Form Structure: Sport Concussion Assessment Tool 5th edition (SCAT-5)
This form structure is an organized set of data definitions for a copyrighted form
Resource:
FITBIR
Title:
Sport Concussion Assessment Tool 5th edition (SCAT-5)
Short Name:
SCAT5
Description:
The SCAT-5 is a standardized tool for evaluating injured athletes for concussion and can be used in athletes aged from 13 years and older. For younger persons, ages 12 and under, please use the Child SCAT-5. SCAT-5 to be done in resting state. Best done 10 or more minutes post exercise. Recommended by CDISC for TBI.
? Concussion in Sport Group 2017
https://bjsm.bmj.com/content/bjsports/early/2017/04/26/bjsports-2017-097506SCAT5.full.pdf
used in Head Kinematics Estimates, Biomechanical sensors study
Disease:
Traumatic Brain Injury
Organization:
NIH/CIT/BRICS
Required Program Form:
No
Standardization:
Standard
Labels:
Form Type:
Clinical Assessment
Publication Date:
2018-10-25
Version:
1.0
Date Created:
2018-09-13
Owner:
Number of Data Elements:
147
eForms:
N
Logically grouped data elements with defined frequency at which they repeat.
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | GUID | Global Unique ID which uniquely identifies a subject | GUID | Required | CDE |
| 2 | Subject identifier number | An identification number assigned to the participant/subject within a given protocol or a study. | SubjectIDNum | Optional | CDE |
| 3 | Age in years | Value for participant's subject age recorded in years. | AgeYrs | Recommended | CDE |
| 4 | Vital status | Status of participant/subject as alive or dead | VitStatus | Optional | CDE |
| 5 | Visit date | Actual interview or visit date | VisitDate | Recommended | CDE |
| 6 | Site name | The name of the site for the study | SiteName | Recommended | CDE |
| 7 | Days since baseline | The number of days since baseline | DaysSinceBaseline | Optional | CDE |
| 8 | Case control indicator | Indicator of whether subject is in the case or control arm of the study. | CaseContrlInd | Optional | CDE |
| 9 | General notes text | General notes | GeneralNotesTxt | Optional | CDE |
Additional Element Groups
Listed below are your additional element groups.
Form Administration (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Language form administration ISO code | Code (ISO 639-2) for the language that was used for CRF/instrument/scale/etc. administration | LangCRFAdministratISOCode | Recommended | CDE |
| 2 | Language form administration ISO code other text | The free-text field related to 'Language used for CRF/instrument/scale/etc. administration ISO code' specifying other text. | LangCRFAdministratISOCodeOTH | Recommended | CDE |
| 3 | Context type | The context to which the questions were answered | ContextType | Recommended | CDE |
| 4 | Context type other text | The free-text related to ContextType specifying other text | ContextTypeOTH | Recommended | CDE |
| 5 | Data source | Source of the data provided on the case report form | DataSource | Recommended | CDE |
| 6 | Data source other text | The free-text field related to Data source specifying other text. Source of the data provided on the case report form | DataSourceOTH | Recommended | CDE |
| 7 | Assessment completion status | Status of completion of an assessment, such as a case report from (CRF), instrument, scale, computer assessment, etc. | AssessmentCompletionStat | Recommended | CDE |
| 8 | Assessment completion status text | A free text related to "Assessment completion status" specifying completion details. This data element should be used along with AssessmenttCompletionStat to further describe the status of assessment completion | AssessmentCompletionStatTxt | Recommended | CDE |
STEP 1 RED FLAGS (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Sport Concussion Assessment Tool (SCAT-5) - red flags type | Type of red flags, as part of Sport Concussion Assessment Tool (SCAT-5) | SCAT5RedFlagTyp | Optional | UDE |
STEP 2 OBSERVABLE SIGNS (Appears Up To 2 Times)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Sport Concussion Assessment Tool (SCAT-5) - observation type | Type of observation, as part of Sport Concussion Assessment Tool (SCAT-5) | SCAT5ObservTyp | Recommended | UDE |
| 2 | Sport Concussion Assessment Tool (SCAT-5) - lying motionless indicator | Indicator of the subject is lying motionless on the playing surface, as part of Sport Concussion Assessment Tool (SCAT-5) | SCAT5MotionlessInd | Recommended | UDE |
