Total correct (memory) Numeric Values Iverson GL, Lovell MR, Collins MW. Validity of ImPACT for measuring processing speed<br />following sports-related concussion. J Clin Exper Neuropsychol. 2005;27(6):683&#8211;699. Adult;Pediatric Core 1.00 2015-07-20 11:52:01.0 Immediate Post-Concussion Assessment and Cognitive Testing (imPACT) Post-Concussive / Mild TBI-Related Symptoms Outcomes and End Points

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C21392 Immediate Post-Concussion Assessment Testing (ImPACT) - Verbal memory Reliable Change Index (RCI) exceed indicator ImPACTVerbMemRCIExceedInd Indicator of whether the subject's composite score in verbal memory exceeded the Reliable Change Index (RCI), as part of the Immediate Post-Concussion Assessment Testing (ImPACT). Indicator of whether the subject's composite score in verbal memory exceeded the Reliable Change Index (RCI), as part of the Immediate Post-Concussion Assessment Testing (ImPACT). No;Yes No;Yes Alphanumeric Iverson GL, Lovell MR, Collins MW. Validity of ImPACT for measuring processing speed<br />following sports-related concussion. J Clin Exper Neuropsychol. 2005;27(6):683&#8211;699. Adult;Pediatric Core 1.00 2015-07-20 11:52:01.0 Immediate Post-Concussion Assessment and Cognitive Testing (imPACT) Post-Concussive / Mild TBI-Related Symptoms Outcomes and End Points

Single Pre-Defined Value Selected

C21424 Immediate Post-Concussion Assessment Testing (ImPACT), the Post -Concussion Symptom Scale (PCSS) - Numbness tingling assessment score ImPACTPCSSNumbTingleScore The subject's current numbness or tingling rating score, as part of the Immediate Post-Concussion Assessment Testing (ImPACT), the Post -Concussion Symptom Scale (PCSS). The subject's current numbness or tingling rating score, as part of the Immediate Post-Concussion Assessment Testing (ImPACT), the Post -Concussion Symptom Scale (PCSS). Numbness or tingling 1;2;3;4;5;6;0 Minor;Minor;Moderate;Moderate;Severe;Severe;Not experiencing this symptom Numeric Values Iverson GL, Lovell MR, Collins MW. Validity of ImPACT for measuring processing speed<br />following sports-related concussion. J Clin Exper Neuropsychol. 2005;27(6):683&#8211;699. Adult;Pediatric Core 1.00 2015-07-20 11:52:01.0 Immediate Post-Concussion Assessment and Cognitive Testing (imPACT) Post-Concussive / Mild TBI-Related Symptoms Outcomes and End Points

Single Pre-Defined Value Selected

C00024 Language primary ISO code LangPrimryCode Code (ISO 639-2) for the language the participant/subject speaks most often Code (ISO 639-2) for the language the participant/subject speaks most often Native language Alphanumeric Iverson GL, Lovell MR, Collins MW. Validity of ImPACT for measuring processing speed<br />following sports-related concussion. J Clin Exper Neuropsychol. 2005;27(6):683&#8211;699. Adult;Pediatric Core 3.00 2013-07-20 10:21:25.65 Immediate Post-Concussion Assessment and Cognitive Testing (imPACT) Post-Concussive / Mild TBI-Related Symptoms Outcomes and End Points 255

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C21456 Immediate Post-Concussion Assessment Testing (ImPACT) - Color match total commission count ImPACTColorMatchTotCommCt The number of total commissions on the color match module, as part of the Immediate Post-Concussion Assessment Testing (ImPACT). The number of total commissions on the color match module, as part of the Immediate Post-Concussion Assessment Testing (ImPACT). Total commissions Numeric Values Iverson GL, Lovell MR, Collins MW. Validity of ImPACT for measuring processing speed<br />following sports-related concussion. J Clin Exper Neuropsychol. 2005;27(6):683&#8211;699. Adult;Pediatric Core 1.00 2015-07-20 11:52:01.0 Immediate Post-Concussion Assessment and Cognitive Testing (imPACT) Post-Concussive / Mild TBI-Related Symptoms Outcomes and End Points

