CDE Detailed Report

Disease: Sport Related Concussion
Subdomain Name: Cognitive Assessment
CRF: Acute Concussion Evaluation (ACE)

Displaying 51 - 59 of 59
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
C54365 Acute Concussion Evaluation (ACE) - Risk factors protracted recovery concussion history duration type ACERskFacPrtrctRcvConcHxDurTyp Type of duration of longest symptom regarding concussion history as a risk factor that may protract the subject/participant recovery process since injury as related to the Acute Concussion Evaluation (ACE) Type of duration of longest symptom regarding concussion history as a risk factor that may protract the subject/participant recovery process since injury as related to the Acute Concussion Evaluation (ACE Longest symptom duration Days;Weeks;Months;years Days;Weeks;Months;years Alphanumeric

Assess the number and date(s) of prior concussions, duration of symptoms for each injury, and whether less biomechanical force resulted in re-injury.

 Centers for the Disease Control and Prevention. Heads Up: Brain Injury in Your Practice Tool Kit, 2006. Adult;Pediatric Supplemental 1.00 2017-02-27 20:22:56.0 Acute Concussion Evaluation (ACE) Cognitive Assessment Outcomes and End Points

Multiple Pre-Defined Values Selected
C54344 Acute Concussion Evaluation (ACE) - Loss of consciousness indicator ACELossConsciousnessInd Indicator of whether subject/participant had loss of consciousness as related to the Acute Concussion Evaluation (ACE) Indicator of whether subject/participant had loss of consciousness as related to the Acute Concussion Evaluation (ACE Loss of consciousness: Did you/ person lose consciousness? No;Yes No;Yes Alphanumeric Centers for the Disease Control and Prevention. Heads Up: Brain Injury in Your Practice Tool Kit, 2006. Adult;Pediatric Supplemental 1.00 2017-02-27 20:29:51.0 Acute Concussion Evaluation (ACE) Cognitive Assessment Outcomes and End Points

Single Pre-Defined Value Selected
C54380 Acute Concussion Evaluation (ACE) - Red flags acute emergency management type ACERedFlagAcuteEmergMgmtTyp Type of red flags for acute emergency management as related to the Acute Concussion Evaluation (ACE) Type of red flags for acute emergency management as related to the Acute Concussion Evaluation (ACE RED FLAGS for acute emergency management: Can't recognize people or places;Change in state of consciousness;Focal neurologic signs;Headaches that worsen;Increasing confusion or irritability;Looks very drowsy/ can't be awakened;Neck pain;Repeated vomiting;Seizures;Unusual behavioral change;Weakness or numbness in arms/legs Can't recognize people or places;Change in state of consciousness;Focal neurologic signs;Headaches that worsen;Increasing confusion or irritability;Looks very drowsy/ can't be awakened;Neck pain;Repeated vomiting;Seizures;Unusual behavioral change;Weakness or numbness in arms/legs Alphanumeric

Refer to the emergency department with sudden onset of any of the following:

 Centers for the Disease Control and Prevention. Heads Up: Brain Injury in Your Practice Tool Kit, 2006. Adult;Pediatric Supplemental 1.00 2017-02-27 20:22:56.0 Acute Concussion Evaluation (ACE) Cognitive Assessment Outcomes and End Points

Multiple Pre-Defined Values Selected
C54355 Acute Concussion Evaluation (ACE) - Symptom check list emotional total count ACESymptomChkLstEmotnlTotCt Total count of emotional symptoms subject/participant has experienced since injury as related to the Acute Concussion Evaluation (ACE) Total count of emotional symptoms subject/participant has experienced since injury as related to the Acute Concussion Evaluation (ACE EMOTIONAL Total (0-4) Numeric Values

Sum total number of symptoms present per area, and sum all four areas into a Total Symptom Score (score range 0–22)(Note: most sleep symptoms are only applicable after a night has passed since the injury.

 Centers for the Disease Control and Prevention. Heads Up: Brain Injury in Your Practice Tool Kit, 2006. Adult;Pediatric Supplemental 1.00 2017-02-27 20:29:51.0 Acute Concussion Evaluation (ACE) Cognitive Assessment Outcomes and End Points

Free-Form Entry

 0 4
C54334 Acute Concussion Evaluation (ACE) - Evidence direct blow head indicator ACEEvidnceDirctBlowHeadInd Indicator whether injury is due to a blow to the head as related to the Acute Concussion Evaluation (ACE) Indicator whether injury is due to a blow to the head as related to the Acute Concussion Evaluation (ACE Is there evidence of a forcible blow to the head (direct or indirect)? No;Yes;Unknown No;Yes;Unknown Alphanumeric Centers for the Disease Control and Prevention. Heads Up: Brain Injury in Your Practice Tool Kit, 2006. Adult;Pediatric Supplemental 1.00 2017-02-27 20:02:13.0 Acute Concussion Evaluation (ACE) Cognitive Assessment Outcomes and End Points

