CDE Detailed Report

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

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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
C21419 Immediate Post-Concussion Assessment Testing (ImPACT), the Post -Concussion Symptom Scale (PCSS) - Noise sensitivity score ImPACTPCSSSensitiveNoiseScore The subject's current sensitivity to noise rating score, as part of the Immediate Post-Concussion Assessment Testing (ImPACT), the Post -Concussion Symptom Scale (PCSS) The subject's current sensitivity to noise rating score, as part of the Immediate Post-Concussion Assessment Testing (ImPACT), the Post -Concussion Symptom Scale (PCSS Sensitivity to noise 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):683-699. 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

C21451 Immediate Post-Concussion Assessment Testing (ImPACT) - Symbol match visible average correct reaction time duration ImPACTSymbMatchVisAvgCorrRTDur The visible average reaction time total correct duration, as part of the Immediate Post-Concussion Assessment Testing (ImPACT) The visible average reaction time total correct duration, as part of the Immediate Post-Concussion Assessment Testing (ImPACT Avg. correct RT (visible) 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):683-699. 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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C21398 Immediate Post-Concussion Assessment Testing (ImPACT) - Visual motor speed Reliable Change Index (RCI) exceed indicator ImPACTVisMotSpeedRCIExceedInd Indicator of whether the subject's composite score in visual motor speed 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 motor speed 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):683-699. 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

C21430 Immediate Post-Concussion Assessment Testing (ImPACT) - Total symptom score ImPACTTotalSymptomScore The subject's total symptom score, as part of the Immediate Post-Concussion Assessment Testing (ImPACT) The subject's total symptom score, as part of the Immediate Post-Concussion Assessment Testing (ImPACT Total Symptom Score 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):683-699. 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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C21366 Immediate Post-Concussion Assessment Testing (ImPACT) - Attention deficit disorder hyperactivity problem indicator ImPACTProbADDHyperInd Indicator of whether the subject has problems with ADD/hyperactivity, as part of the Immediate Post-Concussion Assessment Testing (ImPACT) Indicator of whether the subject has problems with ADD/hyperactivity, as part of the Immediate Post-Concussion Assessment Testing (ImPACT Problems with ADD/hyperactivity 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):683-699. 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

C21462 Immediate Post-Concussion Assessment Testing (ImPACT) - Three letter average count ImPACTThreeLetAvgCt The average number of counted items on the three letters module, as part of the Immediate Post-Concussion Assessment Testing (ImPACT) The average number of counted items on the three letters module, as part of the Immediate Post-Concussion Assessment Testing (ImPACT Avg. counted 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):683-699. 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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C21409 Immediate Post-Concussion Assessment Testing (ImPACT), the Post -Concussion Symptom Scale (PCSS) - Nausea score ImPACTPCSSNauseaScore The subject's current nausea rating score, as part of the Immediate Post-Concussion Assessment Testing (ImPACT), the Post -Concussion Symptom Scale (PCSS) The subject's current nausea rating score, as part of the Immediate Post-Concussion Assessment Testing (ImPACT), the Post -Concussion Symptom Scale (PCSS Nauseau 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):683-699. 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

C21441 Immediate Post-Concussion Assessment Testing (ImPACT) - Design memory delay hit count ImPACTDesignMemDelayHitCt The number of delayed hits on the design memory module, as part of the Immediate Post-Concussion Assessment Testing (ImPACT) The number of delayed hits on the design 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):683-699. 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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C21377 Immediate Post-Concussion Assessment Testing (ImPACT) - Concussion five most recent month year text ImPACT5MostRecentConcussTxt The month/year text of the 5 most recent concussions, as part of the Immediate Post-Concussion Assessment Testing (ImPACT) The month/year text of the 5 most recent concussions, as part of the Immediate Post-Concussion Assessment Testing (ImPACT Concussion history 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):683-699. 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 100

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