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C21403 Immediate Post-Concussion Assessment Testing (ImPACT) - Impulse control composite percentage value ImPACTImplseCntrlCompPercVal The percentile of the subject's impulse control composite score (if available), as part of the Immediate Post-Concussion Assessment Testing (ImPACT). The percentile of the subject's impulse control composite score (if available), as part of the Immediate Post-Concussion Assessment Testing (ImPACT). Impulse control composite Numeric Values Iverson GL, Lovell MR, Collins MW. Validity of ImPACT for measuring processing speed<br />following sports-related concussion. J Clin Exper Neuropsychol. 2005;27(6):683&#8211;699. Adult;Pediatric Core 1.00 2015-07-20 11:52:01.0 Immediate Post-Concussion Assessment and Cognitive Testing (imPACT) Post-Concussive / Mild TBI-Related Symptoms Outcomes and End Points

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C21435 Immediate Post-Concussion Assessment Testing (ImPACT) - Word memory delay correct distractor count ImPACTWordMemDelayCorrDisCt The number of delay correct distractors identified on the word memory module, as part of the Immediate Post-Concussion Assessment Testing (ImPACT). The number of delay correct distractors identified on the word memory module, as part of the Immediate Post-Concussion Assessment Testing (ImPACT). Correct distractors (delay) Numeric Values Iverson GL, Lovell MR, Collins MW. Validity of ImPACT for measuring processing speed<br />following sports-related concussion. J Clin Exper Neuropsychol. 2005;27(6):683&#8211;699. Adult;Pediatric Core 1.00 2015-07-20 11:52:01.0 Immediate Post-Concussion Assessment and Cognitive Testing (imPACT) Post-Concussive / Mild TBI-Related Symptoms Outcomes and End Points

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C21371 Immediate Post-Concussion Assessment Testing (ImPACT) - Current participation level year count ImPACTYrsExpLevelCt Number of years experience at current participation level, as part of the Immediate Post-Concussion Assessment Testing (ImPACT). Number of years experience at current participation level, as part of the Immediate Post-Concussion Assessment Testing (ImPACT). Years of experience at this level Numeric Values Iverson GL, Lovell MR, Collins MW. Validity of ImPACT for measuring processing speed<br />following sports-related concussion. J Clin Exper Neuropsychol. 2005;27(6):683&#8211;699. Adult;Pediatric Core 1.00 2015-07-20 11:52:01.0 Immediate Post-Concussion Assessment and Cognitive Testing (imPACT) Post-Concussive / Mild TBI-Related Symptoms Outcomes and End Points

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C21382 Immediate Post-Concussion Assessment Testing (ImPACT) - Substance alcohol abuse treatment administered indicator ImPACTTreatSubAlcoholAbusInd Indicator of whether the subject has received treatment for substance or alcohol abuse, as part of the Immediate Post-Concussion Assessment Testing (ImPACT). Indicator of whether the subject has received treatment for substance or alcohol abuse, as part of the Immediate Post-Concussion Assessment Testing (ImPACT). Treatment for substance/alcohol abuse No;Yes No;Yes Alphanumeric Iverson GL, Lovell MR, Collins MW. Validity of ImPACT for measuring processing speed<br />following sports-related concussion. J Clin Exper Neuropsychol. 2005;27(6):683&#8211;699. Adult;Pediatric Core 1.00 2015-07-20 11:52:01.0 Immediate Post-Concussion Assessment and Cognitive Testing (imPACT) Post-Concussive / Mild TBI-Related Symptoms Outcomes and End Points

Single Pre-Defined Value Selected

C21414 Immediate Post-Concussion Assessment Testing (ImPACT), the Post -Concussion Symptom Scale (PCSS) - Falling asleep trouble score ImPACTPCSSTroubFallAsleepScore The subject's current trouble falling asleep rating score, as part of the Immediate Post-Concussion Assessment Testing (ImPACT), the Post -Concussion Symptom Scale (PCSS). The subject's current trouble falling asleep rating score, as part of the Immediate Post-Concussion Assessment Testing (ImPACT), the Post -Concussion Symptom Scale (PCSS). Trouble falling asleep 1;2;3;4;5;6;0 Minor;Minor;Moderate;Moderate;Severe;Severe;Not experiencing this symptom Numeric Values Iverson GL, Lovell MR, Collins MW. Validity of ImPACT for measuring processing speed<br />following sports-related concussion. J Clin Exper Neuropsychol. 2005;27(6):683&#8211;699. Adult;Pediatric Core 1.00 2015-07-20 11:52:01.0 Immediate Post-Concussion Assessment and Cognitive Testing (imPACT) Post-Concussive / Mild TBI-Related Symptoms Outcomes and End Points

