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Title

Comfort Behavior Scale (COMFORT-B SCALE)

CDISC ReferenceClinical Classification Supplement to the Study Data Tabulation Model Implementation Guide for Human Clinical Trials
QRS Short Name

COMFORT-B SCALE

QRS Permission StatusApproved
TeamCDISC Questionnaires, Ratings, and Scales (QRS) Subteam
Supplement Version1.0
StatusDRAFT
Date2023-0910-1423 (date current version released, regardless of status - this date should always match the date in the Revision History section below and should be updated every time this supplement is edited.)
Notes to Readers
  • This supplement is available to be used with other CDISC user guides for specific therapeutic/disease areas and follows the CDISC Study Data Tabulation Model Implementation Guide for Human Clinical Trials.
  • This instrument is a US FDA Qualified Clinical Outcome Assessment (COA) instrument. (COA #XXX, Qualified Clinical Outcome Assessments (COA) | FDA) (Use only for instruments this applies to; update COA #.)

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Revision History

DateVersion
2023-10-14231.0 Draft

© 2023 Clinical Data Interchange Standards Consortium, Inc. All rights reserved. 

...

  1. Include a description of scale score or other possible responses (You may need multiple numbered points for this, though the IDS-SR did not.). For scale scores use the following language: The scale points include a numeric rating (1-5) and a definition of what is represented by the rating (e.g., 1 = "deeply asleep (eyes closed, no response to changes in the environment)"). For the COMFORT-B SCALE, RSORRES is populated with the text description while the numeric rating is represented in the standardized character and numeric result variables RSSTRESC and RSSTRESN. 

  2. The RSREPNUM variable is used to indicate the same RSTESTSs are used in trial 1, 2, 3, and 4.
  3. Records are created in rs.xpt for every instrument item

    1. For items with no data, RSORRES, RSSTRESC, and RSSTRESN are all missing and RSSTAT = "NOT DONE". If the reason is known then that reason is represented in RSREASND (e.g., RSREASND = "PREFER NOT TO ANSWER"). If the reason is unknown, then RSSTAT = "NOT DONE" and RSREASND is missing.

    2. Due to the variability of copyright holder and public domain derived score generation processes, records are not included for derived subscores or total scores that are not provided.
  4. Some items on the COMFORT-B SCALE may be conditionally branched per the instrument instructions. Only Respiratory Ventilation or Crying (RSTESTCD = "CBS0103" or "CBS0104") is completed for each subject. The other will be treated as a conditionally branched item. A record is created in rs.xpt for all items. When an item is considered a conditionally branched item, it is represented as follows:

    When assigned with conditionally branched responses are not documented in the instrument’s instructions or a user manual:

    1. QNAM = “RSCBRFL”, QLABEL = “Conditional Branched Item Flag“, QVAL = “Y” (this is a RS supplemental qualifier variable related to the record).
    2. RSORRES, RSSTRESC, and RSSTRESN are set to null (missing).

    When assigned conditionally branched responses are documented in instructions or a user manual:

    1. QNAM = “QSCBRFL”, QLABEL = “Conditional Branched Item Flag“, QVAL = “Y” (this is a QS supplemental qualifier variable).
    2. The QSORRES responses are represented as follows:
      1. For severity items, QSORRES = "None".
      2. For interference items, QSORRES = "Not at all".
    3. If numeric response values are assigned, they are represented here: QSSTRESC = 0 and QSSTRESN = 0.

       or if no numeric responses are assigned: QSSTRESC = NULL and QSSTRESN = NULL.

  5. Include this point if score(s) are submitted to SDTM. Update blue text: The QRS Short_Name instrument includes a total score (and subscores or other scores as needed.  If so, change "that is" to "that are") that The COMFORT-B SCALE instrument includes a total score that is considered as captured data on the instrument and is not considered as derived in the example below. These scores may be submitted in SDTM or derived in the Analysis Data Model (ADaM) per scoring instructions from [Insert copyright holder's name or other source.].

    1. Subtotal and total scores are represented in--ORRES, --STRESC, and --STRESN.
    2. If scores are received or derived by the sponsor, it is recommended that they are submitted to SDTM and verified in ADaM whenever feasible. It is the sponsors repsonsibility responsibility to do this verification based on the instrument's user manual or instructions from the copyright owner.
    Please review the decision on not including –EVAL and --EVALID in the QRS Supplement Best Practices topic “--EVAL/–EVALID not included in QRS domains/datasets”.Now we only represent administrative information if it is explicitly collected on an instrument. No assumptions are made for this data; if it's not on the instrument, it's not in the data.

