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

peds_mri_child_history

01

MRI Child History Form (4:6+ y:m) as defined by the NIH Pediatric MRI Project

Download Definition as
Download Submission Template as
Element NameData TypeSizeRequiredDescriptionValue RangeNotesAliases
subjectkeyGUIDRequiredThe NDAR Global Unique Identifier (GUID) for research subjectNDAR*
src_subject_idString20RequiredSubject ID how it's defined in lab/projectSubject_ID
timepoint_labelString5RecommendedTimepoint/visit label
age_days_doa_to_dobIntegerRecommendedAge in days obtained by subtracting the date of birth from the date of testChild_History_Age_Days_DOA_to_DOB
admin_statusString20RecommendedInstrument administration statusComplete;Partial;Not Administered;Not ApplicableChild_History_Administration_Status
child_hx_respondentString10RecommendedMRI Child History Form: Respondent (Mother, Father, Other)Mother;Father;Other;NANA = Not availableChild_History_Respondent
child_hx_baseballString2RecommendedMRI Child History Form: Baseball (Y, N)
Y;N;NA
Y = Yes; N = No; NA = Not availableChild_History_Baseball
child_hx_baseball_start_yrsIntegerRecommendedMRI Child History Form: Baseball started age (years)Child_History_Baseball_Age_Started_Yrs
child_hx_baseball_duration_yrsIntegerRecommendedMRI Child History Form: Baseball duration (years)Child_History_Baseball_Duration_Yrs
child_hx_basketballString2RecommendedMRI Child History Form: Basketball (Y, N)
Y;N;NA
Y = Yes; N = No; NA = Not availableChild_History_Basketball
child_hx_basketball_start_yrsIntegerRecommendedMRI Child History Form: Basketball started (age)Child_History_Basketball_Age_Started_Yrs
child_hx_basketball_dur_yrsIntegerRecommendedMRI Child History Form: Basketball duration (years)Child_History_Basketball_Duration_Yrs
child_hx_boxingString2RecommendedMRI Child History Form: Boxing (Y, N)
Y;N;NA
Y = Yes; N = No; NA = Not availableChild_History_Boxing
child_hx_boxing_age_start_yrsIntegerRecommendedMRI Child History Form: Boxing started age (years)Child_History_Boxing_Age_Started_Yrs
child_hx_boxing_duration_yrsIntegerRecommendedMRI Child History Form: Boxing duration (years)Child_History_Boxing_Duration_Yrs
child_hx_footballString2RecommendedMRI Child History Form: Football (Y, N)
Y;N;NA
Y = Yes; N = No; NA = Not availableChild_History_Football
child_hx_football_started_yrsIntegerRecommendedMRI Child History Form: Football started age (years)Child_History_Football_Age_Started_Yrs
child_hx_football_duration_yrsIntegerRecommendedMRI Child History Form: Football duration (years)Child_History_Football_Duration_Yrs
child_hx_general_anesthesiaString2RecommendedMRI Child History Form: General anesthesia administered (for surgery, dental work, procedures, etc; Y, N)
Y;N;NA
Y = Yes; N = No; NA = Not availableChild_History_General_Anesthesia
child_hx_gen_anesth_durfirstString10RecommendedMRI Child History Form: General anesthesia duration 1st time (hours; <1,1-2, >2, Unknown)NA;<1;1-2;>2;UnknownNA = Not availableChild_History_General_Anesthesia_Duration_First
child_hx_gen_anesth_age_firstIntegerRecommendedMRI Child History Form: General anesthesia age in yearsfirst timeChild_History_General_Anesthesia_Age_Yrs_First
child_hx_gen_anesth_dursecondString10RecommendedMRI Child History Form: General anesthesia duration 2nd time (hours; <1 ,1-2, >2, Unknown)NA;<1;1-2;>2;UnknownNA = Not availableChild_History_General_Anesthesia_Duration_Second
child_hx_gen_anesth_age_secondIntegerRecommendedMRI Child History Form: General anesthesia age in years second timeChild_History_General_Anesthesia_Age_Yrs_Second
child_hx_gen_anesth_durthirdString10RecommendedMRI Child History Form: General anesthesia duration 3rd time (hours; <1 ,1-2, >2, Unknown)NA;<1;1-2;>2;UnknownNA = Not availableChild_History_General_Anesthesia_Duration_Third