Single Pre-Defined Value Selected

C21446 Immediate Post-Concussion Assessment Testing (ImPACT) - X and O interference total correct count ImPACTXOInterTotCorrCt The interference total correct on the X's and O's module, as part of the Immediate Post-Concussion Assessment Testing (ImPACT). The interference total correct on the X's and O's module, as part of the Immediate Post-Concussion Assessment Testing (ImPACT). Total correct (interference) Numeric Values Iverson GL, Lovell MR, Collins MW. Validity of ImPACT for measuring processing speed<br />following sports-related concussion. J Clin Exper Neuropsychol. 2005;27(6):683&#8211;699. Adult;Pediatric Core 1.00 2015-07-20 11:52:01.0 Immediate Post-Concussion Assessment and Cognitive Testing (imPACT) Post-Concussive / Mild TBI-Related Symptoms Outcomes and End Points

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C21393 Immediate Post-Concussion Assessment Testing (ImPACT) - Visual memory composite score ImPACTVisMemoryCompScore Visual memory composite score, as part of the Immediate Post-Concussion Assessment Testing (ImPACT). Visual memory composite score, as part of the Immediate Post-Concussion Assessment Testing (ImPACT). Memory composite (visual) Numeric Values Iverson GL, Lovell MR, Collins MW. Validity of ImPACT for measuring processing speed<br />following sports-related concussion. J Clin Exper Neuropsychol. 2005;27(6):683&#8211;699. Adult;Pediatric Core 1.00 2015-07-20 11:52:01.0 Immediate Post-Concussion Assessment and Cognitive Testing (imPACT) Post-Concussive / Mild TBI-Related Symptoms Outcomes and End Points

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C21425 Immediate Post-Concussion Assessment Testing (ImPACT), the Post -Concussion Symptom Scale (PCSS) - Slowed down assessment score ImPACTPCSSFeelSlowDownScore The subject's current feeling slowed down rating score, as part of the Immediate Post-Concussion Assessment Testing (ImPACT), the Post -Concussion Symptom Scale (PCSS). The subject's current feeling slowed down rating score, as part of the Immediate Post-Concussion Assessment Testing (ImPACT), the Post -Concussion Symptom Scale (PCSS). Feeling slowed down 1;2;3;4;5;6;0 Minor;Minor;Moderate;Moderate;Severe;Severe;Not experiencing this symptom Numeric Values Iverson GL, Lovell MR, Collins MW. Validity of ImPACT for measuring processing speed<br />following sports-related concussion. J Clin Exper Neuropsychol. 2005;27(6):683&#8211;699. Adult;Pediatric Core 1.00 2015-07-20 11:52:01.0 Immediate Post-Concussion Assessment and Cognitive Testing (imPACT) Post-Concussive / Mild TBI-Related Symptoms Outcomes and End Points

Single Pre-Defined Value Selected

C00025 Language primary text LangPrimryTxt Text for the language the participant/subject speaks most often Text for the language the participant/subject speaks most often Native language eng;spa;sgn;chi;fre;ger;Other, specify English;Spanish;Sign Languages;Chinese languages;French;German;Other, specify Alphanumeric Iverson GL, Lovell MR, Collins MW. Validity of ImPACT for measuring processing speed<br />following sports-related concussion. J Clin Exper Neuropsychol. 2005;27(6):683&#8211;699. Adult;Pediatric Core 3.00 2013-07-20 10:21:25.65 Immediate Post-Concussion Assessment and Cognitive Testing (imPACT) Post-Concussive / Mild TBI-Related Symptoms Outcomes and End Points