| 3 | Balance issues indicator | Indicator of the presence of balance issues. | BalanceIssueInd | Recommended | CDE |
| 4 | Sport Concussion Assessment Tool (SCAT-3, SCAT-5) - Disorientation/confusion indicator | Indicator that the subject is disoriented and/or confused, or unable to respond appropriately to questions, as part of Sport Concussion Assessment Tool (SCAT-3 and SCAT-5) | SCAT3DisorientConfInd | Recommended | CDE |
| 5 | Sport Concussion Assessment Tool (SCAT-3,SCAT-5) - Blank/vacant look indicator | Indicator that the subject has blank and/or vacant look, as part of Sport Concussion Assessment Tool (SCAT-3, SCAT-5) | SCAT3BlankVacantLookInd | Recommended | CDE |
| 6 | Sport Concussion Assessment Tool (SCAT-5) - facial injury after head trauma indicator | Indicator that the subject has facial injury after head trauma, as part of Sport Concussion Assessment Tool (SCAT-3, SCAT-5) | SCAT5FacialInjuryInd | Recommended | UDE |
STEP 3 MEMORY ASSESSMENT MADDOCKS QUESTIONS (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Maddocks Score - incident description text | A free text, which is a subject narrative of the incident, describing what happened, as part of the Maddocks Score | MaddocksScoreDescrTxt | Recommended | CDE |
| 2 | Maddocks Score - Correct venue indicator | Indicator that the subject remembered the location of the game correctly, as part of the Maddocks Score - Recent Memory Questions | MaddocksScoreCorrVenueInd | Recommended | CDE |
| 3 | Maddocks Score - Correct game quarter indicator | Indicator that the subject remembered the quarter correctly, as part of the Maddocks Score - Recent Memory Questions | MaddocksScoreCorrQuarterInd | Recommended | CDE |
| 4 | Maddocks Score - Correct name of team to score last indicator | Indicator that the subject remembered the name of the team that kicked the last goal correctly, as part of the Maddocks Score - Recent Memory Questions | MaddocksScoreCorrTeamScoreInd | Recommended | CDE |
| 5 | Maddocks Score - Correct name of team played last week indicator | Indicator that the subject remembered the name of the team they played last week correctly, as part of the Maddocks Score - Recent Memory Questions | MaddocksScoreCorrTeamPlayInd | Recommended | CDE |
| 6 | Maddocks Score - Correct winning team indicator | Indicator that the subject remembered correctly whether their team won last week, as part of the Maddocks Score - Recent Memory Questions | MaddocksScoreCorrTeamWonInd | Recommended | CDE |
| 7 | Maddocks Score - Total score | Total score, as part of the Maddocks Score | MaddocksScoreTotalScore | Recommended | CDE |
STEP 4 EXAMINATION GLASGOW COMA SCALE (GCS) ADULT (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Assessment performed date | The date of assessment of the examination being performed. | AssessmentPerformedDate | Recommended | CDE |
| 2 | Glasgow Coma Scale (GCS) - Eye response scale | Glasgow Coma Scale (GCS) - Best eye response (E). The GCS is a standardized instrument for assessing the level of consciousness. It evaluates three aspects of responsiveness: eye opening, motor response, verbal response. | GCSEyeRespnsScale | Recommended | CDE |
| 3 | Glasgow Coma Scale (GCS) - Motor response scale | Glasgow Coma Scale (GCS) - Best motor response (M). The GCS is a standardized instrument for assessing the level of consciousness. It evaluates three aspects of responsiveness: eye opening, motor response, verbal response. | GCSMotorRespnsScale | Recommended | CDE |
| 4 | Glasgow Coma Scale (GCS) - Verbal response scale | Score that describes the participant's verbal response according to the Glasgow Coma Scale (GCS) | GCSVerbalRspnsScale | Recommended | CDE |
| 5 | Glasgow Coma Scale (GCS) - Total score | Glasgow Coma Scale (GCS) - Total Score. The GCS is a standardized instrument for assessing the level of consciousness. | GCSTotalScore | Recommended | CDE |
CERVICAL SPINE ASSESSMENT (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Sport Concussion Assessment Tool (SCAT-5) - cervical spine assessment neck pain indicator | Indicator if the subject neck is pain free at rest, as part of Sport Concussion Assessment Tool (SCAT-5) - cervical spine assessment | SCAT5CervSpineNeckPainInd | Recommended | UDE |
