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Peds - MRI Child History Form (4:6+ y:m)

554 Shared Subjects

MRI Child History Form (4:6+ y:m) as defined by the NIH Pediatric MRI Project
Clinical Assessments
Med History
03/08/2010
peds_mri_child_history01
12/16/2022
View Change History
01
Definition
Submission Template
Query Element Name Data Type Size Required Description Value Range Notes Aliases
subjectkey GUID Required The NDAR Global Unique Identifier (GUID) for research subject NDAR*
src_subject_id String 20 Required Subject ID how it's defined in lab/project Subject_ID
Query timepoint_label String 50 Recommended Timepoint/visit label
Query age_days_doa_to_dob Integer Recommended Age in days obtained by subtracting the date of birth from the date of test Child_History_Age_Days_DOA_to_DOB
Query admin_status String 20 Recommended Instrument administration status Complete;Partial;Not Administered;Not Applicable Child_History_Administration_Status
Query child_hx_respondent String 10 Recommended MRI Child History Form: Respondent (Mother, Father, Other) Mother;Father;Other;NA NA = Not available Child_History_Respondent
Query child_hx_baseball String 2 Recommended MRI Child History Form: Baseball (Y, N)
Y;N;NA
Y = Yes; N = No; NA = Not available Child_History_Baseball
Query child_hx_baseball_start_yrs Integer Recommended MRI Child History Form: Baseball started age (years) Child_History_Baseball_Age_Started_Yrs
Query child_hx_baseball_duration_yrs Integer Recommended MRI Child History Form: Baseball duration (years) Child_History_Baseball_Duration_Yrs
Query child_hx_basketball String 2 Recommended MRI Child History Form: Basketball (Y, N)
Y;N;NA
Y = Yes; N = No; NA = Not available Child_History_Basketball
Query child_hx_basketball_start_yrs Integer Recommended MRI Child History Form: Basketball started (age) Child_History_Basketball_Age_Started_Yrs
Query child_hx_basketball_dur_yrs Integer Recommended MRI Child History Form: Basketball duration (years) Child_History_Basketball_Duration_Yrs
Query child_hx_boxing String 2 Recommended MRI Child History Form: Boxing (Y, N)
Y;N;NA
Y = Yes; N = No; NA = Not available Child_History_Boxing
Query child_hx_boxing_age_start_yrs Integer Recommended MRI Child History Form: Boxing started age (years) Child_History_Boxing_Age_Started_Yrs
Query child_hx_boxing_duration_yrs Integer Recommended MRI Child History Form: Boxing duration (years) Child_History_Boxing_Duration_Yrs
Query child_hx_football String 2 Recommended MRI Child History Form: Football (Y, N)
Y;N;NA
Y = Yes; N = No; NA = Not available Child_History_Football
Query child_hx_football_started_yrs Integer Recommended MRI Child History Form: Football started age (years) Child_History_Football_Age_Started_Yrs
Query child_hx_football_duration_yrs Integer Recommended MRI Child History Form: Football duration (years) Child_History_Football_Duration_Yrs
Query child_hx_general_anesthesia String 2 Recommended MRI Child History Form: General anesthesia administered (for surgery, dental work, procedures, etc; Y, N)
Y;N;NA
Y = Yes; N = No; NA = Not available Child_History_General_Anesthesia
Query child_hx_gen_anesth_durfirst String 10 Recommended MRI Child History Form: General anesthesia duration 1st time (hours; <1,1-2, >2, Unknown) NA;<1;1-2;>2;Unknown NA = Not available Child_History_General_Anesthesia_Duration_First