Single Pre-Defined Value Selected

C21457 Immediate Post-Concussion Assessment Testing (ImPACT) - Color match average commissions reaction time duration ImPACTColorMatchAvgCommRTDur The average commissions reaction time duration on the color match module, as part of the Immediate Post-Concussion Assessment Testing (ImPACT). The average commissions reaction time duration on the color match module, as part of the Immediate Post-Concussion Assessment Testing (ImPACT). Avg. commissions RT Numeric Values Iverson GL, Lovell MR, Collins MW. Validity of ImPACT for measuring processing speed<br />following sports-related concussion. J Clin Exper Neuropsychol. 2005;27(6):683&#8211;699. Adult;Pediatric Core 1.00 2015-07-20 11:52:01.0 Immediate Post-Concussion Assessment and Cognitive Testing (imPACT) Post-Concussive / Mild TBI-Related Symptoms Outcomes and End Points

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C21404 Immediate Post-Concussion Assessment Testing (ImPACT) - Impulse control Reliable Change Index (RCI) exceeded indicator ImPACTImplseCntrlRCIExceedInd Indicator of whether the subject's composite score in impulse control exceeded the Reliable Change Index (RCI), as part of the Immediate Post-Concussion Assessment Testing (ImPACT). Indicator of whether the subject's composite score in impulse control exceeded the Reliable Change Index (RCI), as part of the Immediate Post-Concussion Assessment Testing (ImPACT). No;Yes No;Yes Alphanumeric Iverson GL, Lovell MR, Collins MW. Validity of ImPACT for measuring processing speed<br />following sports-related concussion. J Clin Exper Neuropsychol. 2005;27(6):683&#8211;699. Adult;Pediatric Core 1.00 2015-07-20 11:52:01.0 Immediate Post-Concussion Assessment and Cognitive Testing (imPACT) Post-Concussive / Mild TBI-Related Symptoms Outcomes and End Points

Single Pre-Defined Value Selected

C21436 Immediate Post-Concussion Assessment Testing (ImPACT) - Word memory delayed percent correct percentage value ImPACTWordMemDelayCorrPercVal The delayed memory percent correct number on the word memory module, as part of the Immediate Post-Concussion Assessment Testing (ImPACT). The delayed memory percent correct number on the word memory module, as part of the Immediate Post-Concussion Assessment Testing (ImPACT). Delayed memory pct. Correct Numeric Values Iverson GL, Lovell MR, Collins MW. Validity of ImPACT for measuring processing speed<br />following sports-related concussion. J Clin Exper Neuropsychol. 2005;27(6):683&#8211;699. Adult;Pediatric Core 1.00 2015-07-20 11:52:01.0 Immediate Post-Concussion Assessment and Cognitive Testing (imPACT) Post-Concussive / Mild TBI-Related Symptoms Outcomes and End Points

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C21372 Immediate Post-Concussion Assessment Testing (ImPACT) - Loss of consciousness concussion result count ImPACTConcussResultLOCCt Number of concussions that resulted in loss of consciousness (LOC), as part of the Immediate Post-Concussion Assessment Testing (ImPACT). Number of concussions that resulted in loss of consciousness (LOC), as part of the Immediate Post-Concussion Assessment Testing (ImPACT). Concussions that resulted in loss of consciousness Numeric Values Iverson GL, Lovell MR, Collins MW. Validity of ImPACT for measuring processing speed<br />following sports-related concussion. J Clin Exper Neuropsychol. 2005;27(6):683&#8211;699. Adult;Pediatric Core 1.00 2015-07-20 11:52:01.0 Immediate Post-Concussion Assessment and Cognitive Testing (imPACT) Post-Concussive / Mild TBI-Related Symptoms Outcomes and End Points

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C21383 Immediate Post-Concussion Assessment Testing (ImPACT) - Psychiatric condition treatment administered indicator ImPACTTreatPsychiatricCondInd Indicator of whether the subject has received treatment for a psychiatric condition such as depression or anxiety, as part of the Immediate Post-Concussion Assessment Testing (ImPACT). Indicator of whether the subject has received treatment for a psychiatric condition such as depression or anxiety, as part of the Immediate Post-Concussion Assessment Testing (ImPACT). Treatment for psychiatric condition (depression, anxiety) No;Yes No;Yes Alphanumeric Iverson GL, Lovell MR, Collins MW. Validity of ImPACT for measuring processing speed<br />following sports-related concussion. J Clin Exper Neuropsychol. 2005;27(6):683&#8211;699. Adult;Pediatric Core 1.00 2015-07-20 11:52:01.0 Immediate Post-Concussion Assessment and Cognitive Testing (imPACT) Post-Concussive / Mild TBI-Related Symptoms Outcomes and End Points

