CDE Detailed Report

Disease: Epilepsy
Sub-Domain: Assessing Comorbidities
CRF: Post-Traumatic Epilepsy Screening Form

Displaying 1 - 11 of 11
CDE ID CDE Name Variable Name Definition Short Description Additional Notes (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
C19510 Post traumatic brain injury diagnosis epilepsy seizure diagnosis indicator PstTBIDiagEpilpSeizDiagInd Indicator for the diagnosis of the participant with epilepsy, a seizure disorder, or a single seizure after the date of the traumatic brain injury diagnosis Indicator for the diagnosis of the participant with epilepsy, a seizure disorder, or a single seizure after the date of the traumatic brain injury diagnosis Hast the participant been diagnosed with epilepsy, a seizure disorder, or a single seizure after the date of the traumatic brain injury diagnosis? No;Yes;Unknown No;Yes;Unknown Alphanumeric Adult;Pediatric Supplemental 1.00 2014-06-30 11:33:00.0 Post-Traumatic Epilepsy Screening Form Assessing Comorbidities Outcomes and End Points

Single Pre-Defined Value Selected

C19511 Seven days post traumatic brain injury seizure occurrence indicator SevnDaysPstTBISeizOccurncInd Indicator for the occurrence of seizure(s) later than seven days after the date of the traumatic brain injury Indicator for the occurrence of seizure(s) later than seven days after the date of the traumatic brain injury Did seizure(s) occur later than seven days after the date of the traumatic brain injury? No;Yes;Unknown No;Yes;Unknown Alphanumeric Adult;Pediatric Supplemental 1.00 2014-06-30 11:38:13.0 Post-Traumatic Epilepsy Screening Form Assessing Comorbidities Outcomes and End Points

Single Pre-Defined Value Selected

C19512 Diagnosis giver type DiagnosisGiverTyp Type of professional who gave the diagnosis Type of professional who gave the diagnosis Who gave this diagnosis? Neurologist;Neurosurgeon;Nurse Practitioner;Pediatric Neurologist;Pediatrician;Primary Care Physician;Psychiatrist;Psychologist Neurologist;Neurosurgeon;Nurse Practitioner;Pediatric Neurologist;Pediatrician;Primary Care Physician;Psychiatrist;Psychologist Alphanumeric Adult;Pediatric Supplemental 1.00 2014-06-30 11:41:47.0 Post-Traumatic Epilepsy Screening Form Assessing Comorbidities Outcomes and End Points

Single Pre-Defined Value Selected

C19513 Seizure or epilepsy medication patient reception indicator SeizEpilepMedicaPatntReceptInd Indicator for the patient's reception of medication for seizures or epilepsy Indicator for the patient's reception of medication for seizures or epilepsy Has the patient received medication for seizures or epilepsy? No;Yes;Unknown No;Yes;Unknown Alphanumeric Adult;Pediatric Supplemental 1.00 2014-06-30 11:51:50.0 Post-Traumatic Epilepsy Screening Form Assessing Comorbidities Outcomes and End Points

Single Pre-Defined Value Selected

C08007 Diagnosis first given date and time DiagnosFirstGivnDateTime Date (and time if applicable and known) the participant/subject was initially diagnosed with the disease or disorder Date (and time if applicable and known) the participant/subject was initially diagnosed with the disease or disorder Date of diagnosis Date or Date & Time

Record the date/time according to the ISO 8601, the International Standard for the representation of dates and times (http://www.iso.org/iso/home.html). The date/time should be recorded to the level of granularity known (e.g., year, year and month, complete date plus hours and minutes, etc.).