| 2 | Sport Concussion Assessment Tool (SCAT-5) - cervical spine assessment pain free movement indicator | Indicator if the subject neck is pain free at rest, as part of Sport Concussion Assessment Tool (SCAT-5) - cervical spine assessment | SCAT5CervSpinePainFreeAMovInd | Recommended | UDE |
| 3 | Sport Concussion Assessment Tool (SCAT-5) - cervical spine assessment limb strength and sensation normal indicator | Indicator I if the subject has the limb strength and sensation normal, as part of Sport Concussion Assessment Tool (SCAT-5) - cervical spine assessment | SCAT5CervSpineLimbStrengthInd | Recommended | UDE |
OFFICE OF OFF-FIELD STEP 1 ATHLETE BACKGROUND (Appears Exactly 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Sport team participation type | The sport or team that the athlete participates in | SportTeamParticipationTyp | Recommended | UDE |
| 2 | Sport team participation other text | The free-text related to Sport team participation type specifying the other type of sport or team | SportTeamParticipationTypOTH | Optional | UDE |
| 3 | Education year count | Number of years of education completed (age 5 and beyond) | EduYrCt | Recommended | CDE |
| 4 | Hand preference type | Hand which the participant/subject uses predominantly, not necessarily the hand he/she writes with exclusively. | HandPrefTyp | Recommended | CDE |
| 5 | Concussion prior number | Number of prior concussions | ConcussionPriorNum | Recommended | CDE |
| 6 | Concussion event date | Date (and time, if applicable and known) of concussion event | ConcussionEventDate | Recommended | UDE |
| 7 | Concussion symptom duration | Number of days that the participant suffered from post-concussive symptoms | ConcussionSymptomDurDays | Recommended | CDE |
| 8 | Sport Concussion Assessment Tool (SCAT-3) - Hospitalized or had medical imaging done for a head injury indicator | Indicator if the subject was hospitalized or had medical imaging done for a head injury, as part of Sport Concussion Assessment Tool (SCAT-3) | SCAT3HospitaImgHeadInjInd | Recommended | UDE |
| 9 | Headache migraine diagnosis indicator | Indicator of whether the participant/subject has been diagnosed with the type of headache or migraine | HeadachMigranDiagnsInd | Recommended | CDE |
| 10 | Sport Concussion Assessment Tool ( SCAT-5) - learning disability, dyslexia diagnosis indicator | Indicator whether the participant/subject was ever given formal diagnosis of any learning disability or dislexia, as part of Sport Concussion Assessment Tool (SCAT-5) | SCAT5LearnDisabDiagnosInd | Recommended | UDE |
| 11 | Sport Concussion Assessment Tool ( SCAT-5) - ADD or ADHD diagnosis indicator | Indicator whether the participant/subject was ever given formal diagnosis of ADD/ADHD, as part of Sport Concussion Assessment Tool (SCAT-5) | SCAT5ADDADHDDiagnosInd | Recommended | UDE |
| 12 | Sport Concussion Assessment Tool (SCAT-3) - Diagnosed with depression, anxiety or other psychiatric disorder | Indicator if the subject was diagnosed with depression, anxiety or other psychiatric disorder, as part of Sport Concussion Assessment Tool (SCAT-3) | SCAT3AnxDeprPsychDxInd | Recommended | UDE |
| 13 | Medication prior or concomitant ongoing indicator | Indicator of or description that the prior/concomitant medication usage is ongoing. | MedctPrConcomOngoingInd | Recommended | CDE |
| 14 | Medication prior or concomitant name | Name of the prior/concomitant agent or drug administered. | MedctnPriorConcomName | Recommended | CDE |
OFFICE OF OFF-FIELD STEP 2 SYMPTOM EVALUATION (Appears Up To 2 Times)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Context type | The context to which the questions were answered | ContextType | Recommended | CDE |
| 2 | Context type other text | The free-text related to ContextType specifying other text | ContextTypeOTH | Optional | CDE |
| 3 | Sport Concussion Assessment Tool (SCAT-3, SCAT-5) - Headache scale | Headache scale, as part of Sport Concussion Assessment Tool (SCAT-3) | Scat3Headache | Recommended | CDE |
| 4 | Sport Concussion Assessment Tool (SCAT-3, SCAT-5) - Pressure in head scale | Pressure in head scale, as part of Sport Concussion Assessment Tool (SCAT-3) | Scat3Pressureinhead | Recommended | CDE |
| 5 | Sport Concussion Assessment Tool (SCAT-3, SCAT-5) - Neck pain scale | Neck pain scale, as part of Sport Concussion Assessment Tool (SCAT-3) | Scat3Neckpain | Recommended | CDE |