Single Pre-Defined Value Selected

C21415 Immediate Post-Concussion Assessment Testing (ImPACT), the Post -Concussion Symptom Scale (PCSS) - Sleep greater than normal duration score ImPACTPCSSSlpMoreThnUsualScore The subject's current sleep more than usual rating score, as part of the Immediate Post-Concussion Assessment Testing (ImPACT), the Post -Concussion Symptom Scale (PCSS). The subject's current sleep more than usual rating score, as part of the Immediate Post-Concussion Assessment Testing (ImPACT), the Post -Concussion Symptom Scale (PCSS). Sleeping more than usual 1;2;3;4;5;6;0 Minor;Minor;Moderate;Moderate;Severe;Severe;Not experiencing this symptom Numeric Values Iverson GL, Lovell MR, Collins MW. Validity of ImPACT for measuring processing speed<br />following sports-related concussion. J Clin Exper Neuropsychol. 2005;27(6):683&#8211;699. Adult;Pediatric Core 1.00 2015-07-20 11:52:01.0 Immediate Post-Concussion Assessment and Cognitive Testing (imPACT) Post-Concussive / Mild TBI-Related Symptoms Outcomes and End Points

Single Pre-Defined Value Selected

C21447 Immediate Post-Concussion Assessment Testing (ImPACT) - X and O interference average correct reaction time duration ImPACTXOInterAvgCorrRTDur The interference average correct reaction time duration on the X's and O's module, as part of the Immediate Post-Concussion Assessment Testing (ImPACT). The interference average correct reaction time duration on the X's and O's module, as part of the Immediate Post-Concussion Assessment Testing (ImPACT). Avg. correct RT (interference) Numeric Values Iverson GL, Lovell MR, Collins MW. Validity of ImPACT for measuring processing speed<br />following sports-related concussion. J Clin Exper Neuropsychol. 2005;27(6):683&#8211;699. Adult;Pediatric Core 1.00 2015-07-20 11:52:01.0 Immediate Post-Concussion Assessment and Cognitive Testing (imPACT) Post-Concussive / Mild TBI-Related Symptoms Outcomes and End Points

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C21394 Immediate Post-Concussion Assessment Testing (ImPACT) - Visual memory composite percentage value ImPACTVisMemCompPercVal The percentile of the subject's visual memory composite score (if available), as part of the Immediate Post-Concussion Assessment Testing (ImPACT). The percentile of the subject's visual memory composite score (if available), as part of the Immediate Post-Concussion Assessment Testing (ImPACT). Memory composite (visual) Numeric Values Iverson GL, Lovell MR, Collins MW. Validity of ImPACT for measuring processing speed<br />following sports-related concussion. J Clin Exper Neuropsychol. 2005;27(6):683&#8211;699. Adult;Pediatric Core 1.00 2015-07-20 11:52:01.0 Immediate Post-Concussion Assessment and Cognitive Testing (imPACT) Post-Concussive / Mild TBI-Related Symptoms Outcomes and End Points

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0 100
C21426 Immediate Post-Concussion Assessment Testing (ImPACT), the Post -Concussion Symptom Scale (PCSS) - Mental fog assessment score ImPACTPCSSFeelMentFogScore The subject's current feeling mentally foggy rating score, as part of the Immediate Post-Concussion Assessment Testing (ImPACT), the Post -Concussion Symptom Scale (PCSS). The subject's current feeling mentally foggy rating score, as part of the Immediate Post-Concussion Assessment Testing (ImPACT), the Post -Concussion Symptom Scale (PCSS). Feeling mentally foggy 1;2;3;4;5;6;0 Minor;Minor;Moderate;Moderate;Severe;Severe;Not experiencing this symptom Numeric Values Iverson GL, Lovell MR, Collins MW. Validity of ImPACT for measuring processing speed<br />following sports-related concussion. J Clin Exper Neuropsychol. 2005;27(6):683&#8211;699. Adult;Pediatric Core 1.00 2015-07-20 11:52:01.0 Immediate Post-Concussion Assessment and Cognitive Testing (imPACT) Post-Concussive / Mild TBI-Related Symptoms Outcomes and End Points