Single Pre-Defined Value Selected
C54366 Acute Concussion Evaluation (ACE) - Risk factors protracted recovery multiple concussion force reinjury indicator ACERskFcPtrcRcvMltCncFrcRnjInd Indicator of whether multiple concussions occur with less force caused reinjury is a risk factor that may protract the subject/participant recovery process since injury as related to the Acute Concussion Evaluation (ACE) Indicator of whether multiple concussions occur with less force caused reinjury is a risk factor that may protract the subject/participant recovery process since injury as related to the Acute Concussion Evaluation (ACE If multiple concussions, less force caused reinjury? No;Yes No;Yes Alphanumeric

Assess the number and date(s) of prior concussions, duration of symptoms for each injury, and whether less biomechanical force resulted in re-injury.

 Centers for the Disease Control and Prevention. Heads Up: Brain Injury in Your Practice Tool Kit, 2006. Adult;Pediatric Supplemental 1.00 2017-02-27 20:22:56.0 Acute Concussion Evaluation (ACE) Cognitive Assessment Outcomes and End Points

Multiple Pre-Defined Values Selected
C54345 Acute Concussion Evaluation (ACE) - Loss of consciousness duration ACELossConsciousnessDur Duration of the subject/participant's loss of consciousness as related to the Acute Concussion Evaluation (ACE) Duration of the subject/participant's loss of consciousness as related to the Acute Concussion Evaluation (ACE Loss of consciousness duration Numeric Values Centers for the Disease Control and Prevention. Heads Up: Brain Injury in Your Practice Tool Kit, 2006. Adult;Pediatric Supplemental 1.00 2017-02-27 20:29:51.0 Acute Concussion Evaluation (ACE) Cognitive Assessment Outcomes and End Points

Free-Form Entry
C54390 Acute Concussion Evaluation (ACE) - Diagnosis (ICD) concussion type ACEDiagnosisIcdConcussionTyp Type of ICD diagnosis of concussion as related to the Acute Concussion Evaluation (ACE) Type of ICD diagnosis of concussion as related to the Acute Concussion Evaluation (ACE Diagnosis (ICD) No diagnosis;850.0 Concussion without Loss of Consciousness (LOC);850.1 Concussion with Loss of Consciousness (LOC);850.9 Concussion (Unspecified);Other (854) No diagnosis;850.0 Concussion without Loss of Consciousness (LOC);850.1 Concussion with Loss of Consciousness (LOC);850.9 Concussion (Unspecified);Other (854) Alphanumeric

The following ICD diagnostic codes may be applicable.
850.0 (Concussion with no loss of consciousness) – Positive injury description with evidence of forcible direct/indirect blow to the head (A1a); plus evidence of active symptoms (B) of any type and number related to the trauma (Total Symptom Score >0); no evidence of LOC (A5), skull fracture or intracranial injury (A1b).
850.1 (Concussion, with brief loss of consciousness 0); positive evidence of LOC (A5), skull fracture or intracranial injury (A1b).
850.9 (Concussion, unspecified) – Positive injury description with evidence of forcible direct/indirect blow to the head (A1a); plus evidence of active symptoms (B) of any type and number related to the trauma (Total Symptom Score >0); unclear/unknown injury details; unclear evidence of LOC (A5), no skull fracture or intracranial injury.
Other diagnosis – If patient presents with a positive injury description and associated symptoms, but additional evidence of intracranial injury (A1b) such as from neuroimaging, a moderate TBI and diagnostic category of 854 (Intracranial injury) should be considered.

 Centers for the Disease Control and Prevention. Heads Up: Brain Injury in Your Practice Tool Kit, 2006. Adult;Pediatric Supplemental 1.00 2017-02-27 20:22:56.0 Acute Concussion Evaluation (ACE) Cognitive Assessment Outcomes and End Points

Multiple Pre-Defined Values Selected
C54356 Acute Concussion Evaluation (ACE) - Symptom check list sleep indicator ACESymptomChkLstSleepInd Indicator of whether subject/participant has experienced sleep symptoms since injury as related to the Acute Concussion Evaluation (ACE) Indicator of whether subject/participant has experienced sleep symptoms since injury as related to the Acute Concussion Evaluation (ACE SLEEP (4) 0;1;N/A 0=No;1=Yes;N/A Alphanumeric

Indicate presence of each symptom (0=No 1=Yes).

 Centers for the Disease Control and Prevention. Heads Up: Brain Injury in Your Practice Tool Kit, 2006. Adult;Pediatric Supplemental 1.00 2017-02-27 20:29:51.0 Acute Concussion Evaluation (ACE) Cognitive Assessment Outcomes and End Points

Single Pre-Defined Value Selected
CSV