Query child_hx_gen_anesth_age_first Integer Recommended MRI Child History Form: General anesthesia age in yearsfirst time Child_History_General_Anesthesia_Age_Yrs_First
Query child_hx_gen_anesth_dursecond String 10 Recommended MRI Child History Form: General anesthesia duration 2nd time (hours; <1 ,1-2, >2, Unknown) NA;<1;1-2;>2;Unknown NA = Not available Child_History_General_Anesthesia_Duration_Second
Query child_hx_gen_anesth_age_second Integer Recommended MRI Child History Form: General anesthesia age in years second time Child_History_General_Anesthesia_Age_Yrs_Second
Query child_hx_gen_anesth_durthird String 10 Recommended MRI Child History Form: General anesthesia duration 3rd time (hours; <1 ,1-2, >2, Unknown) NA;<1;1-2;>2;Unknown NA = Not available Child_History_General_Anesthesia_Duration_Third
Query child_hx_gen_anesth_age_third Integer Recommended MRI Child History Form: General anesthesia age in years third time Child_History_General_Anesthesia_Age_Yrs_Third
Query child_hx_hockey String 2 Recommended MRI Child History Form: Hockey (Y, N)
Y;N;NA
Y = Yes; N = No; NA = Not available Child_History_Hockey
Query child_hx_hockey_age_start_yrs Integer Recommended MRI Child History Form: Hockey started age (years) Child_History_Hockey_Age_Started_Yrs
Query child_hx_hockey_duration_yrs Integer Recommended MRI Child History Form: Hockey duration (years) Child_History_Hockey_Duration_Yrs
Query child_hx_lacrosse String 2 Recommended MRI Child History Form: Lacrosse (Y, N)
Y;N;NA
Y = Yes; N = No; NA = Not available Child_History_Lacrosse
Query child_hx_lacrosse_age_strt_yrs Integer Recommended MRI Child History Form: Lacrosse started age (years) Child_History_Lacrosse_Age_Started_Yrs
Query child_hx_lacrosse_duration_yrs Integer Recommended MRI Child History Form: Lacrosse duration (years) Child_History_Lacrosse_Duration_Yrs
Query child_hx_other_sports String 2 Recommended MRI Child History Form: Other sports (Y, N)
Y;N;NA
Y = Yes; N = No; NA = Not available Child_History_Other_Sports
Query child_hx_othr_sports_age_start Integer Recommended MRI Child History Form: Other sports started age (years) Child_History_Other_Sports_Age_Started_Yrs
Query child_hx_other_sports_dur_yrs Integer Recommended MRI Child History Form: Other sports duration (years) Child_History_Other_Sports_Duration_Yrs
Query child_hx_played_musical_instru String 2 Recommended MRI Child History Form: Played musical instrument (Y, N)
Y;N;NA
Y = Yes; N = No; NA = Not available Child_History_Played_Musical_Instrument
Query child_hx_played_instrument_age Integer Recommended MRI Child History Form: Played instrument started age (years) Child_History_Played_Instrument_Age_Started_Yrs
Query child_hx_played_instrument_dur Integer Recommended MRI Child History Form: Played instrument duration (years) Child_History_Played_Instrument_Duration_Yrs
Query child_hx_q1_lead_level_checked String 10 Recommended MRI Child History Form: Q1 lead level checked (Y, N, Unsure)
Y;N;Unsure;NA
Y = Yes; N = No; NA = Not available Child_History_Q1_Lead_Level_Checked
Query child_hx_q1b_lead_level String 10 Recommended MRI Child History Form: Q1b lead level (High, Marginal, Normal, Unknown) High;Marginal;Normal;Unknown;NA NA = Not available Child_History_Q1b_Lead_Level
Query child_hx_q1a_age_lead_lvl_chck Integer Recommended MRI Child History Form: Q1a age lead level checked (years) Child_History_Q1a_Age_Lead_Level_Checked_Yrs