Single Pre-Defined Value Selected

C02014 Medication prior or concomitant name MedctnPriorConcomName Name of the prior/concomitant agent or drug administered. Name of the prior/concomitant agent or drug administered. Prior or concomitant medication name Alphanumeric Iverson GL, Lovell MR, Collins MW. Validity of ImPACT for measuring processing speed<br />following sports-related concussion. J Clin Exper Neuropsychol. 2005;27(6):683&#8211;699. Adult;Pediatric Core 3.00 2013-08-28 16:08:00.453 Immediate Post-Concussion Assessment and Cognitive Testing (imPACT) Post-Concussive / Mild TBI-Related Symptoms Outcomes and End Points 4000

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3162728
C21458 Immediate Post-Concussion Assessment Testing (ImPACT) - Three letters total sequence correct count ImPACTThreeLetTotSeqCorrCt The number of total sequence items correct on the three letters module, as part of the Immediate Post-Concussion Assessment Testing (ImPACT). The number of total sequence items correct on the three letters module, as part of the Immediate Post-Concussion Assessment Testing (ImPACT). Total sequence correct Numeric Values Iverson GL, Lovell MR, Collins MW. Validity of ImPACT for measuring processing speed<br />following sports-related concussion. J Clin Exper Neuropsychol. 2005;27(6):683&#8211;699. Adult;Pediatric Core 1.00 2015-07-20 11:52:01.0 Immediate Post-Concussion Assessment and Cognitive Testing (imPACT) Post-Concussive / Mild TBI-Related Symptoms Outcomes and End Points

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C21405 Immediate Post-Concussion Assessment Testing (ImPACT) - Total symptom Reliable Change Index (RCI) exceeded indicator ImPACTTotalSymptomRCIExceedInd Indicator of whether the subject's total symptom score exceeded the Reliable Change Index (RCI), as part of the Immediate Post-Concussion Assessment Testing (ImPACT). Indicator of whether the subject's total symptom score exceeded the Reliable Change Index (RCI), as part of the Immediate Post-Concussion Assessment Testing (ImPACT). No;Yes No;Yes Alphanumeric Iverson GL, Lovell MR, Collins MW. Validity of ImPACT for measuring processing speed<br />following sports-related concussion. J Clin Exper Neuropsychol. 2005;27(6):683&#8211;699. Adult;Pediatric Core 1.00 2015-07-20 11:52:01.0 Immediate Post-Concussion Assessment and Cognitive Testing (imPACT) Post-Concussive / Mild TBI-Related Symptoms Outcomes and End Points

Single Pre-Defined Value Selected

C21437 Immediate Post-Concussion Assessment Testing (ImPACT) - Word memory total percent correct percentage value ImPACTWordMemTotCorrPercVal The total percent correct on the word memory module, as part of the Immediate Post-Concussion Assessment Testing (ImPACT). The total percent correct on the word memory module, as part of the Immediate Post-Concussion Assessment Testing (ImPACT). Total percent correct Numeric Values Iverson GL, Lovell MR, Collins MW. Validity of ImPACT for measuring processing speed<br />following sports-related concussion. J Clin Exper Neuropsychol. 2005;27(6):683&#8211;699. Adult;Pediatric Core 1.00 2015-07-20 11:52:01.0 Immediate Post-Concussion Assessment and Cognitive Testing (imPACT) Post-Concussive / Mild TBI-Related Symptoms Outcomes and End Points

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C21373 Immediate Post-Concussion Assessment Testing (ImPACT) - Confusion concussion result count ImPACTConcussResultConfCt Number of concussions that resulted in confusion, as part of the Immediate Post-Concussion Assessment Testing (ImPACT). Number of concussions that resulted in confusion, as part of the Immediate Post-Concussion Assessment Testing (ImPACT). Concussions that resulted in confusion Numeric Values Iverson GL, Lovell MR, Collins MW. Validity of ImPACT for measuring processing speed<br />following sports-related concussion. J Clin Exper Neuropsychol. 2005;27(6):683&#8211;699. Adult;Pediatric Core 1.00 2015-07-20 11:52:01.0 Immediate Post-Concussion Assessment and Cognitive Testing (imPACT) Post-Concussive / Mild TBI-Related Symptoms Outcomes and End Points