child_hx_gen_anesth_age_thirdIntegerRecommendedMRI Child History Form: General anesthesia age in years third timeChild_History_General_Anesthesia_Age_Yrs_Third
child_hx_hockeyString2RecommendedMRI Child History Form: Hockey (Y, N)
Y;N;NA
Y = Yes; N = No; NA = Not availableChild_History_Hockey
child_hx_hockey_age_start_yrsIntegerRecommendedMRI Child History Form: Hockey started age (years)Child_History_Hockey_Age_Started_Yrs
child_hx_hockey_duration_yrsIntegerRecommendedMRI Child History Form: Hockey duration (years)Child_History_Hockey_Duration_Yrs
child_hx_lacrosseString2RecommendedMRI Child History Form: Lacrosse (Y, N)
Y;N;NA
Y = Yes; N = No; NA = Not availableChild_History_Lacrosse
child_hx_lacrosse_age_strt_yrsIntegerRecommendedMRI Child History Form: Lacrosse started age (years)Child_History_Lacrosse_Age_Started_Yrs
child_hx_lacrosse_duration_yrsIntegerRecommendedMRI Child History Form: Lacrosse duration (years)Child_History_Lacrosse_Duration_Yrs
child_hx_other_sportsString2RecommendedMRI Child History Form: Other sports (Y, N)
Y;N;NA
Y = Yes; N = No; NA = Not availableChild_History_Other_Sports
child_hx_othr_sports_age_startIntegerRecommendedMRI Child History Form: Other sports started age (years)Child_History_Other_Sports_Age_Started_Yrs
child_hx_other_sports_dur_yrsIntegerRecommendedMRI Child History Form: Other sports duration (years)Child_History_Other_Sports_Duration_Yrs
child_hx_played_musical_instruString2RecommendedMRI Child History Form: Played musical instrument (Y, N)
Y;N;NA
Y = Yes; N = No; NA = Not availableChild_History_Played_Musical_Instrument
child_hx_played_instrument_ageIntegerRecommendedMRI Child History Form: Played instrument started age (years)Child_History_Played_Instrument_Age_Started_Yrs
child_hx_played_instrument_durIntegerRecommendedMRI Child History Form: Played instrument duration (years)Child_History_Played_Instrument_Duration_Yrs
child_hx_q1_lead_level_checkedString10RecommendedMRI Child History Form: Q1 lead level checked (Y, N, Unsure)
Y;N;Unsure;NA
Y = Yes; N = No; NA = Not availableChild_History_Q1_Lead_Level_Checked
child_hx_q1b_lead_levelString10RecommendedMRI Child History Form: Q1b lead level (High, Marginal, Normal, Unknown)High;Marginal;Normal;Unknown;NANA = Not availableChild_History_Q1b_Lead_Level
child_hx_q1a_age_lead_lvl_chckIntegerRecommendedMRI Child History Form: Q1a age lead level checked (years)Child_History_Q1a_Age_Lead_Level_Checked_Yrs
child_hx_q2_breastfedString2RecommendedMRI Child History Form: Q2 Breastfed (Y, N)
Y;N;NA
Y = Yes; N = No; NA = Not availableChild_History_Q2_Breastfed
child_hx_q2a_length_bf_monthsIntegerRecommendedMRI Child History Form: Q2a length breastfed (months)Child_History_Q2a_Length_Breastfed_Months
child_hx_length_bf_twice_dailyIntegerRecommendedMRI Child History Form: Length breastfed at least twice daily (months)Child_History_Length_Breastfed_Twice_Daily
child_hx_age_mo_disc_breastfedString20RecommendedMRI 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;NANA = Not availableChild_History_Age_Months_Discontinued_Breastfeeding
child_hx_rugbyString2RecommendedMRI Child History Form: Rugby (Y, N)
Y;N;NA
Y = Yes; N = No; NA = Not availableChild_History_Rugby
child_hx_rugby_age_started_yrsIntegerRecommendedMRI Child History Form: Rugby started age (years)Child_History_Rugby_Age_Started_Yrs
child_hx_rugby_duration_yrsIntegerRecommendedMRI Child History Form: Rugbyduration (years)Child_History_Rugby_Duration_Yrs
child_hx_soccerString2RecommendedMRI Child History Form: Soccer (Y, N)
Y;N;NA
Y = Yes; N = No; NA = Not availableChild_History_Soccer
child_hx_soccer_age_start_yrsIntegerRecommendedMRI Child History Form: Soccer started age (years)Child_History_Soccer_Age_Started_Yrs
