_Comprehensive Athletic Screening Evaluation (CASE):

_What is CASE?
The Comprehensive Athletic Screening Evaluation (CASE) is an in-depth examination tool that is designed to serve two functions. The evaluation screens the competitive adolescent athlete for potential orthopedic, neurologic and cardiac problems prior to beginning training or a season. The testing is also valuable to establish baseline cognitive performance scores that may be referenced in the event of head trauma or suspected concussion. If the athlete does suffer this kind of injury then he/she may be followed and retested sequentially until these baseline scores have been re-achieved.
The level of detail included in CASE is unavailable and impractical in most primary care settings. Because of the unique practice model of 1-to-1 Pediatrics, CASE is offered to all competitive athletes ages 12 through 20 years regardless of whether they are a regularly seen by this office.
What are the Components of CASE?
The Comprehensive Athletic Screening Evaluation is comprised of four components:
About Cardiac Screening:
Every few weeks the news brings us yet another tragic report of a seemingly healthy young athlete collapsing and dying on the basketball court or football field. Sudden Cardiac Death (SCD) is a rare event among the healthy adolescent athlete. Many (but not all) cases of SCD can be prevented by an experienced clinician taking an in-depth personal and family history that focuses on specific symptoms and events that put the athlete at risk. Furthermore, performing a 12-lead electrocardiogram (ECG) can detect certain underlying electrical disturbances that can predispose to SCD. "Red flags" in the history or abnormalities on exam or on the ECG are referred for more in depth evaluation.
Whether or not it is cost effective to screen all competitive athletes has been a subject of considerable debate within the medical community and the insurance industry. The time necessary to perform this level of screening is not practical within the 20-30 minute time frame allotted for most preventative health visits. Consequently, in most cases, a "sports physical" is in reality a routine well check with the physician signing off on any required forms for the athlete to participate. While the science of medicine, is imperfect and will not be able to prevent every sports related mortality, more in-depth screening can minimize this risk
The Comprehensive Athletic Screening Evaluation (CASE) is an in-depth examination tool that is designed to serve two functions. The evaluation screens the competitive adolescent athlete for potential orthopedic, neurologic and cardiac problems prior to beginning training or a season. The testing is also valuable to establish baseline cognitive performance scores that may be referenced in the event of head trauma or suspected concussion. If the athlete does suffer this kind of injury then he/she may be followed and retested sequentially until these baseline scores have been re-achieved.
The level of detail included in CASE is unavailable and impractical in most primary care settings. Because of the unique practice model of 1-to-1 Pediatrics, CASE is offered to all competitive athletes ages 12 through 20 years regardless of whether they are a regularly seen by this office.
What are the Components of CASE?
The Comprehensive Athletic Screening Evaluation is comprised of four components:
- A detailed history of the athlete and their family looking for problems and "red flags" that might put them at risk for injury or sudden death.
- A physical exam with detail on the cardiac, neurologic and orthopedic systems.
- A 12-lead electrocardiogram with computerized interpretation.
- Neuro-cognitive ImPACT testing to establish baseline levels in the event of a future head injury.
About Cardiac Screening:
Every few weeks the news brings us yet another tragic report of a seemingly healthy young athlete collapsing and dying on the basketball court or football field. Sudden Cardiac Death (SCD) is a rare event among the healthy adolescent athlete. Many (but not all) cases of SCD can be prevented by an experienced clinician taking an in-depth personal and family history that focuses on specific symptoms and events that put the athlete at risk. Furthermore, performing a 12-lead electrocardiogram (ECG) can detect certain underlying electrical disturbances that can predispose to SCD. "Red flags" in the history or abnormalities on exam or on the ECG are referred for more in depth evaluation.
Whether or not it is cost effective to screen all competitive athletes has been a subject of considerable debate within the medical community and the insurance industry. The time necessary to perform this level of screening is not practical within the 20-30 minute time frame allotted for most preventative health visits. Consequently, in most cases, a "sports physical" is in reality a routine well check with the physician signing off on any required forms for the athlete to participate. While the science of medicine, is imperfect and will not be able to prevent every sports related mortality, more in-depth screening can minimize this risk

Management of Traumatic Brain Injury:
Over the past few years, the medical community has become increasingly aware of the effect of head trauma on the adolescent brain. Teenagers and young adults often don't exhibit symptoms of a mild traumatic brain injury (MTBI) resulting from a level of impact that would cause more obvious findings in an adult. Consequently, an adolescent athlete with post-concussive syndrome most likely has suffered a more substantial injury than an adult with a similar level of symptoms. After suffering an initial MTBI, the young athlete is at a five-fold risk of sustaining another. If repeated trauma, however mild, occurs after the initial injury has had a chance to fully resolve "second impact syndrome" may result--with tragic consequences. The International Conference on Concussion in Sport has developed a Consensus Statement expounding the recommended protocol for management of MTBI in the competitive athlete. Pre-season baseline evaluation as well as close post-injury follow up are the mainstay of proper management.
What is ImPACT?
ImPACT is a computer based neurocognitive testing tool that was established by researchers at the University of Pittsburgh. This testing is used to establish baseline scores in athletes. The evaluation is then re-administered to athletes following head injuries or suspected concussions to follow the recovery process. This valuable data aids the clinician in determining when the athlete is ready to resume training and return to play. ImPACT testing has been researched and advocated by The International Conference on Concussion in Sport. The evaluation is widely used by all teams in the NFL and NHL and many other professional sports teams. Dr. Nash has completed rigorous training in concussion management and has been granted the status of Credentialed ImPACT Consultant. He is the only primary care physician in California to achieve this certification.
Is CASE Covered by Health Insurance?
Because all four components of CASE are designed to screen for and prevent potential medical problems rather than treat existing ones, the evaluation is not covered by traditional medical health plans. If problems are detected during the examination, then follow-up visits at our office or referral to a specialist are covered. You will be provided with a 'superbill' for services rendered that may be submitted to HSA accounts for reimbursement.
Additionally, if the athlete sustains a head injury and requires follow-up evaluations and testing, these are covered by most PPO insurance plans.
Call today to schedule your athlete's CASE or click HERE to request more information.