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C21384 Immediate Post-Concussion Assessment Testing (ImPACT) - Dyslexia diagnosis indicator ImPACTDxDyslexiaInd Indicator of whether the subject has been diagnosed with dyslexia, as part of the Immediate Post-Concussion Assessment Testing (ImPACT). Indicator of whether the subject has been diagnosed with dyslexia, as part of the Immediate Post-Concussion Assessment Testing (ImPACT). Diagnosed with Dyslexia No;Yes No;Yes Alphanumeric Iverson GL, Lovell MR, Collins MW. Validity of ImPACT for measuring processing speed<br />following sports-related concussion. J Clin Exper Neuropsychol. 2005;27(6):683&#8211;699. Adult;Pediatric Core 1.00 2015-07-20 11:52:01.0 Immediate Post-Concussion Assessment and Cognitive Testing (imPACT) Post-Concussive / Mild TBI-Related Symptoms Outcomes and End Points

Single Pre-Defined Value Selected

C21416 Immediate Post-Concussion Assessment Testing (ImPACT), the Post -Concussion Symptom Scale (PCSS) - Sleep less than normal duration score ImPACTPCSSSlpLessThnUsualScore The subject's current sleep less than usual rating score, as part of the Immediate Post-Concussion Assessment Testing (ImPACT), the Post -Concussion Symptom Scale (PCSS). The subject's current sleep less than usual rating score, as part of the Immediate Post-Concussion Assessment Testing (ImPACT), the Post -Concussion Symptom Scale (PCSS). Sleeping less than usual 1;2;3;4;5;6;0 Minor;Minor;Moderate;Moderate;Severe;Severe;Not experiencing this symptom Numeric Values Iverson GL, Lovell MR, Collins MW. Validity of ImPACT for measuring processing speed<br />following sports-related concussion. J Clin Exper Neuropsychol. 2005;27(6):683&#8211;699. Adult;Pediatric Core 1.00 2015-07-20 11:52:01.0 Immediate Post-Concussion Assessment and Cognitive Testing (imPACT) Post-Concussive / Mild TBI-Related Symptoms Outcomes and End Points

Single Pre-Defined Value Selected

C21448 Immediate Post-Concussion Assessment Testing (ImPACT) - X and O interference total incorrect count ImPACTXOInterTotIncorrCt The interference total incorrect number on the X's and O's module, as part of the Immediate Post-Concussion Assessment Testing (ImPACT). The interference total incorrect number on the X's and O's module, as part of the Immediate Post-Concussion Assessment Testing (ImPACT). Total incorrect (interference) Numeric Values Iverson GL, Lovell MR, Collins MW. Validity of ImPACT for measuring processing speed<br />following sports-related concussion. J Clin Exper Neuropsychol. 2005;27(6):683&#8211;699. Adult;Pediatric Core 1.00 2015-07-20 11:52:01.0 Immediate Post-Concussion Assessment and Cognitive Testing (imPACT) Post-Concussive / Mild TBI-Related Symptoms Outcomes and End Points

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C21395 Immediate Post-Concussion Assessment Testing (ImPACT) - Visual memory Reliable Change Index (RCI) exceeded indicator ImPACTVisMemRCIExceedInd Indicator of whether the subject's composite score in visual memory exceeded the Reliable Change Index (RCI), as part of the Immediate Post-Concussion Assessment Testing (ImPACT). Indicator of whether the subject's composite score in visual memory exceeded the Reliable Change Index (RCI), as part of the Immediate Post-Concussion Assessment Testing (ImPACT). No;Yes No;Yes Alphanumeric Iverson GL, Lovell MR, Collins MW. Validity of ImPACT for measuring processing speed<br />following sports-related concussion. J Clin Exper Neuropsychol. 2005;27(6):683&#8211;699. Adult;Pediatric Core 1.00 2015-07-20 11:52:01.0 Immediate Post-Concussion Assessment and Cognitive Testing (imPACT) Post-Concussive / Mild TBI-Related Symptoms Outcomes and End Points

