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Clinical Effectiveness of School Screening for Adolescent Idiopathic Scoliosis: A Large Population-Based Retrospective Cohort Study

Luk, Keith D. K. MCh (Orth)*; Lee, C. F. PhD†; Cheung, Kenneth M. C. MD*; Cheng, Jack C. Y. MD‡; Ng, Bobby K. W. MD§; Lam, T. P. MD‡; Mak, K. H. MSc (PH)¶; Yip, Paul S. F. PhD∥; Fong, Daniel Y. T. PhD†

doi: 10.1097/BRS.0b013e3181c7cb8c
Health Services Research

Study Design. Retrospective cohort study.

Objective. To evaluate the clinical effectiveness of school scoliosis screening using a large and long–term-followed cohort of students in Hong Kong.

Summary of Background Data. School screening for adolescent idiopathic scoliosis has been criticized as resulting in over-referrals for radiography and having low predictive values. Indeed, all but one previous retrospective cohort studies had no follow-up assessments of students until their skeletal maturity, leaving any late-developed curves undetected. The one study that completed this follow-up was well conducted but had low precisions due to its small sample size.

Methods. A total of 157,444 students were eligible for a biennial scoliosis screening, and their screening results and medical records up to 19 years of age were available. Students first had forward bending test and angle of trunk rotation (ATR) performed. Those with ATR between 5° and 14° or signs of adolescent idiopathic scoliosis were assessed by moiré topography regularly. Students with an ATR ≥15°, ≥2 moiré lines, or significant clinical signs were referred for radiography and had their Cobb angle measured.

Results. Of the 115,190 screened students in the cohort, 3228 (2.8%, 95% confidence interval [CI] = 2.7%–2.9%) were referred for radiography. At the final follow-up, the positive predictive values were 43.6% (41.8%–45.3%) for a Cobb angle ≥20° and 9.4% (8.4%–10.5%) for needing treatment, while the sensitivities were 88.1% (86.4%–89.6%) and 80.0% (75.6%–83.9%), respectively.

Conclusion. This is the largest study that has demonstrated that school scoliosis screening in Hong Kong is predictive and sensitive with a low referral rate. Screening should thus be continued in order to facilitate early administration of conservative treatments.

This study evaluated the clinical effectiveness of the school scoliosis screening program in Hong Kong. Of the 115,190 screened students in the cohort, 2.8% were referred for radiography. The positive predictive values were 43.6% and 9.4% for detecting curves ≥20° and treatment, and the sensitivities were 88.1% and 80.0% respectively.

From the Departments of *Orthopaedics and Traumatology and †Nursing Studies, The University of Hong Kong, Pokfulam, Hong Kong SAR, China; ‡Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China; §Department of Orthopaedics and Traumatology, Prince of Wales Hospital, Hong Kong SAR, China; ¶Department of Health, Hong Kong SAR, China; and ∥Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong SAR, China.

Acknowledgment date: July 8, 2009. Revision date: September 15, 2009. Acceptance date: September 15, 2009.

The manuscript submitted does not contain information about medical device(s)/drug(s).

Institutional funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

The authors Keith D. K. Luk, Chun F. Lee, Kenneth M. C. Cheung, and Daniel Y. T. Fong contributed equally to this paper.

Supported by the Central Policy Unit of the Government of the Hong Kong Special Administrative Region and the Research Grants Council of the Hong Kong Special Administrative Region, China (Project No.: HKU 7006-PPR-20051).

Address correspondence and reprint requests to Daniel Y. T. Fong, PhD, School of Nursing, The University of Hong Kong, 4/F William M.W. Mong Block, Faculty of Medicine Building, 21 Sassoon Road, Pokfulam, Hong Kong SAR, China; E-mail: dytfong@hku.hk

© 2010 Lippincott Williams & Wilkins, Inc.