A Meta-Analysis of the Clinical Effectiveness of School Scoliosis Screening

Daniel Yee Tak Fong, Chun Fan Lee, Kenneth Man Chee Cheung, Jack Chun Yiu Cheng, Bobby Kin Wah Ng, Tsz Ping Lam, Kwok Hang Mak, Paul Siu Fai Yip, Keith Dip Kei Luk
2010 Spine  
Study Design. A meta-analysis that systematically reviewed the evaluation studies of a scoliosis screening program reported in the literature. Objective. To evaluate the best current evidence on the clinical effectiveness of school screening for adolescent idiopathic scoliosis. Summary of Background Data. The use of school scoliosis screening is controversial, and its clinical effectiveness has been diversely reported. Methods. Data sources included three databases, namely PubMed, Google
more » ... , CINAHL database, and the references from identified reviews and studies. Studies were included if: 1) they adopted a retrospective cohort design; 2) were screened utilizing either the forward bending test (FBT), angle of trunk rotation, or Moiré topography; 3) reported results of screening tests and radiographic assessments; 4) screened adolescents only; 5) reported the incidence of curves with a minimum Cobb angle of 10 or greater; and 6) reported the number of referrals for radiography. Reviews, comments, case studies, and editorials were excluded. Results. Thirty-six studies, including thirty-four from the 775 initially identified studies and two from the references, met the selection criteria. The pooled referral rate for radiography was 5.0%, and the pooled positive predictive value (PPV) for detecting 5 curves ≥10, curves ≥20, and treatment were 28.0%, 5.6%, and 2.6%, respectively. There was substantial heterogeneity across studies. Meta-regression showed that programs using the FBT alone reported a higher referral rate (odds ratio [OR] = 2.91) and lower PPV for curves ≥10 (OR = 0.49) and curves ≥20 (OR = 0.34) than programs using other tests. Only one small study followed students until skeletal maturity and reported the sensitivity of screening; however, the specificity was not reported. No severe publication bias was noted. Conclusions. The use of the FBT alone in school scoliosis screening is insufficient. We need large, retrospective cohort studies with sufficient follow-up to properly assess the clinical effectiveness of school scoliosis screening. Key Words: adolescent idiopathic scoliosis, school screening program, meta-analysis, retrospective cohort studies. 6 Key Points  Studies that reported the clinical effectiveness of a school screening program for adolescent idiopathic scoliosis were systematically reviewed. Finally, thirty-six studies were included in a meta-analysis.  The pooled referral rate for radiography was 5.0%, and the pooled positive predictive values (PPV) for detecting curves ≥10, curves ≥20, and treatment were 28.0%, 5.6%, and 2.6%, respectively.  Programs that used the forward bending test as the only screening tool had a higher referral rate and a lower precision in detecting scoliotic curves.  Only one small study followed the screened children until their skeletal maturity, and reported the sensitivity of the screening program. and the value of school screening programs. Am J Public Health. Dec 1985;75(12):1377-1380. 37. Pin LH, Mo LY, Lin L, et al. Early diagnosis of scoliosis based on school-screening. J Bone Joint Surg Am. Oct 1985;67(8):1202-1205. 38. Chan A, Moller J, Vimpani G, Paterson D, Southwood R, Sutherland A. The case for scoliosis screening in Australian adolescents. Med J Aust. Oct 20 1986;145(8):379-383. 39. Keret D, Fishman J, Lucian M. [Screening for scoliosis in Haifa schools].
doi:10.1097/brs.0b013e3181bcc835 pmid:20393399 fatcat:ocwumropkfaglneskes2zb7o6e