    The SUPPQUAL variables used are a series of non-standard variables that represent collected administrator information, administration device, etc., and these updated SUPPQUAL variables are included in the WIKI non-standard variable registry (Non-standard Variable Registry). For example:

    1. PPRAID which is "Preprinted Administrator Identifier".
    2. COLAVL which is "Collected Administrator Value".

    The supplement version 1.0 of the FAS-NACC UDS V3.0 instrument shows an implementation example.

    The QRS Short_Name instrument collects administrative information as the preprinted examiner’s initials and the collected response. This is represented in the SUPPQUAL variable QNAM = --PPRAID” with QNAM = “Preprinted Administrator Identifier” and QVAL = “EXAMINER’S INITIALS”. The collected initials response is represented with QNAM = “--COLAID” and QNAM = “Collected Administrator Identifier” and QVAL = “ADM1”.

    This is part of the data example for the SUPPQUAL variables.

    The SUPPRS table represents the preprinted and collected administrative items represented on the CRF. 

     supprs.xpt

    STUDYID

    RDOMAIN

    USUBJID

    IDVAR

    IDVARVAL

    QNAM

    QLABEL

    QVAL

    QORIG

    STUDYX

    RS

    100-10001

    RSCAT

    FAS-NACC UDS V3.0

    RSPPRAID

    Preprinted Administrator Identifier

    EXAMINER'S INITIALS

    CRF

    STUDYX

    RS

    100-10001

    RSCAT

    FAS-NACC UDS V3.0

    RSCOLAID

    Collected Administrator Identifier

    ADM1

    CRF

  6. Include this point if there are comments at the end of the instrument. Remove this point if it does not apply.: Comments located at the end of the QRS Short_Name will be recorded in the Comments domain (CO). All assumptions and business rules described in the SDTMIG CO domain are applicable.

  7. Include this point if there are responses over 200 characters. Remove this point if it does not apply: Some responses to the QRS Short_Name items exceeded the 200-character limit for the QSORRES variable and needed to be reduced to fewer than 200 characters. Section 4, SDTM Mapping Strategy, indicates which item responses were revised in order to fit the 200-character limit.

  8. Terminology

    1. RSCAT, RSTESTCD, RSTEST values are included in CDISC Controlled Terminology.

    2. A full list of value sets for the qualifier, timing, resultand unit fields is provided in Section 4, SDTM Mapping Strategy. (Note: Only the result field is always used. Include qualifier, timing, and unit fields as needed and remove this note.)

3.2 Example for the COMFORT-B SCALE RS Domain Model

The COMFORT-B SCALE example below shows the terminology used to implement the instrument in the RS domain. This example shows the data for 1 subject collected at the baseline visit for the COMFORT-B SCALE instrument. The example uses CDISC Controlled Terminology for RSTESTCD, RSTEST, and RSCATAll original results, matching the CRF item response text, are represented in RSORRES. This result is then represented as a standard numeric score in RSSTRESN and as a standard character representation in RSSTRESC.

...

Update the data in the table below to the current instrument. Include row descriptions as needed to highlight idiosyncrasies or items otherwise of note in this particular instrument. If only 1 or 2 row descriptions are needed, then the information should be included as a paragraph instead.

For the not done visit that is now being included in all QRS supplements, when no reason is collected, information should be included, either in the paragraph before, or as a row description as follows:

...

When the reason is collected for a not done visit, information or a row description should be added as follows:

  1. Terminology

    1. RSCAT, RSTESTCD, RSTEST values are included in CDISC Controlled Terminology.

    2. A full list of value sets for the qualifier, timing, resultand unit fields is provided in Section 4, SDTM Mapping Strategy. (Note: Only the result field is always used. Include qualifier, timing, and unit fields as needed and remove this note.)

3.2 Example for the COMFORT-B SCALE RS Domain Model

The COMFORT-B SCALE example below shows the terminology used to implement the instrument in the RS domain. This example shows the data for 1 subject collected at the baseline visit for the COMFORT-B SCALE instrument. The example uses CDISC Controlled Terminology for RSTESTCD, RSTEST, and RSCATAll original results, matching the CRF item response text, are represented in RSORRES. This result is then represented as a standard numeric score in RSSTRESN and as a standard character representation in RSSTRESC.


Info

Update the data in the table below to the current instrument. Include row descriptions as needed to highlight idiosyncrasies or items otherwise of note in this particular instrument. If only 1 or 2 row descriptions are needed, then the information should be included as a paragraph instead.