Query child_hx_q2_breastfed String 2 Recommended MRI Child History Form: Q2 Breastfed (Y, N)
Y;N;NA
Y = Yes; N = No; NA = Not available Child_History_Q2_Breastfed
Query child_hx_q2a_length_bf_months Integer Recommended MRI Child History Form: Q2a length breastfed (months) Child_History_Q2a_Length_Breastfed_Months
Query child_hx_length_bf_twice_daily Integer Recommended MRI Child History Form: Length breastfed at least twice daily (months) Child_History_Length_Breastfed_Twice_Daily
Query child_hx_age_mo_disc_breastfed String 20 Recommended MRI Child History Form: Age when discontinued breastfeeding exclusively (<1 month, 1-3 months, 4-6 months, 6-9 months, 9-12 months, 12-18 months) <1 months;1-3 months;4-6 months;6-9 months;9-12 months;12-18 months;NA NA = Not available Child_History_Age_Months_Discontinued_Breastfeeding
Query child_hx_rugby String 2 Recommended MRI Child History Form: Rugby (Y, N)
Y;N;NA
Y = Yes; N = No; NA = Not available Child_History_Rugby
Query child_hx_rugby_age_started_yrs Integer Recommended MRI Child History Form: Rugby started age (years) Child_History_Rugby_Age_Started_Yrs
Query child_hx_rugby_duration_yrs Integer Recommended MRI Child History Form: Rugbyduration (years) Child_History_Rugby_Duration_Yrs
Query child_hx_soccer String 2 Recommended MRI Child History Form: Soccer (Y, N)
Y;N;NA
Y = Yes; N = No; NA = Not available Child_History_Soccer
Query child_hx_soccer_age_start_yrs Integer Recommended MRI Child History Form: Soccer started age (years) Child_History_Soccer_Age_Started_Yrs
Query child_hx_soccer_duration_yrs Integer Recommended MRI Child History Form: Soccer duration (years) Child_History_Soccer_Duration_Yrs
Query child_hx_ster_inh_c_birthto1yr String 5 Recommended MRI Child History Form: Steroid inhaler use birth to 1 year number of courses (0, 1-2, 3-5, >5) 0;1-2;3-5;>5;NA NA = Not available Child_History_Steroid_Inhaler_Courses_Birth_To_1Yr
Query child_hx_ster_inh_d_birthto1yr Integer Recommended MRI Child History Form: Steroid inhaler use birth to 1 year duration (months) Child_History_Steroid_Inhaler_Duration_Birth_To_1Yr
Query child_hx_ster_inh_crs_1to3yrs String 5 Recommended MRI Child History Form: Steroid inhaler use1 to 3 years number of courses (0, 1-2, 3-5, >5) 0;1-2;3-5;>5;NA NA = Not available Child_History_Steroid_Inhaler_Courses_1_To_3Yrs
Query child_hx_ster_inh_dur_1to3yrs Integer Recommended MRI Child History Form: Steroid inhaler use 1 to 3 years duration (months) Child_History_Steroid_Inhaler_Duration_1_To_3Yrs
Query child_hx_ster_inh_crs_3to5yrs String 5 Recommended MRI Child History Form: Steroid inhaler use 3 to 5 years number of courses (0, 1-2, 3-5, >5) 0;1-2;3-5;>5;NA NA = Not available Child_History_Steroid_Inhaler_Courses_3_To_5Yrs
Query child_hx_ster_inh_dur_3to5yrs Integer Recommended MRI Child History Form: Steroid inhaler use 3 to 5 years duration (months) Child_History_Steroid_Inhaler_Duration_3_To_5Yrs
Query child_hx_ster_inh_crs_5to10yrs String 5 Recommended MRI Child History Form: Steroid inhaler use 5 to10 years number of courses (0, 1-2, 3-5, >5) 0;1-2;3-5;>5;NA NA = Not available Child_History_Steroid_Inhaler_Courses_5_To_10Yrs
Query child_hx_ster_inh_dur_5to10yrs Integer Recommended MRI Child History Form: Steroid inhaler use 5 to10 years duration (months) Child_History_Steroid_Inhaler_Duration_5_To_10Yrs