| 6 | Sport Concussion Assessment Tool (SCAT-3, SCAT-5) - Nausea, vomiting scale | Nausea vomiting scale, as part of Sport Concussion Assessment Tool (SCAT-3) | Scat3Nauseavomiting | Recommended | CDE |
| 7 | Sport Concussion Assessment Tool (SCAT-3, SCAT-5) - Dizziness scale | Dizziness scale, as part of Sport Concussion Assessment Tool (SCAT-3) | Scat3Dizziness | Recommended | CDE |
| 8 | Sport Concussion Assessment Tool (SCAT-3, SCAT-5) - Blurred vision scale | Blurred vision scale, as part of Sport Concussion Assessment Tool (SCAT-3) | Scat3BlurryVision | Recommended | CDE |
| 9 | Sport Concussion Assessment Tool (SCAT-3, SCAT-5) - Balance problems scale | Balance problems scale, as part of Sport Concussion Assessment Tool (SCAT-3) | Scat3BalanceProblem | Recommended | CDE |
| 10 | Sport Concussion Assessment Tool (SCAT-3, SCAT-5) - Sensitivity to light scale | Sensitivity to light scale, as part of Sport Concussion Assessment Tool (SCAT-3) | Scat3SenssivityLight | Recommended | CDE |
| 11 | Sport Concussion Assessment Tool (SCAT-3, SCAT-5) - Sensitivity to noise scale | Sensitivity to noise scale, as part of Sport Concussion Assessment Tool (SCAT-3) | Scat3SensitivityNoise | Recommended | CDE |
| 12 | Sport Concussion Assessment Tool (SCAT-3, SCAT-5) - Feeling slowed down scale | Feeling slowed down scale, as part of Sport Concussion Assessment Tool (SCAT-3) | Scat3FeelSlowDown | Recommended | CDE |
| 13 | Sport Concussion Assessment Tool (SCAT-3, SCAT-5) - Feeling in a fog scale | Feeling in a fog scale, as part of Sport Concussion Assessment Tool (SCAT-3) | Scat3FeelFog | Recommended | CDE |
| 14 | Sport Concussion Assessment Tool (SCAT-3, SCAT-5) - Don't feel right scale | Don't feel right scale, as part of Sport Concussion Assessment Tool (SCAT-3) | Scat3DontFeelRight | Recommended | CDE |
| 15 | Sport Concussion Assessment Tool (SCAT-3, SCAT-5) - Difficult concentrating scale | Difficult concentrating scale, as part of Sport Concussion Assessment Tool (SCAT-3) | Scat3DifficultyConcent | Recommended | CDE |
| 16 | Sport Concussion Assessment Tool (SCAT-3, SCAT-5) - Difficulty remembering scale | Difficulty remembering scale, as part of Sport Concussion Assessment Tool (SCAT-3) | Scat3DifficultyRemembering | Recommended | CDE |
| 17 | Sport Concussion Assessment Tool (SCAT-3, SCAT-5) - Fatigue or low energy scale | Fatigue or low energy scale, as part of Sport Concussion Assessment Tool (SCAT-3) | Scat3FatgLowEnergy | Recommended | CDE |
| 18 | Sport Concussion Assessment Tool (SCAT-3, SCAT-5) - Confusion scale | Confusion scale, as part of Sport Concussion Assessment Tool (SCAT-3) | Scat3Confusion | Recommended | CDE |
| 19 | Sport Concussion Assessment Tool (SCAT-3, SCAT-5) - Drowsiness scale | Drowsiness scale, as part of Sport Concussion Assessment Tool (SCAT-3) | Scat3Drowsiness | Recommended | CDE |
| 20 | Sport Concussion Assessment Tool (SCAT-3, SCAT-5) - More emotional scale | More emotional scale, as part of Sport Concussion Assessment Tool (SCAT-3) | Scat3MoreEmotional | Recommended | CDE |
| 21 | Sport Concussion Assessment Tool (SCAT-3, SCAT-5) - Irritability scale | Irritability scale, as part of Sport Concussion Assessment Tool (SCAT-3) | Scat3Irritable | Recommended | CDE |
| 22 | Sport Concussion Assessment Tool (SCAT-3, SCAT-5) - Sadness scale | Sadness scale, as part of Sport Concussion Assessment Tool (SCAT-3) | Scat3Sadness | Recommended | CDE |
| 23 | Sport Concussion Assessment Tool (SCAT-3, SCAT-5) - Nervous or anxious scale | Nervous or anxious scale, as part of Sport Concussion Assessment Tool (SCAT-3) | Scat3NervousAnxious | Recommended | CDE |
| 24 | Sport Concussion Assessment Tool (SCAT-3, SCAT-5) - Trouble falling asleep | SCAT-3 Trouble falling asleep indicator | Scat3TroublFallAsleep | Recommended | CDE |
| 25 | Sport Concussion Assessment Tool (SCAT-3, SCAT-5) - Total symptoms | Value for total number of symptoms reported, as part of Sport Concussion Assessment Tool (SCAT-3) | Scat3TotalSymptoms | Recommended | CDE |
| 26 | Sport Concussion Assessment Tool (SCAT-3, SCAT-5) - Total symptom score | Value for total symptom score, as part of Sport Concussion Assessment Tool (SCAT-3) | Scat3TotSympScore | Recommended | CDE |
| 27 | Sport Concussion Assessment Tool (SCAT-3, SCAT-5) - Symptoms worsen with physical activity indicator | Symptoms get worse with physical activity indicator, as part of Sport Concussion Assessment Tool (SCAT-3) | Scat3SympPhysActvty | Recommended | CDE |
