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Article: Clinical effectiveness of school screening for adolescent idiopathic scoliosis: A large population-based retrospective cohort study
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TitleClinical effectiveness of school screening for adolescent idiopathic scoliosis: A large population-based retrospective cohort study
 
AuthorsLuk, KDK
Lee, CF1
Cheung, KMC
Cheng, JCY3
Ng, BKW2
Lam, TP3
Mak, KH
Yip, PSF1
Fong, DYT1
 
Keywordsadolescent idiopathic scoliosis
clinical effectiveness
school screening program
 
Issue Date2010
 
PublisherLippincott, Williams & Wilkins. The Journal's web site is located at http://www.spinejournal.com
 
CitationSpine, 2010, v. 35 n. 17, p. 1607-1614 [How to Cite?]
DOI: http://dx.doi.org/10.1097/BRS.0b013e3181c7cb8c
 
AbstractStudy 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. Sumary 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. © 2010, Lippincott Williams & Wilkins.
 
ISSN0362-2436
2012 Impact Factor: 2.159
2012 SCImago Journal Rankings: 1.447
 
DOIhttp://dx.doi.org/10.1097/BRS.0b013e3181c7cb8c
 
ISI Accession Number IDWOS:000280465200005
Funding AgencyGrant Number
Central Policy Unit of the Government of the Hong Kong Special Administrative Region
Hong Kong Special Administrative Region, ChinaHKU 7006-PPR-20051
Funding Information:

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).

 
ReferencesReferences in Scopus
 
DC FieldValue
dc.contributor.authorLuk, KDK
 
dc.contributor.authorLee, CF
 
dc.contributor.authorCheung, KMC
 
dc.contributor.authorCheng, JCY
 
dc.contributor.authorNg, BKW
 
dc.contributor.authorLam, TP
 
dc.contributor.authorMak, KH
 
dc.contributor.authorYip, PSF
 
dc.contributor.authorFong, DYT
 
dc.date.accessioned2010-10-31T14:02:14Z
 
dc.date.available2010-10-31T14:02:14Z
 
dc.date.issued2010
 
dc.description.abstractStudy 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. Sumary 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. © 2010, Lippincott Williams & Wilkins.
 
dc.description.naturepostprint
 
dc.identifier.citationSpine, 2010, v. 35 n. 17, p. 1607-1614 [How to Cite?]
DOI: http://dx.doi.org/10.1097/BRS.0b013e3181c7cb8c
 
dc.identifier.doihttp://dx.doi.org/10.1097/BRS.0b013e3181c7cb8c
 
dc.identifier.epage1614
 
dc.identifier.hkuros196983
 
dc.identifier.isiWOS:000280465200005
Funding AgencyGrant Number
Central Policy Unit of the Government of the Hong Kong Special Administrative Region
Hong Kong Special Administrative Region, ChinaHKU 7006-PPR-20051
Funding Information:

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).

 
dc.identifier.issn0362-2436
2012 Impact Factor: 2.159
2012 SCImago Journal Rankings: 1.447
 
dc.identifier.issue17
 
dc.identifier.openurl
 
dc.identifier.pmid20453727
 
dc.identifier.scopuseid_2-s2.0-77955468376
 
dc.identifier.spage1607
 
dc.identifier.urihttp://hdl.handle.net/10722/128052
 
dc.identifier.volume35
 
dc.languageeng
 
dc.publisherLippincott, Williams & Wilkins. The Journal's web site is located at http://www.spinejournal.com
 
dc.publisher.placeUnited States
 
dc.relation.ispartofSpine
 
dc.relation.referencesReferences in Scopus
 
dc.rightsThis is a non-final version of an article published in final form in Spine, 2010, v. 35 n. 17, p. 1607-1614
 
dc.rightsCreative Commons: Attribution 3.0 Hong Kong License
 
dc.subject.meshHong Kong
 
dc.subject.meshHumans
 
dc.subject.meshMass Screening - methods
 
dc.subject.meshRetrospective Studies
 
dc.subject.meshScoliosis - diagnosis
 
dc.subjectadolescent idiopathic scoliosis
 
dc.subjectclinical effectiveness
 
dc.subjectschool screening program
 
dc.titleClinical effectiveness of school screening for adolescent idiopathic scoliosis: A large population-based retrospective cohort study
 
dc.typeArticle
 
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<contributor.author>Lam, TP</contributor.author>
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<description.abstract>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. Sumary 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&#176; and 14&#176; or signs of adolescent idiopathic scoliosis were assessed by moir&#233; topography regularly. Students with an ATR 15&#176;, 2 moir&#233; 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&#176; 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. &#169; 2010, Lippincott Williams &amp; Wilkins.</description.abstract>
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Author Affiliations
  1. The University of Hong Kong
  2. Prince of Wales Hospital Hong Kong
  3. Chinese University of Hong Kong