Query child_hx_ster_inh_crs_10yrs_up String 5 Recommended MRI Child History Form: Steroid inhaler use > 10 years number of courses (0, 1-2, 3-5, >5) 0;1-2;3-5;>5;NA NA = Not available Child_History_Steroid_Inhaler_Courses_10Yrs_Up
Query child_hx_ster_inh_dur_10yrs_up Integer Recommended MRI Child History Form: Steroid inhaler use > 10 years duration (months) Child_History_Steroid_Inhaler_Duration_10Yrs_Up
Query child_hx_ster_ns_c_birthto1yr String 5 Recommended MRI Child History Form: Steroid nasal spray birth to 1 year number of courses (0, 1-2, 3-5, >5) 0;1-2;3-5;>5;NA NA = Not available Child_History_Steroid_Nasal_Spray_Courses_Birth_To_1Yr
Query child_hx_ster_ns_d_birthto1yr Integer Recommended MRI Child History Form: Steroid nasal spray birth to 1 year duration (months) Child_History_Steroid_Nasal_Spray_Duration_Birth_To_1Yr
Query child_hx_ster_ns_crs_1to3yrs String 5 Recommended MRI Child History Form: Steroid nasal spray 1 to 3 years number of courses (0, 1-2, 3-5, >5) 0;1-2;3-5;>5;NA NA = Not available Child_History_Steroid_Nasal_Spray_Courses_1_To_3Yrs
Query child_hx_ster_ns_dur_1to3yrs Integer Recommended MRI Child History Form: Steroid nasal spray 1 to 3 years duration (months) Child_History_Steroid_Nasal_Spray_Duration_1_To_3Yrs
Query child_hx_ster_ns_crs_3to5yrs String 5 Recommended MRI Child History Form: Steroid nasal spray 3 to 5 years number of courses (0, 1-2, 3-5, >5) 0;1-2;3-5;>5;NA NA = Not available Child_History_Steroid_Nasal_Spray_Courses_3_To_5Yrs
Query child_hx_ster_ns_dur_3to5yrs Integer Recommended MRI Child History Form: Steroid nasal spray 3 to 5 years duration (months) Child_History_Steroid_Nasal_Spray_Duration_3_To_5Yrs
Query child_hx_ster_ns_crs_5to10yrs String 5 Recommended MRI Child History Form: Steroid nasal spray 5 to 10 years number of courses (0, 1-2, 3-5, >5) 0;1-2;3-5;>5;NA NA = Not available Child_History_Steroid_Nasal_Spray_Courses_5_To_10Yrs
Query child_hx_ster_ns_dur_5to10yrs Integer Recommended MRI Child History Form: Steroid nasal spray 5 to 10 years duration (months) Child_History_Steroid_Nasal_Spray_Duration_5_To_10Yrs
Query child_hx_ster_ns_crs_10yrs_up String 5 Recommended MRI Child History Form: Steroid nasal spray >10 years number of courses (0, 1-2, 3-5, >5) 0;1-2;3-5;>5;NA NA = Not available Child_History_Steroid_Nasal_Spray_Courses_10Yrs_Up
Query child_hx_ster_ns_dur_10yrs_up Integer Recommended MRI Child History Form: Steroid nasal spray >10 years duration (months) Child_History_Steroid_Nasal_Spray_Duration_10Yrs_Up
Query child_hx_ster_os_c_birthto1yr String 5 Recommended MRI Child History Form: Steroid pills liquids shots birth to 1 year number of courses (0, 1-2, 3-5, >5) 0;1-2;3-5;>5;NA NA = Not available Child_History_Steroid_Oral_Shots_Courses_Birth_To_1Yr
Query child_hx_ster_os_d_birthto1yr Integer Recommended MRI Child History Form: Steroid pills liquids shots birth to 1 year duration (months) Child_History_Steroid_Oral_Shots_Duration_Birth_To_1Yr
Query child_hx_ster_os_crs_1to3yrs String 5 Recommended MRI Child History Form: Steroid pills liquids shots 1 to 3 years number of courses (0, 1-2, 3-5, >5) 0;1-2;3-5;>5;NA NA = Not available Child_History_Steroid_Oral_Shots_Courses_1_To_3Yrs
Query child_hx_ster_os_dur_1to3yrs Integer Recommended MRI Child History Form: Steroid pills liquids shots 1 to 3 years duration (months) Child_History_Steroid_Oral_Shots_Duration_1_To_3Yrs