| 28 | Sport Concussion Assessment Tool (SCAT-3, SCAT-5) - Symptoms worsen with mental activity indicator | Symptoms get worse with mental activity indicator, as part of Sport Concussion Assessment Tool (SCAT-3) | Scat3SympMentActvty | Recommended | CDE |
| 29 | Sport Concussion Assessment Tool (SCAT-3) - Source of data rating type | Type of rating applied for the "How do you feel?" section, as part of Sport Concussion Assessment Tool (SCAT-3) | SCAT3DataSourceTyp | Optional | UDE |
| 30 | Sport Concussion Assessment Tool (SCAT-3) - Difference in athlete acting scale | Scale showing how different is the athlete acting compared to his / her usual (before injury) self, as part of Sport Concussion Assessment Tool (SCAT-3) | SCAT3DifferAthleteActScore | Recommended | UDE |
| 31 | Sport Concussion Assessment Tool (SCAT-3, SCAT-5) - Feel normal percent text | A free text, related to "Sport Concussion Assessment Tool (SCAT-3, SCAT-5) - Feel normal percent" explaining why the subject does not feel 100% normal, as part of Sport Concussion Assessment Tool (SCAT-3) | SCAT5FeelNormalPecentTxt | Recommended | CDE |
| 32 | Sport Concussion Assessment Tool (SCAT-3, SCAT-5) - Feel normal percent | Percent use as a score to evaluate how normal the subject feels, as part of Sport Concussion Assessment Tool (SCAT-3) | SCAT5FeelNormalPecent | Recommended | CDE |
OFFICE OFF-FIELD STEP 3 CS ORIENTATION (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Standardized Assessment of Concussion (SAC) - Orientation current month score | Scored ability to identify the current month, as part of the Standardized Assessment of Concussion (SAC) Orientation subtest | SACOrientationCurrMonthScore | Recommended | UDE |
| 2 | Standardized Assessment of Concussion (SAC) - current date score | Scored ability to identify the current date as part of the Standardized Assessment of Concussion (SAC) Orientation subtest | SACOrientationCurrDateScore | Recommended | UDE |
| 3 | Standardized Assessment of Concussion (SAC) - current day of the week score | Scored ability to identify the current day of the week as part of the Standardized Assessment of Concussion (SAC) Orientation subtest | SACOrientationCurrDayWeekScore | Recommended | UDE |
| 4 | Standardized Assessment of Concussion (SAC) - current year score | Scored ability to identify the current year as part of the Standardized Assessment of Concussion (SAC) Orientation subtest | SACOrientationCurrYearScore | Recommended | UDE |
| 5 | Standardized Assessment of Concussion (SAC) - current time score | Scored ability to identify the current time (within 1 hour) as part of the Standardized Assessment of Concussion (SAC) Orientation subtest | SACOrientationCurrTimeScore | Recommended | UDE |
| 6 | Standardized Assessment of Concussion (SAC) - Orientation subset score | Total score as part of the Standardized Assessment of Concussion (SAC) orientation subtest | SACOrientationSubsetScore | Recommended | UDE |
OFFICE OFF-FIELD STEP 3 CS IMMEDIATE MEMORY (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Standardized Assessment of Concussion (SAC) - immediate memory list type | Type of list, as part of the Standardized Assessment of Concussion (SAC) | SACListTyp | Recommended | UDE |
| 2 | Standardized Assessment of Concussion (SAC) - List sub- type | Sub-type of the list presented as a letter to be used in capturing immediate memory and concentration trials lists (for words and digits backwards), as part of the Standardized Assessment of Concussion (SAC) | SACListSubTyp | Recommended | UDE |
| 3 | Trial number (numeric) | The number representing the sequence for any repeated measure test or assessment when it is performed multiple times. | TrialNumber | Recommended | UDE |
| 4 | Standardized Assessment of Concussion (SAC) - Immediate memory 5 words subset trial total score | Trial score as part of the Standardized Assessment of Concussion (SAC) immediate memory subtest 5 words list | SACImmdMemoryTrialScore | Recommended | UDE |
| 5 | Standardized Assessment of Concussion (SAC) - Immediate memory 5 words subset score | Total score as part of the Standardized Assessment of Concussion (SAC) immediate memory subtest 5 words list | SACImmdMemorySubsetScore | Recommended | UDE |
| 6 | Standardized Assessment of Concussion (SAC) - Immediate memory 10 words subset score | Total score as part of the Standardized Assessment of Concussion (SAC) immediate memory subtest 10 words list | SACImmdMemorySubset10Score | Recommended | UDE |