For the not done visit that is now being included in all QRS supplements, when no reason is collected, information should be included, either in the paragraph before, or as a row description as follows:

Rows 13-24:Show the subject was not evaluated on this instrument at visit 2. Since the visit was missed, the reason for not completing the visit was not collected, no date is assumed for when the visit would have occurred.  The following variable RSMETHOD is also not represented when this happens

When the reason is collected for a not done visit, information or a row description should be added as follows:

Rows 49-60:Show the subject was not evaluated on this instrument at visit 2. Since the reason for not completing the visit was collected, the date is included in --DTC for when the visit was planned.
Info

We are unable to make the example consistently show blue in the Wiki. All examples are updated for each QRS instrument, so we ask that you please review the example below.


The table represents the items from the COMFORT-B SCALE instrument.

Dataset wrap
Namers
Rowcaps
Rows 13-14:Items 11 and 12 are presented for illustrative purposes only. When the instrument is conducted, only one will be represented based on the CRF instructions. In this example, Item 12 would not appear in the actual dataset and has result values of "XXX".
Rows 15-16:Items 13 and 14 are presented for illustrative purposes only. When the instrument is conducted, only one will be represented based on the CRF instructions. In this example, Item 14 would not appear in the actual dataset and has result values of "XXX".
Row 33:The total score does not have an evaluation interval value represented, since there is a mixture of evaluation interval values with items 13 and 14 that differ from the remaining items on the CRF.
Dataset2
RowSTUDYIDDOMAINUSUBJIDRSSEQRSTESTCDRSTESTRSCATRSORRESRSSTRESCRSSTRESNRSSTATRSREASNDRSMETHODRSLOBXFLRSREPNUMVISITNUMRSDTC
1STUDYXRS2324-P00011CBS0101CBS01-AlertnessCOMFORT-B SCALElightly asleep (eyes mostly closed, occasional responses)22

...

Info

We are unable to make the example consistently show blue in the Wiki. All examples are updated for each QRS instrument, so we ask that you please review the example below.

...

Dataset wrap
Namers
Rowcaps
Rows 13-14:Items 11 and 12 are presented for illustrative purposes only. When the instrument is conducted, only one will be represented based on the CRF instructions. In this example, Item 12 would not appear in the actual dataset and has result values of "XXX".
Rows 15-16:Items 13 and 14 are presented for illustrative purposes only. When the instrument is conducted, only one will be represented based on the CRF instructions. In this example, Item 14 would not appear in the actual dataset and has result values of "XXX".
Row 33:The total score does not have an evaluation interval value represented, since there is a mixture of evaluation interval values with items 13 and 14 that differ from the remaining items on the CRF.
Dataset2
RowSTUDYIDDOMAINUSUBJIDRSSEQRSTESTCDRSTESTRSCATRSORRESRSSTRESCRSSTRESNRSSTATRSREASNDRSMETHODRSLOBXFLRSREPNUMVISITNUMRSDTC
1STUDYXRS2324-P00011CBS0101CBS01-AlertnessCOMFORT-B SCALElightlylightly asleep (eyes mostly closed, occasional responses)22Y

1

12023-05-152STUDYXRS2324-P00012CBS0102CBS01-Calmness/AgitationCOMFORT-B SCALEslightly anxious (child shows slight anxiety)22Y112023-05-153STUDYXRS2324-P00013CBS0103CBS01-Respiratory ResponseCOMFORT-B SCALEno spontaneous respiration11


Y

1

12023-05-15
42STUDYXRS2324-P000142CBS0104CBS0102CBS01-CryingCalmness/AgitationCOMFORT-B SCALEslightly anxious (child shows slight anxiety)22


Y112023-05-15
53STUDYXRS2324-P000153CBS0105CBS0103CBS01-Physical MovementRespiratory ResponseCOMFORT-B SCALEoccasional, (three or fewer) slight movements2no spontaneous respiration112


Y112023-05-15
64STUDYXRS2324-P000164CBS0106CBS0104CBS01-Muscle ToneCryingCOMFORT-B SCALEnormal muscle tone33





Y112023-05-15
75STUDYXRS2324-P000175CBS0107CBS0105CBS01-Facial TensionPhysical MovementCOMFORT-B SCALEnormal facial toneSCALEoccasional, (three or fewer) slight movements22


Y112023-05-15
86STUDYXRS2324-P000186CBS0108CBS0106CBS01-Total ScoreMuscle ToneCOMFORT-B SCALE12normal muscle tone123123


Y112023-05-15
97STUDYXRS2324-P000197CBS0109CBS0107CBS01-NRS PainFacial TensionCOMFORT-B SCALE5normal facial tone525NUMERICAL RATING SCALE 11-POINT2


Y112023-05-15
108STUDYXRS2324-P0001108CBS0110CBS0108CBS01-NISSTotal ScoreCOMFORT-B SCALE212212212


Y112023-05-15
119STUDYXRS2324-P0001119CBS0111CBS0109CBS01-Details Sedatives/AnalgesicsNRS PainCOMFORT-B SCALEMidazolam555