Query child_hx_ster_os_crs_3to5yrs String 5 Recommended MRI Child History Form: Steroid pills liquids shots 3 to 5 years number of courses (0, 1-2, 3-5, >5) 0;1-2;3-5;>5;NA NA = Not available Child_History_Steroid_Oral_Shots_Courses_3_To_5Yrs
Query child_hx_ster_os_dur_3to5yrs Integer Recommended MRI Child History Form: Steroid pills liquids shots 3 to 5 years duration (months) Child_History_Steroid_Oral_Shots_Duration_3_To_5Yrs
Query child_hx_ster_os_crs_5to10yrs String 5 Recommended MRI Child History Form: Steroid pills liquids shots 5 to 10 years number of courses (0, 1-2, 3-5, >5) 0;1-2;3-5;>5;NA NA = Not available Child_History_Steroid_Oral_Shots_Courses_5_To_10Yrs
Query child_hx_ster_os_dur_5to10yrs Integer Recommended MRI Child History Form: Steroid pills liquids shots 5 to 10 years duration (months) Child_History_Steroid_Oral_Shots_Duration_5_To_10Yrs
Query child_hx_ster_os_crs_10yrs_up String 5 Recommended MRI Child History Form: Steroid pills liquids shots > 10 years number of courses (0, 1-2, 3-5, >5) 0;1-2;3-5;>5;NA NA = Not available Child_History_Steroid_Oral_Shots_Courses_10Yrs_Up
Query child_hx_ster_os_dur_10yrs_up Integer Recommended MRI Child History Form: Steroid pills liquids shots > 10 years duration (months) Child_History_Steroid_Oral_Shots_Duration_10Yrs_Up
Query child_hx_steroid_med_use String 2 Recommended MRI Child History Form: Steroid medication use (Y, N)
Y;N;NA
Y = Yes; N = No; NA = Not available Child_History_Steroid_Medication_Use
Query child_hx_strep_throat_diag String 2 Recommended MRI Child History Form: Strep throat diagnosis (Y, N)
Y;N;NA
Y = Yes; N = No; NA = Not available Child_History_Strep_Throat_Diagnosis
Query child_hx_strep_throat_no_times String 5 Recommended MRI Child History Form: Strep throat number of times (1, 2, 3-5, 6-10, >10) 1;2;3-5;6-10;>10;NA NA = Not available Child_History_Strep_Throat_Number_of_Times
Query child_hx_concussion String 2 Recommended MRI Child History Form: Concussion (Y, N)
Y;N;NA
Y = Yes; N = No; NA = Not available Child_History_Concussion
Query child_hx_sports_rel_concussion String 2 Recommended MRI Child History Form: Sports related concussion (Y, N)
Y;N;NA
Y = Yes; N = No; NA = Not available Child_History_Sports_Related_Concussion
Query child_hx_head_injury String 2 Recommended MRI Child History Form: Head injury (Physician called or office/hospital visit; Y, N)
Y;N;NA
Y = Yes; N = No; NA = Not available Child_History_Head_Injury
Query child_hx_head_injury_age_yrs Integer Recommended MRI Child History Form: Head injury age (years) Child_History_Head_Injury_Age_in_Yrs
Query child_hx_sports_rel_head_inj String 2 Recommended MRI Child History Form: Sports related head injury (Y, N)
Y;N;NA
Y = Yes; N = No; NA = Not available Child_History_Sports_Related_Head_Injury
Query child_hx_unconscious String 2 Recommended MRI Child History Form: Unconscious (Y, N)
Y;N;NA
Y = Yes; N = No; NA = Not available Child_History_Unconscious
Query child_hx_unconscious_dur_min Integer Recommended MRI Child History Form: Unconscious duration (minutes) Child_History_Unconscious_Duration_Minutes
Data Structure

This page displays the data structure defined for the measure identified in the title and structure short name. The table below displays a list of data elements in this structure (also called variables) and the following information:

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