No references available Adult;Pediatric Supplemental 3.00 2013-07-24 11:38:01.2 Post-Traumatic Epilepsy Screening Form Assessing Comorbidities Outcomes and End Points

Free-Form Entry

C19504 Family member body uncontrolled movement indicator FamMmberBodyUncntrlldMovmntInd Indicator for uncontrolled movements of part or all of the body such as twitching, jerking, shaking, or going limp, lasting about 5 minutes or less, that a family member has had or told you that you/they had Indicator for uncontrolled movements of part or all of the body such as twitching, jerking, shaking, or going limp, lasting about 5 minutes or less, that a family member has had or told you that you/they had Uncontrolled movements of part or all of the body such as twitching, jerking, shaking or going limp, lasting about 5 minutes or less? No;Yes;Unknown No;Yes;Unknown Alphanumeric Adult;Pediatric Supplemental 1.00 2014-06-30 10:35:45.0 Post-Traumatic Epilepsy Screening Form Assessing Comorbidities Outcomes and End Points

Single Pre-Defined Value Selected

C19505 Family member mental state awareness level unexplained change indicator FamMmbrMentlSteAwrnsLvlChngInd Indicator for an unexplained change in mental state or level of awareness; or an episode of "spacing out which you/your family member could not control, lasting about 5 minutes or less, that a family member has had or told you that you/they had Indicator for an unexplained change in mental state or level of awareness; or an episode of "spacing out which you/your family member could not control, lasting about 5 minutes or less, that a family member has had or told you that you/they had An unexplained change in mental state or level of awareness; or an episode of "spacing out" which you/your family member could not control, lasting about 5 minutes or less? No;Yes;Unknown No;Yes;Unknown Alphanumeric Adult;Pediatric Supplemental 1.00 2014-06-30 10:35:45.0 Post-Traumatic Epilepsy Screening Form Assessing Comorbidities Outcomes and End Points

Single Pre-Defined Value Selected

C19506 Family member repeated unusual attack or convulsion other type indicator FamMemRepUnuslAtkCnvlOthTypInd Indicator for any other type of repeated unusual attacks or convulsions lasting about 5 minutes or less that a family member has had or told you that you/they had Indicator for any other type of repeated unusual attacks or convulsions lasting about 5 minutes or less that a family member has had or told you that you/they had Any other type of repeated unusual attacks or convulsions lasting about 5 minutes or less? No;Yes;Unknown No;Yes;Unknown Alphanumeric Adult;Pediatric Supplemental 1.00 2014-06-30 10:35:45.0 Post-Traumatic Epilepsy Screening Form Assessing Comorbidities Outcomes and End Points

Single Pre-Defined Value Selected

C19507 Family member seizures or epilepsy indicator FamMembrSeizureEpilepsyInd Indicator for someone having told you that you/your family member have seizures or epilepsy Indicator for someone having told you that you/your family member have seizures or epilepsy Has anyone ever told you that you/your family member have seizure(s) or epilepsy? No;Yes;Unknown No;Yes;Unknown Alphanumeric Adult;Pediatric Supplemental 1.00 2014-06-30 11:14:02.0 Post-Traumatic Epilepsy Screening Form Assessing Comorbidities Outcomes and End Points

Single Pre-Defined Value Selected

C19508 Source of information queried type SourceOfInformationQueriedTyp Type of source of information queried Type of source of information queried Which of the following sources of information were queried? Caregiver;Medical record;Patient Caregiver;Medical record;Patient Alphanumeric

Check all that apply

Adult;Pediatric Supplemental 1.00 2014-06-30 11:20:53.0 Post-Traumatic Epilepsy Screening Form Assessing Comorbidities Outcomes and End Points

Multiple Pre-Defined Values Selected

C19509 Pre traumatic brain injury seizure or epilepsy indicator PreTBISeizureEpilepsyInd Indicator for seizures or epilepsy that the patient had prior to the traumatic brain injury Indicator for seizures or epilepsy that the patient had prior to the traumatic brain injury Has the participant had seizures or epilepsy prior to the traumatic brain injury? No;Yes;Unknown No;Yes;Unknown Alphanumeric Adult;Pediatric Supplemental 1.00 2014-06-30 11:28:11.0 Post-Traumatic Epilepsy Screening Form Assessing Comorbidities Outcomes and End Points

Single Pre-Defined Value Selected

CSV