CDE Detailed Report

Disease: Cerebral Palsy
Subdomain Name: General Health History
CRF: Medical History

Displaying 101 - 117 of 117
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
C13520 Dysphagia indicator DysphagiaInd Did the participant/subject have dysphagia (difficulty swallowing) identified at bedside assessment? The dysphagia screening should utilize a validated tool that incorporates a swallow assessment and an assessment of level of consciousness and neurological function Did the participant/subject have dysphagia (difficulty swallowing) identified at bedside assessment? The dysphagia screening should utilize a validated tool that incorporates a swallow assessment and an assessment of level of consciousness and neurological functio Dysphagia indicator Yes;No;Unknown Yes;No;Unknown Alphanumeric

The dysphagia screening should utilize a validated tool that incorporates a swallow assessment and an assessment of level of consciousness and neurological function.

 Adult;Pediatric Supplemental 3.00 2013-06-21 00:00:00.0 Medical History General Health History Participant History and Family History

Single Pre-Defined Value Selected
C17486 Psychiatric history clinical depressive diagnosis indicator PsychHistClinDepressDiagnosInd Indicator as to whether the participant/subject had a depressive disorder diagnosis Indicator as to whether the participant/subject had a depressive disorder diagnosis Depressive disorder diagnosis Yes;No;Unknown Yes;No;Unknown Alphanumeric Adult;Pediatric Supplemental 3.00 2013-07-15 16:08:48.687 Medical History General Health History Participant History and Family History

Single Pre-Defined Value Selected
C00328 Prior traumatic injury type PriorTraumInjryType General location of traumatic injury, if evidence of prior traumatic injury General location of traumatic injury, if evidence of prior traumatic injury Prior traumatic injury type Brain Injury;Spine Injury;Other Extracranial Injury Brain Injury;Spine Injury;Other Extracranial Injury Alphanumeric Adult;Pediatric Supplemental 3.00 2013-07-19 21:21:51.533 Medical History General Health History Participant History and Family History

Multiple Pre-Defined Values Selected
C22673 Medical history autism indicator MedHistAutInd Indicator of whether participant/subject has Autism Indicator of whether participant/subject has Autism Autism Yes;No;Unknown Yes;No;Unknown Alphanumeric Adult;Pediatric Supplemental 1.00 2016-07-27 11:40:25.0 Medical History General Health History Participant History and Family History

Single Pre-Defined Value Selected
C17464 Cardiovascular history abnormal echocardiogram left ventricular hypertrophy indicator CardioHistAbnrmlECGLVHInd Indicator as to whether the participant/subject has or had an abnormal echocardiogram (ECG) specifically exhibiting left ventricular hypertrophy (LVH) Indicator as to whether the participant/subject has or had an abnormal echocardiogram (EKG) specifically exhibiting left ventricular hypertrophy (LVH) LVH Yes;No;Unknown Yes;No;Unknown Alphanumeric Adult;Pediatric Supplemental 3.00 2013-07-15 16:08:48.687 Medical History General Health History Participant History and Family History

Single Pre-Defined Value Selected
C19769 Medical history pulmonary aspiration diagnosis indicator MedHistPlmnryAspirDiagInd Indicator of history of aspiration Indicator of history of aspiration Pulmonary aspiration diagnosis indicator No;Yes;Unknown No;Yes;Unknown Alphanumeric Adult;Pediatric Supplemental 1.00 2015-02-05 00:00:00.0 Medical History General Health History Participant History and Family History

Single Pre-Defined Value Selected
C22652 Medical history recurrent ear infection indicator MedHistReccEarInfInd Indicator of whether the participant/subject has been affected by recurrent ear infections Indicator of whether the participant/subject has been affected by recurrent ear infections Recurrent ear infections Yes;No;Unknown Yes;No;Unknown Alphanumeric Adult;Pediatric Supplemental 1.00 2016-07-27 11:25:54.0 Medical History General Health History Participant History and Family History

Single Pre-Defined Value Selected
C10516 Scoliosis maximum spine curvature measurement ScolMaxSpnCrvtrMsrmnt The maximum curvature of the spine in degrees for a participant/subject who has been diagnosed with scoliosis The maximum curvature of the spine in degrees for a participant/subject who has been diagnosed with scoliosi Scoliosis maximum spine curvature measurement Numeric Values Adult;Pediatric Supplemental 3.00 2013-07-11 15:03:49.2 Medical History General Health History Participant History and Family History

Free-Form Entry
C17475 Cardiovascular history cardiac surgery type CardioHistCardSurgTyp Type of cardiac surgery or mechanical intervention the participant/subject underwent Type of cardiac surgery or mechanical intervention the participant/subject underwent If yes, indicate type (choose all that apply) Coronary artery bypass graft;Cardiac valve surgery, including non-open surgery;Pacemaker;Implantable cardiac defibrillator;Other, specify Coronary artery bypass graft (CABG);Cardiac valve surgery, including non-open surgery (i.e. percutaneous valvuloplasty);Pacemaker;Implantable cardiac defibrillator;Other, specify Alphanumeric Adult;Pediatric Supplemental 3.00 2013-07-15 16:08:48.687 Medical History General Health History Participant History and Family History

Multiple Pre-Defined Values Selected
C22663 Medical history gastroesophageal reflux disease (GERD) indicator MedHistGERDInd Indicator of whether the participant/subject has/had gastroesophageal reflux disease Indicator of whether the participant/subject has/had gastroesophageal reflux disease Gastroesophageal reflux disease Yes;No;Unknown Yes;No;Unknown Alphanumeric Adult;Pediatric Supplemental 1.00 2016-07-27 11:33:08.0 Medical History General Health History Participant History and Family History

