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
C21367 Immediate Post-Concussion Assessment Testing (ImPACT) - Student performance type ImPACTStudentPerfType Type of student performance at school, as part of the Immediate Post-Concussion Assessment Testing (ImPACT) Type of student performance at school, as part of the Immediate Post-Concussion Assessment Testing (ImPACT Performance at school Below Average;Average;Above Average Below Average;Average;Above Average 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

C21463 Immediate Post-Concussion Assessment Testing (ImPACT) - Three letter average correct count ImPACTThreeLetAvCorrCt The average number of correctly counted items on the three letters module, as part of the Immediate Post-Concussion Assessment Testing (ImPACT) The average number of correctly counted items on the three letters module, as part of the Immediate Post-Concussion Assessment Testing (ImPACT Avg. counted correctly 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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C21399 Immediate Post-Concussion Assessment Testing (ImPACT) - Reaction time composite score ImPACTReactTimeCompScore Reaction time composite score, as part of the Immediate Post-Concussion Assessment Testing (ImPACT) Reaction time composite score, as part of the Immediate Post-Concussion Assessment Testing (ImPACT Reaction time 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):683-699. 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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C21410 Immediate Post-Concussion Assessment Testing (ImPACT), the Post -Concussion Symptom Scale (PCSS) - Vomiting score ImPACTPCSSVomitingScore The subject's current vomiting rating score, as part of the Immediate Post-Concussion Assessment Testing (ImPACT), the Post -Concussion Symptom Scale (PCSS) The subject's current vomiting rating score, as part of the Immediate Post-Concussion Assessment Testing (ImPACT), the Post -Concussion Symptom Scale (PCSS Vomiting 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

C21442 Immediate Post-Concussion Assessment Testing (ImPACT) - Design memory delay correct distractor count ImPACTDesignMemDelayCorrDisCt The number of delayed correct distractors on the design memory module, as part of the Immediate Post-Concussion Assessment Testing (ImPACT) The number of delayed correct distractors on the design 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):683-699. 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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C21378 Immediate Post-Concussion Assessment Testing (ImPACT) - Headache treatment physician administered indicator ImPACTTreatHeadPhysicianInd Indicator of whether the subject was treated for headaches by a physician, as part of the Immediate Post-Concussion Assessment Testing (ImPACT) Indicator of whether the subject was treated for headaches by a physician, as part of the Immediate Post-Concussion Assessment Testing (ImPACT Treatment for headaches by physician 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

C21421 Immediate Post-Concussion Assessment Testing (ImPACT), the Post -Concussion Symptom Scale (PCSS) - Sadness score ImPACTPCSSSadnessScore The subject's current sadness rating score, as part of the Immediate Post-Concussion Assessment Testing (ImPACT), the Post -Concussion Symptom Scale (PCSS) The subject's current sadness rating score, as part of the Immediate Post-Concussion Assessment Testing (ImPACT), the Post -Concussion Symptom Scale (PCSS Sadness 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

C21453 Immediate Post-Concussion Assessment Testing (ImPACT) - Symbol match hidden average correct reaction time duration ImPACTSymbMatchHidAvgCorrRTDur The hidden average reaction time total correct duration, as part of the Immediate Post-Concussion Assessment Testing (ImPACT) The hidden average reaction time total correct duration, as part of the Immediate Post-Concussion Assessment Testing (ImPACT Avg. correct RT (hidden) 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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C21389 Immediate Post-Concussion Assessment Testing (ImPACT) - Test version type ImPACTTestVersionType Type of test version used for the exam, as part of the Immediate Post-Concussion Assessment Testing (ImPACT) Type of test version used for the exam, as part of the Immediate Post-Concussion Assessment Testing (ImPACT Test Version 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 10

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