NUMERICAL RATING SCALE 11-POINTMidazolamY112023-05-15

1210

STUDYXRS2324-P00011210CBS0112CBS0110CBS01-Reason AssessmentNISSCOMFORT-B SCALEPost surgery follow-up222Post surgery follow-up


Y112023-05-15

1311

STUDYXRS2324-P00011

11

CBS0101CBS0111CBS01-AlertnessDetails Sedatives/AnalgesicsCOMFORT-B SCALEMidazolamMidazolam



YNOT DONE1212023-05-2215

1412

STUDYXRS2324-P0001212CBS0102CBS0112CBS01-Calmness/AgitationReason AssessmentCOMFORT-B SCALEPost surgery follow-upPost surgery follow-up



YNOT DONE1212023-05-2215

1513

STUDYXRS2324-P000131CBS0103CBS0101CBS01-Respiratory ResponseAlertnessCOMFORT-B SCALE


NOT DONE


122023-05-22

16


14

STUDYXRS2324-P000142CBS0104CBS0102CBS01-CryingCalmness/AgitationCOMFORT-B SCALE


NOT DONE


122023-05-22

1715

STUDYXRS2324-P000153CBS0105CBS0103CBS01-Physical MovementRespiratory ResponseCOMFORT-B SCALE


NOT DONE


122023-05-22

18


16

STUDYXRS2324-P000164CBS0106CBS0104CBS01-Muscle ToneCryingCOMFORT-B SCALE


NOT DONE


122023-05-22

19


17

STUDYXRS2324-P000175CBS0107CBS0105CBS01-Facial TensionPhysical MovementCOMFORT-B SCALE


NOT DONE


122023-05-22

2018

STUDYXRS2324-P000186CBS0108CBS0106CBS01-Total ScoreMuscle ToneCOMFORT-B SCALE


NOT DONE


122023-05-22

2119

STUDYXRS2324-P000197CBS0109CBS0107CBS01-NRS PainFacial TensionCOMFORT-B SCALE


NOT DONE


122023-05-22

22


20

STUDYXRS2324-P0001108CBS0110CBS0108CBS01-NISSTotal ScoreCOMFORT-B SCALE


NOT DONE


122023-05-222

2123

STUDYXRS2324-P0001119CBS0111CBS0109CBS01-Details Sedatives/AnalgesicsNRS PainCOMFORT-B SCALE


NOT DONE


12
2023-05-

22

24

STUDYXRS2324-P00011210CBS0112CBS0110CBS01-Reason AssessmentNISSCOMFORT-B SCALE


NOT DONE


122023-05-222

23

Rows 11-32 removed for ease of use of template. (fyi, this row has merged cells so don't try to overwrite it when using the template; just delete it.)33

STUDYXQSRS2324-P00013311IDSR131CBS0111CBS01-Details Sedatives/AnalgesicsCOMFORT-B SCALE


NOT DONE


12

24

STUDYXRS2324-P000112CBS0112CBS01-Reason AssessmentCOMFORT-B SCALE


NOT DONE


12IDSR1-ScoreIDS-SR181818Y12015-05-15
Info

The following is for illustrative purposes and would not really be included for the IDS-SR instrument in this template. It provides an example of what would need to be included if the instrument required supplemental qualifiers (see Section 5 Supplemental Qualifier Name Codes):

Text that would remain unchanged has been left in black:

The evaluation interval text text value for data collection needs to be populated in SUPPQS SUPPRS as follows. The standard terminology for QNAM and QLABEL are listed below.

Dataset wrap
Namesuppqssupprs
STUDYIDRDOMAINUSUBJIDIDVARIDVARVALQNAMQLABELQVALQORIG
STUDYXRS2324-P0001RSSEQ4RSCBRFLConditionally Branched Item FlagYCRF
STUDYXRS2324-P0001RSTESTCDCBS0109RSANTXLOAnchor Text Lowno painCRF
STUDYXRS2324-P0001RSTESTCDCBS0109RSANTXHIAnchor Text Highworst pain possibleCRF
STUDYXRS2324-P0001RSTESTCDCBS0109RSANVLLOAnchor Value Low0CRF
STUDYXRS2324-P0001RSTESTCDCBS0109RSANVLHIAnchor Value High10CRF

...

RSORRESRSSTRESCRSSTRESN
deeply asleep (eyes closed, no response to changes in the environment)11
lightlylightly lightly asleep (eyes mostly closed, occasional responses)22
drowsy (child closes his/her eyes frequently, less responsive to the environment)33
awake and alert (child responsive to the environment)44
awake and hyper-alert (exaggerated responses to environmental stimuli)55

...