| 7 | Standardized Assessment of Concussion (SAC) - Immediate memory 10 words subset trial total score | Trial score as part of the Standardized Assessment of Concussion (SAC) immediate memory subtest 10 words list | SACImmdMemorySubset10TrScore | Recommended | UDE |
| 8 | Trial completion date and time | The date and time (if available) when the given trial was completed. Should be used along with TrialNumber to define the trial number | TrialCompletionDatTime | Recommended | UDE |
OFFICE OFF-FIELD STEP 3 CS CONC DIGITS BACKWARDS (Appears Up To 8 Times)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Standardized Assessment of Concussion (SAC) - List sub- type | Sub-type of the list presented as a letter to be used in capturing immediate memory and concentration trials lists (for words and digits backwards), as part of the Standardized Assessment of Concussion (SAC) | SACListSubTyp | Recommended | UDE |
| 2 | Standardized Assessment of Concussion (SAC) - Concentration subtest digits backward set indicator | Indicator of the participant to recite the first set of digits backwards, as part of the Standardized Assessment of Concussion (SAC) concentration subtest digits backward | SACConcDigitBackwrdsSetInd | Recommended | UDE |
| 3 | Standardized Assessment of Concussion (SAC) - Concentration subtest digits backward set 1 score | Scored ability of the participant to recite the first set of digits backwards, as part of the Standardized Assessment of Concussion (SAC) concentration subtest digits backward | SACConcDigitBackwrdsSet1Score | Recommended | UDE |
| 4 | Standardized Assessment of Concussion (SAC) - Concentration subtest digits backward set 2 score | Scored ability of the participant to recite the second set of digits backwards, as part of the Standardized Assessment of Concussion (SAC) concentration subtest digits backward | SACConcDigitBackwrdsSet2Score | Recommended | UDE |
| 5 | Standardized Assessment of Concussion (SAC) - Concentration subtest digits backward set 3 score | Scored ability of the participant to recite the third set of digits backwards, as part of the Standardized Assessment of Concussion (SAC) concentration subtest digits backward | SACConcDigitBackwrdsSet3Score | Recommended | UDE |
| 6 | Standardized Assessment of Concussion (SAC) - Concentration subtest digits backward set 4 score | Scored ability of the participant to recite the fourth set of digits backwards, as part of the Standardized Assessment of Concussion (SAC) concentration subtest digits backward | SACConcDigitBackwrdsSet4Score | Recommended | UDE |
| 7 | Standardized Assessment of Concussion (SAC) - Concentration digits backwards subset total score | Total score as part of the Standardized Assessment of Concussion (SAC) concentration subtest | SACConcentationDigitsTotScore | Recommended | UDE |
OFFICE OFF-FIELD STEP 3 CS CONC MONTHS (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Standardized Assessment of Concussion (SAC) - Concentration subtest months in reverse order score | Scored ability of the participant to recite months of the year backward as part of the Standardized Assessment of Concussion (SAC) concentration subtest month in reverse order | SACConcMonthReverseScore | Recommended | UDE |
OFFICE OFF-FIELD STEP 3 CS CONC TOTAL (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Standardized Assessment of Concussion (SAC) - Concentration subset score | Total score as part of the Standardized Assessment of Concussion (SAC) concentration subtest | SACConcentationSubsetScore | Recommended | UDE |
OFFICE OFF-FIELD STEP 4 NEUROLOGICAL (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Sport Concussion Assessment Tool (SCAT-5) - neurological screen read aloud indicator | Indicator if the subject can read aloud and follow instructions, as part of Sport Concussion Assessment Tool (SCAT-5) - cervical spine assessment | SCAT5NSReadAlodInd | Recommended | UDE |
| 2 | Sport Concussion Assessment Tool (SCAT-5) - neurological screen pain free passive movement indicator | Indicator if the subject has a full range of PASSIVE pain free movement, as part of Sport Concussion Assessment Tool (SCAT-5) - cervical spine assessment | SCAT5CervSpinePainFreePMovInd | Recommended | UDE |