Single Pre-Defined Value Selected
C14126 Seizure classification type SeizClassTyp The type of seizures present by classification The type of seizures present by classificatio Seizure classification type Generalized;Focal;Unclassified Generalized;Focal;Unclassified seizures are considered unidentifiable due to lack of data and do not fit in to the aforementioned categories for Generalized and Focal Seizures Alphanumeric Adult;Pediatric Supplemental 3.00 2013-08-28 16:08:00.453 Medical History General Health History Participant History and Family History

Multiple Pre-Defined Values Selected
C17488 Psychiatric history psychotic diagnosis type PsychHistPsychoticDiagnosTyp Type of psychotic disorder the participant/subject has been diagnosed with, if any Type of psychotic disorder the participant/subject has been diagnosed with, if any If yes, choose all disorders that apply Schizophrenia;Bipolar disorder;Depression with psychotic features;Dementia with psychotic ideation;Other, specify Schizophrenia;Bipolar disorder;Depression with psychotic features;Dementia with psychotic ideation;Other, specify Alphanumeric Adult;Pediatric Supplemental 3.00 2013-07-15 16:08:48.687 Medical History General Health History Participant History and Family History

Multiple Pre-Defined Values Selected
C00312 Body system category BodySysCat Category or grouping used in the comprehensive assessment of a participant/subject, which includes a subjective history taking component as well as an objective based structured interview and physical examination of all the body systems Category or grouping used in the comprehensive assessment of a participant/subject, which includes a subjective history taking component as well as an objective based structured interview and physical examination of all the body system Body System Allergic/Immunologic;Cardiovascular;Constitutional symptoms (e.g., fever, weight loss);Dermatological;Ears, Nose, Mouth, Throat;Endocrine;Eyes;Gastrointestinal;Gastrointestinal/Abdominal;Genitourinary;Gynecologic/Urologic/ Renal;Hematologic/Lymphatic;Hepatobiliary;Integumentary (skin and/or breast);Musculoskeletal;Musculoskeletal (separate from ALS exam);Neurological;Neurologic/CNS;Neurological (separate from ALS exam);Oncologic;Psychiatric;Pulmonary;Respiratory;Other, specify: Allergic/Immunologic;Cardiovascular;Constitutional symptoms (e.g., fever, weight loss);Dermatological;Ears, Nose, Mouth, Throat;Endocrine;Eyes;Gastrointestinal;Gastrointestinal/Abdominal;Genitourinary;Gynecologic/Urologic/ Renal;Hematologic/Lymphatic;Hepatobiliary;Integumentary (skin and/or breast);Musculoskeletal;Musculoskeletal (separate from ALS exam);Neurological;Neurologic/CNS;Neurological (separate from ALS exam);Oncologic;Psychiatric;Pulmonary;Respiratory;Other, specify: Alphanumeric

Record the appropriate body system for each line of medical history.

 Review of Symptoms from Centers for Medicare and Medicaid Services https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/eval_mgmt_serv_guide-ICN006764.pdf Adult;Pediatric Core 3.00 2013-07-25 08:54:08.2 Medical History General Health History Participant History and Family History

Single Pre-Defined Value Selected

 2002895
C05460 Seizure indicator SeizInd Indicator of seizure activity Indicator of seizure activity Seizures/Epilepsy Yes;No;Suspected;Unknown Yes;No;Suspected;Unknown Alphanumeric McHugh GS, Engel DC, Butcher I, et al. Prognostic value of secondary insults in traumatic brain injury: results from the IMPACT study. J Neurotrauma. 2007;24(2):287–293. Signorini DF, Andrews PJ, Jones PA, et al. Adding insult to injury: the prognostic value of early secondary insults for survival after traumatic brain injury. J Neurol Neurosurg Psychiatry. 1999;66(1):26–31. Adult;Pediatric Supplemental 3.00 2013-07-20 10:21:25.65 Medical History General Health History Participant History and Family History

Single Pre-Defined Value Selected
C22674 Medical history obsessive compulsive disorder indicator MedHistOCDInd Indicator of whether participant/subject has Obsessive Compulsive Disorder (OCD) Indicator of whether participant/subject has Obsessive Compulsive Disorder (OCD) Obsessive Compulsive Disorder (OCD) Yes;No;Unknown Yes;No;Unknown Alphanumeric Adult;Pediatric Supplemental 1.00 2016-07-27 11:40:50.0 Medical History General Health History Participant History and Family History

Single Pre-Defined Value Selected
C17465 Cardiovascular history abnormal echocardiogram other text CardioHistAbnrmlECGOtherTxt Text description of any abnormal characteristics other than left ventricular hypertrophy (LVH), or decreased left ventricular (LV) function that the participant/subject has ever exhibited on an echocardiogram (ECG) Text description of any abnormal characteristics other than left ventricular hypertrophy (LVH), or decreased left ventricular (LV) function that the participant/subject has ever exhibited on an echocardiogram (EKG) Other, specify Alphanumeric Adult;Pediatric Supplemental 3.00 2013-07-15 16:08:48.687 Medical History General Health History Participant History and Family History 255

Free-Form Entry
C19835 Pain indicator PainInd Indicator of pain present Indicator of pain present Pain indicator No;Yes;Unknown No;Yes;Unknown Alphanumeric Adult;Pediatric Supplemental 1.00 2015-02-05 00:00:00.0 Medical History General Health History Participant History and Family History

Single Pre-Defined Value Selected
CSV