Single Pre-Defined Value Selected

C21427 Immediate Post-Concussion Assessment Testing (ImPACT), the Post -Concussion Symptom Scale (PCSS) - Concentration difficultly assessment score ImPACTPCSSDiffConcentrateScore The subject's current difficulty concentrating rating score, as part of the Immediate Post-Concussion Assessment Testing (ImPACT), the Post -Concussion Symptom Scale (PCSS). The subject's current difficulty concentrating rating score, as part of the Immediate Post-Concussion Assessment Testing (ImPACT), the Post -Concussion Symptom Scale (PCSS). Difficulty concentrating 1;2;3;4;5;6;0 Minor;Minor;Moderate;Moderate;Severe;Severe;Not experiencing this symptom Numeric Values Iverson GL, Lovell MR, Collins MW. Validity of ImPACT for measuring processing speed<br />following sports-related concussion. J Clin Exper Neuropsychol. 2005;27(6):683&#8211;699. Adult;Pediatric Core 1.00 2015-07-20 11:52:01.0 Immediate Post-Concussion Assessment and Cognitive Testing (imPACT) Post-Concussive / Mild TBI-Related Symptoms Outcomes and End Points

Single Pre-Defined Value Selected

C21363 Immediate Post-Concussion Assessment Testing (ImPACT) - Second language spoken year duration ImPACTSecondLanguageYrDur The count of years the subject spoke a language, as part of the Immediate Post-Concussion Assessment Testing (ImPACT). The count of years the subject spoke a language, as part of the Immediate Post-Concussion Assessment Testing (ImPACT). Years speaking Numeric Values Iverson GL, Lovell MR, Collins MW. Validity of ImPACT for measuring processing speed<br />following sports-related concussion. J Clin Exper Neuropsychol. 2005;27(6):683&#8211;699. Adult;Pediatric Core 1.00 2015-07-20 11:52:01.0 Immediate Post-Concussion Assessment and Cognitive Testing (imPACT) Post-Concussive / Mild TBI-Related Symptoms Outcomes and End Points

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C21459 Immediate Post-Concussion Assessment Testing (ImPACT) - Three letters total letters correct count ImPACTThreeLetTotLetCorrCt The number of total correct letters on the three letters module, as part of the Immediate Post-Concussion Assessment Testing (ImPACT). The number of total correct letters on the three letters module, as part of the Immediate Post-Concussion Assessment Testing (ImPACT). Total letters correct Numeric Values Iverson GL, Lovell MR, Collins MW. Validity of ImPACT for measuring processing speed<br />following sports-related concussion. J Clin Exper Neuropsychol. 2005;27(6):683&#8211;699. Adult;Pediatric Core 1.00 2015-07-20 11:52:01.0 Immediate Post-Concussion Assessment and Cognitive Testing (imPACT) Post-Concussive / Mild TBI-Related Symptoms Outcomes and End Points

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C21406 Immediate Post-Concussion Assessment Testing (ImPACT) - Cognitive efficiency index score ImPACTCogEfficiencyIndexScore Cognitive efficiency index score (CEI) is the subject's cognitive efficiency index score, as part of the Immediate Post-Concussion Assessment Testing (ImPACT). Cognitive efficiency index score (CEI) is the subject's cognitive efficiency index score, as part of the Immediate Post-Concussion Assessment Testing (ImPACT). Cognitive Efficiency Index: Numeric Values Iverson GL, Lovell MR, Collins MW. Validity of ImPACT for measuring processing speed<br />following sports-related concussion. J Clin Exper Neuropsychol. 2005;27(6):683&#8211;699. Adult;Pediatric Core 1.00 2015-07-20 11:52:01.0 Immediate Post-Concussion Assessment and Cognitive Testing (imPACT) Post-Concussive / Mild TBI-Related Symptoms Outcomes and End Points

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C21438 Immediate Post-Concussion Assessment Testing (ImPACT) - Design memory immediate hit count ImPACTDesignMemImmedHitCt The number of immediate hits on the design memory module, as part of the Immediate Post-Concussion Assessment Testing (ImPACT). The number of immediate hits on the design memory module, as part of the Immediate Post-Concussion Assessment Testing (ImPACT). Hits (Immediate) Numeric Values Iverson GL, Lovell MR, Collins MW. Validity of ImPACT for measuring processing speed<br />following sports-related concussion. J Clin Exper Neuropsychol. 2005;27(6):683&#8211;699. Adult;Pediatric Core 1.00 2015-07-20 11:52:01.0 Immediate Post-Concussion Assessment and Cognitive Testing (imPACT) Post-Concussive / Mild TBI-Related Symptoms Outcomes and End Points

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CSV