| 3 | Sport Concussion Assessment Tool (SCAT-5) - neurological screen no double-vision indicator | Indicator if the subject can move eyes without having double-vision, as part of Sport Concussion Assessment Tool (SCAT-5) - cervical spine assessment | SCAT5NSDoubleVisionInd | Recommended | UDE |
| 4 | Sport Concussion Assessment Tool (SCAT-5) - neurological screen finger-nose indicator | Indicator if the subject can perform finger to nose movement, as part of Sport Concussion Assessment Tool (SCAT-5) - cervical spine assessment | SCAT5NSFingerNoseInd | Recommended | UDE |
| 5 | Sport Concussion Assessment Tool (SCAT-5) - neurological screen tandem gait indicator | Indicator if the subject can perform tandem gait normally, as part of Sport Concussion Assessment Tool (SCAT-5) - cervical spine assessment | SCAT5NSTandemGaitInd | Recommended | UDE |
OFFICE OFF-FIELD STEP 4 NEUROLOGICAL BESS (Appears Up To 48 Times)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Balance Error Scoring System Modified (BESS Modified) - Foot tested anatomic site | Anatomic site of non-dominant foot tested, as part of Balance Error Scoring System Modified (BESS Modified). | BESSFootTestAnatSite | Recommended | CDE |
| 2 | Ground surface type | The type of ground surface. | GroundSurfTyp | Recommended | CDE |
| 3 | Footwear use type | The type of footwear used. | FootwearUseTyp | Recommended | CDE |
| 4 | Balance Error Scoring System (BESS) - Double leg stance firm surface error count | Number of errors during double leg stance with feet together on firm surface, as part of Balance Error Scoring System (BESS). | BESSDblLegFirmErrorCt | Recommended | CDE |
| 5 | Balance Error Scoring System (BESS) - Double leg stance foam surface error count | Number of errors during double leg stance with feet together on foam surface, as part of Balance Error Scoring System (BESS). | BESSDblLegFoamErrorCt | Recommended | CDE |
| 6 | Balance Error Scoring System (BESS) - Single leg stance firm surface error count | Number of errors during single leg stance with non-dominant foot tested on firm surface, as part of Balance Error Scoring System (BESS). | BESSSglLegFirmErrorCt | Recommended | CDE |
| 7 | Balance Error Scoring System (BESS) - Single leg stance foam surface error count | Number of errors during single leg stance with non-dominant foot tested on foam surface, as part of Balance Error Scoring System (BESS). | BESSSglLegFoamErrorCt | Recommended | CDE |
| 8 | Balance Error Scoring System (BESS) - Tandem stance firm surface error count | Number of errors during tandem stance with non-dominant foot in back on firm surface, as part of Balance Error Scoring System (BESS). | BESSTandemFirmErrorCt | Recommended | CDE |
| 9 | Balance Error Scoring System (BESS) - Tandem stance foam surface error count | Number of errors during tandem stance with non-dominant foot in back on foam surface, as part of Balance Error Scoring System (BESS). | BESSTandemStncFoamSrfcErrorCt | Recommended | CDE |
| 10 | Balance Error Scoring System Modified (BESS Modified) - Double leg stance total error count | Total number of errors during double leg stance with feet together on both firm and foam surfaces, as part of Balance Error Scoring System (BESS). | BESSDblLegTotalErrorCt | Recommended | CDE |
| 11 | Balance Error Scoring System Modified (BESS Modified) - Single leg stance total error count | Total number of errors during single leg stance with non-dominant foot tested on both firm and foam surfaces, as part of Balance Error Scoring System (BESS). | BESSSglLegTotalErrorCt | Recommended | CDE |
| 12 | Balance Error Scoring System Modified (BESS Modified) - Tandem stance total error count | Total number of errors tandem stance on both firm and foam surfaces, as part of Balance Error Scoring System (BESS). | BESSTandemStncTotalErrorCt | Recommended | CDE |
| 13 | Balance Error Scoring System (BESS) - Both firm foam surface total error count | Total number of errors for both firm and foam surface, as part of Balance Error Scoring System (BESS). | BESSTotalErrorCt | Recommended | CDE |
OFFICE OFF-FIELD STEP 5 DELAYED RECALL (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Standardized Assessment of Concussion (SAC) - immediate memory list type | Type of list, as part of the Standardized Assessment of Concussion (SAC) | SACListTyp | Recommended | UDE |
| 2 | Trial completion date and time | The date and time (if available) when the given trial was completed. Should be used along with TrialNumber to define the trial number | TrialCompletionDatTime | Recommended | UDE |