child_hx_soccer_duration_yrsIntegerRecommendedMRI Child History Form: Soccer duration (years)Child_History_Soccer_Duration_Yrs
child_hx_ster_inh_c_birthto1yrString5RecommendedMRI 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;NANA = Not availableChild_History_Steroid_Inhaler_Courses_Birth_To_1Yr
child_hx_ster_inh_d_birthto1yrIntegerRecommendedMRI Child History Form: Steroid inhaler use birth to 1 year duration (months)Child_History_Steroid_Inhaler_Duration_Birth_To_1Yr
child_hx_ster_inh_crs_1to3yrsString5RecommendedMRI Child History Form: Steroid inhaler use1 to 3 years number of courses (0, 1-2, 3-5, >5)0;1-2;3-5;>5;NANA = Not availableChild_History_Steroid_Inhaler_Courses_1_To_3Yrs
child_hx_ster_inh_dur_1to3yrsIntegerRecommendedMRI Child History Form: Steroid inhaler use 1 to 3 years duration (months)Child_History_Steroid_Inhaler_Duration_1_To_3Yrs
child_hx_ster_inh_crs_3to5yrsString5RecommendedMRI 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;NANA = Not availableChild_History_Steroid_Inhaler_Courses_3_To_5Yrs
child_hx_ster_inh_dur_3to5yrsIntegerRecommendedMRI Child History Form: Steroid inhaler use 3 to 5 years duration (months)Child_History_Steroid_Inhaler_Duration_3_To_5Yrs
child_hx_ster_inh_crs_5to10yrsString5RecommendedMRI Child History Form: Steroid inhaler use 5 to10 years number of courses (0, 1-2, 3-5, >5)0;1-2;3-5;>5;NANA = Not availableChild_History_Steroid_Inhaler_Courses_5_To_10Yrs
child_hx_ster_inh_dur_5to10yrsIntegerRecommendedMRI Child History Form: Steroid inhaler use 5 to10 years duration (months)Child_History_Steroid_Inhaler_Duration_5_To_10Yrs
child_hx_ster_inh_crs_10yrs_upString5RecommendedMRI Child History Form: Steroid inhaler use > 10 years number of courses (0, 1-2, 3-5, >5)0;1-2;3-5;>5;NANA = Not availableChild_History_Steroid_Inhaler_Courses_10Yrs_Up
child_hx_ster_inh_dur_10yrs_upIntegerRecommendedMRI Child History Form: Steroid inhaler use > 10 years duration (months)Child_History_Steroid_Inhaler_Duration_10Yrs_Up
child_hx_ster_ns_c_birthto1yrString5RecommendedMRI 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;NANA = Not availableChild_History_Steroid_Nasal_Spray_Courses_Birth_To_1Yr
child_hx_ster_ns_d_birthto1yrIntegerRecommendedMRI Child History Form: Steroid nasal spray birth to 1 year duration (months)Child_History_Steroid_Nasal_Spray_Duration_Birth_To_1Yr
child_hx_ster_ns_crs_1to3yrsString5RecommendedMRI 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;NANA = Not availableChild_History_Steroid_Nasal_Spray_Courses_1_To_3Yrs
child_hx_ster_ns_dur_1to3yrsIntegerRecommendedMRI Child History Form: Steroid nasal spray 1 to 3 years duration (months)Child_History_Steroid_Nasal_Spray_Duration_1_To_3Yrs
child_hx_ster_ns_crs_3to5yrsString5RecommendedMRI 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;NANA = Not availableChild_History_Steroid_Nasal_Spray_Courses_3_To_5Yrs
child_hx_ster_ns_dur_3to5yrsIntegerRecommendedMRI Child History Form: Steroid nasal spray 3 to 5 years duration (months)Child_History_Steroid_Nasal_Spray_Duration_3_To_5Yrs
child_hx_ster_ns_crs_5to10yrsString5RecommendedMRI 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;NANA = Not availableChild_History_Steroid_Nasal_Spray_Courses_5_To_10Yrs
child_hx_ster_ns_dur_5to10yrsIntegerRecommendedMRI Child History Form: Steroid nasal spray 5 to 10 years duration (months)Child_History_Steroid_Nasal_Spray_Duration_5_To_10Yrs
child_hx_ster_ns_crs_10yrs_upString5RecommendedMRI Child History Form: Steroid nasal spray >10 years number of courses (0, 1-2, 3-5, >5)0;1-2;3-5;>5;NANA = Not availableChild_History_Steroid_Nasal_Spray_Courses_10Yrs_Up
child_hx_ster_ns_dur_10yrs_upIntegerRecommendedMRI Child History Form: Steroid nasal spray >10 years duration (months)Child_History_Steroid_Nasal_Spray_Duration_10Yrs_Up
child_hx_ster_os_c_birthto1yrString5RecommendedMRI 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;NANA = Not availableChild_History_Steroid_Oral_Shots_Courses_Birth_To_1Yr
child_hx_ster_os_d_birthto1yrIntegerRecommendedMRI Child History Form: Steroid pills liquids shots birth to 1 year duration (months)Child_History_Steroid_Oral_Shots_Duration_Birth_To_1Yr
child_hx_ster_os_crs_1to3yrsString5RecommendedMRI 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;NANA = Not availableChild_History_Steroid_Oral_Shots_Courses_1_To_3Yrs
child_hx_ster_os_dur_1to3yrsIntegerRecommendedMRI Child History Form: Steroid pills liquids shots 1 to 3 years duration (months)Child_History_Steroid_Oral_Shots_Duration_1_To_3Yrs
child_hx_ster_os_crs_3to5yrsString5RecommendedMRI 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;NANA = Not availableChild_History_Steroid_Oral_Shots_Courses_3_To_5Yrs
child_hx_ster_os_dur_3to5yrsIntegerRecommendedMRI Child History Form: Steroid pills liquids shots 3 to 5 years duration (months)Child_History_Steroid_Oral_Shots_Duration_3_To_5Yrs
child_hx_ster_os_crs_5to10yrsString5RecommendedMRI 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;NANA = Not availableChild_History_Steroid_Oral_Shots_Courses_5_To_10Yrs
child_hx_ster_os_dur_5to10yrsIntegerRecommendedMRI Child History Form: Steroid pills liquids shots 5 to 10 years duration (months)Child_History_Steroid_Oral_Shots_Duration_5_To_10Yrs
child_hx_ster_os_crs_10yrs_upString5RecommendedMRI Child History Form: Steroid pills liquids shots > 10 years number of courses (0, 1-2, 3-5, >5)0;1-2;3-5;>5;NANA = Not availableChild_History_Steroid_Oral_Shots_Courses_10Yrs_Up
child_hx_ster_os_dur_10yrs_upIntegerRecommendedMRI Child History Form: Steroid pills liquids shots > 10 years duration (months)Child_History_Steroid_Oral_Shots_Duration_10Yrs_Up
child_hx_steroid_med_useString2RecommendedMRI Child History Form: Steroid medication use (Y, N)
Y;N;NA
Y = Yes; N = No; NA = Not availableChild_History_Steroid_Medication_Use
child_hx_strep_throat_diagString2RecommendedMRI Child History Form: Strep throat diagnosis (Y, N)
Y;N;NA
Y = Yes; N = No; NA = Not availableChild_History_Strep_Throat_Diagnosis
child_hx_strep_throat_no_timesString5RecommendedMRI Child History Form: Strep throat number of times (1, 2, 3-5, 6-10, >10)1;2;3-5;6-10;>10;NANA = Not availableChild_History_Strep_Throat_Number_of_Times
child_hx_concussionString2RecommendedMRI Child History Form: Concussion (Y, N)
Y;N;NA
Y = Yes; N = No; NA = Not availableChild_History_Concussion
child_hx_sports_rel_concussionString2RecommendedMRI Child History Form: Sports related concussion (Y, N)
Y;N;NA
Y = Yes; N = No; NA = Not availableChild_History_Sports_Related_Concussion
child_hx_head_injuryString2RecommendedMRI Child History Form: Head injury (Physician called or office/hospital visit; Y, N)
Y;N;NA
Y = Yes; N = No; NA = Not availableChild_History_Head_Injury
child_hx_head_injury_age_yrsIntegerRecommendedMRI Child History Form: Head injury age (years)Child_History_Head_Injury_Age_in_Yrs
child_hx_sports_rel_head_injString2RecommendedMRI Child History Form: Sports related head injury (Y, N)
Y;N;NA
Y = Yes; N = No; NA = Not availableChild_History_Sports_Related_Head_Injury
child_hx_unconsciousString2RecommendedMRI Child History Form: Unconscious (Y, N)
Y;N;NA
Y = Yes; N = No; NA = Not availableChild_History_Unconscious
child_hx_unconscious_dur_minIntegerRecommendedMRI Child History Form: Unconscious duration (minutes)Child_History_Unconscious_Duration_Minutes
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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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Distribution for DataStructure: peds_mri_child_history01 and Element:
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