| 3 | Standardized Assessment of Concussion (SAC) - Delayed recall 5 words list subset score | Total score as part of the Standardized Assessment of Concussion (SAC) delayed recall 5 words list subtest | SACDelayedRecallSubsetScore | Recommended | UDE |
| 4 | Standardized Assessment of Concussion (SAC) - Delayed recall 10 words list subset score | Total score as part of the Standardized Assessment of Concussion (SAC) delayed recall 10 words list subtest | SACDelayedRecall10SubsetScore | Recommended | UDE |
| 5 | Standardized Assessment of Concussion (SAC) - Delayed recall words text | A free text, a list of words recalled by the subject during the delayed recall trial and recorded by the examiner, s part of the Standardized Assessment of Concussion (SAC) delayed recall trial | SACDelayedRecallwordsTxt | Recommended | UDE |
OFFICE OFF-FIELD STEP 6 DECISION (Appears Up To 3 Times)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Assessment date and time | The date of participant's injury | AssessDateTime | Recommended | CDE |
| 2 | Sport Concussion Assessment Tool (SCAT-3, SCAT-5) - Total symptoms | Value for total number of symptoms reported, as part of Sport Concussion Assessment Tool (SCAT-3) | Scat3TotalSymptoms | Recommended | CDE |
| 3 | Sport Concussion Assessment Tool (SCAT-3, SCAT-5) - Total symptom score | Value for total symptom score, as part of Sport Concussion Assessment Tool (SCAT-3) | Scat3TotSympScore | Recommended | CDE |
| 4 | Standardized Assessment of Concussion (SAC) - Orientation subset score | Total score as part of the Standardized Assessment of Concussion (SAC) orientation subtest | SACOrientationSubsetScore | Recommended | UDE |
| 5 | Standardized Assessment of Concussion (SAC) - Immediate memory 5 words subset score | Total score as part of the Standardized Assessment of Concussion (SAC) immediate memory subtest 5 words list | SACImmdMemorySubsetScore | Recommended | UDE |
| 6 | Standardized Assessment of Concussion (SAC) - Immediate memory 10 words subset score | Total score as part of the Standardized Assessment of Concussion (SAC) immediate memory subtest 10 words list | SACImmdMemorySubset10Score | Recommended | UDE |
| 7 | Standardized Assessment of Concussion (SAC) - Concentration subset score | Total score as part of the Standardized Assessment of Concussion (SAC) concentration subtest | SACConcentationSubsetScore | Recommended | UDE |
| 8 | Sport Concussion Assessment Tool (SCAT-5) - neurological screen status | Status of neurological screening (abnormal or normal), as part of Sport Concussion Assessment Tool (SCAT-5) - neurological screen | SCAT5NSStatus | Recommended | UDE |
| 9 | Balance Error Scoring System (BESS) - Both firm foam surface total error count | Total number of errors for both firm and foam surface, as part of Balance Error Scoring System (BESS). | BESSTotalErrorCt | Recommended | CDE |
| 10 | Standardized Assessment of Concussion (SAC) - Delayed recall 5 words list subset score | Total score as part of the Standardized Assessment of Concussion (SAC) delayed recall 5 words list subtest | SACDelayedRecallSubsetScore | Recommended | UDE |
| 11 | Standardized Assessment of Concussion (SAC) - Delayed recall 10 words list subset score | Total score as part of the Standardized Assessment of Concussion (SAC) delayed recall 10 words list subtest | SACDelayedRecall10SubsetScore | Recommended | UDE |
| 12 | Injury date time | Date (and time, if applicable and known) of injury | InjDateTime | Recommended | CDE |
| 13 | Sport Concussion Assessment Tool (SCAT-3) - Difference in athlete acting scale | Scale showing how different is the athlete acting compared to his / her usual (before injury) self, as part of Sport Concussion Assessment Tool (SCAT-3) | SCAT3DifferAthleteActScore | Recommended | UDE |
| 14 | Concussion diagnosis status | Indicator, whether the reported concussion was or was not diagnosed by a medical provider | ConcussDxStatus | Recommended | CDE |
| 15 | Subject improved indicator | Indicator, if the subject (an athlete) showed the signs of improvement in his /her conditions during re-testing | SubjectImproveInd | Recommended | UDE |
CLINICAL NOTES (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | General notes text | General notes | GeneralNotesTxt | Recommended | CDE |
Keywords
