Article: Referral criteria for school scoliosis screening: Assessment and recommendations based on a large longitudinally followed cohort
| Title | Referral criteria for school scoliosis screening: Assessment and recommendations based on a large longitudinally followed cohort | ||||||
|---|---|---|---|---|---|---|---|
| Authors | Lee, CF1 Fong, DYT1 Cheung, KMC1 Cheng, JCY3 Ng, BKW2 Lam, TP3 Mak, KH Yip, PSF1 Luk, KDK1 | ||||||
| Keywords | adolescent idiopathic scoliosis moiré positive predictive value schoolbased scoliosis screening program sensitivity topography | ||||||
| Issue Date | 2010 | ||||||
| Publisher | Lippincott, Williams & Wilkins. The Journal's web site is located at http://www.spinejournal.com | ||||||
| Citation | Spine, 2010, v. 35 n. 25, p. E1492-E1498 [How to Cite?] DOI: http://dx.doi.org/10.1097/BRS.0b013e3181ecf3fe | ||||||
| Abstract | Study Design.: This study was a retrospective cohort study. Objective: To examine the criteria recommended in the literature for the school-based scoliosis screening program in Hong Kong. Summary of Background Data: School-based screening for scoliosis has been a controversy. Objectors to the policy were concerned about the high over-referral and false-positive rates. Recommendations were then made for improvement, but the feasibility of these recommendations has not been studied. Methods: The cohort consisted of students in Grade 5 in 1995/1996 or 1996/1997 who underwent scoliosis screening in Hong Kong. Participants who had an angle of trunk rotation (ATR) ≥15°, 2 or more moiré lines, or presented significant clinical signs were referred for radiography. Screening histories and radiography records before the age of 19 years were extracted. The accuracy measures for different combinations of screening tests were examined. RESULTS.: There were 115,178 students in the cohort, of which 3228 (2.8%) were referred for radiography. Among the 1406 students who displayed a curve ≥20° during screening, 257 (18.3%) were boys and 336 (23.9%) were identified as 16 years or older, ruling out the suggestion of screening only 10-year-old girls. The sensitivity and positive predictive value for the current referral criteria were 88.1% and 43.6%, respectively. The sensitivity would drop substantially if the use of moiré topography (39.8%) or clinical signs (55.5%) were discarded. With the inclusion of these 2 tests, the clinical effectiveness measures were robust to the cutoff for ATR, unless it was set below 10°. Conclusion.: Selectively screening only premenarche girls was not feasible, as this screen would have missed a significant proportion of children with significant curvature. No refinement of the current protocol was necessary, although boys could be screened beginning at 12 years of age. The tandem use of ATR, moiré topography, and clinical signs was recommended for future studies. © 2010, Lippincott Williams & Wilkins. | ||||||
| ISSN | 0362-2436 2011 Impact Factor: 2.078 2011 SCImago Journal Rankings: 0.137 | ||||||
| DOI | http://dx.doi.org/10.1097/BRS.0b013e3181ecf3fe | ||||||
| ISI Accession Number ID | WOS:000284578400022
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). | ||||||
| References | References in Scopus |
| dc.contributor.author | Lee, CF | ||||||
|---|---|---|---|---|---|---|---|
| dc.contributor.author | Fong, DYT | ||||||
| dc.contributor.author | Cheung, KMC | ||||||
| dc.contributor.author | Cheng, JCY | ||||||
| dc.contributor.author | Ng, BKW | ||||||
| dc.contributor.author | Lam, TP | ||||||
| dc.contributor.author | Mak, KH | ||||||
| dc.contributor.author | Yip, PSF | ||||||
| dc.contributor.author | Luk, KDK | ||||||
| dc.date.accessioned | 2011-10-28T02:46:01Z | ||||||
| dc.date.available | 2011-10-28T02:46:01Z | ||||||
| dc.date.issued | 2010 | ||||||
| dc.description.abstract | Study Design.: This study was a retrospective cohort study. Objective: To examine the criteria recommended in the literature for the school-based scoliosis screening program in Hong Kong. Summary of Background Data: School-based screening for scoliosis has been a controversy. Objectors to the policy were concerned about the high over-referral and false-positive rates. Recommendations were then made for improvement, but the feasibility of these recommendations has not been studied. Methods: The cohort consisted of students in Grade 5 in 1995/1996 or 1996/1997 who underwent scoliosis screening in Hong Kong. Participants who had an angle of trunk rotation (ATR) ≥15°, 2 or more moiré lines, or presented significant clinical signs were referred for radiography. Screening histories and radiography records before the age of 19 years were extracted. The accuracy measures for different combinations of screening tests were examined. RESULTS.: There were 115,178 students in the cohort, of which 3228 (2.8%) were referred for radiography. Among the 1406 students who displayed a curve ≥20° during screening, 257 (18.3%) were boys and 336 (23.9%) were identified as 16 years or older, ruling out the suggestion of screening only 10-year-old girls. The sensitivity and positive predictive value for the current referral criteria were 88.1% and 43.6%, respectively. The sensitivity would drop substantially if the use of moiré topography (39.8%) or clinical signs (55.5%) were discarded. With the inclusion of these 2 tests, the clinical effectiveness measures were robust to the cutoff for ATR, unless it was set below 10°. Conclusion.: Selectively screening only premenarche girls was not feasible, as this screen would have missed a significant proportion of children with significant curvature. No refinement of the current protocol was necessary, although boys could be screened beginning at 12 years of age. The tandem use of ATR, moiré topography, and clinical signs was recommended for future studies. © 2010, Lippincott Williams & Wilkins. | ||||||
| dc.description.nature | Link_to_subscribed_fulltext | ||||||
| dc.identifier.citation | Spine, 2010, v. 35 n. 25, p. E1492-E1498 [How to Cite?] DOI: http://dx.doi.org/10.1097/BRS.0b013e3181ecf3fe | ||||||
| dc.identifier.doi | http://dx.doi.org/10.1097/BRS.0b013e3181ecf3fe | ||||||
| dc.identifier.epage | E1498 | ||||||
| dc.identifier.hkuros | 196991 | ||||||
| dc.identifier.isi | WOS:000284578400022
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.issn | 0362-2436 2011 Impact Factor: 2.078 2011 SCImago Journal Rankings: 0.137 | ||||||
| dc.identifier.issue | 25 | ||||||
| dc.identifier.pmid | 21102278 | ||||||
| dc.identifier.scopus | eid_2-s2.0-78650545166 | ||||||
| dc.identifier.spage | E1492 | ||||||
| dc.identifier.uri | http://hdl.handle.net/10722/142436 | ||||||
| dc.identifier.volume | 35 | ||||||
| dc.language | eng | ||||||
| dc.publisher | Lippincott, Williams & Wilkins. The Journal's web site is located at http://www.spinejournal.com | ||||||
| dc.publisher.place | United States | ||||||
| dc.relation.ispartof | Spine | ||||||
| dc.relation.references | References in Scopus | ||||||
| dc.subject.mesh | Mass Screening - methods | ||||||
| dc.subject.mesh | Predictive Value of Tests | ||||||
| dc.subject.mesh | Referral and Consultation | ||||||
| dc.subject.mesh | School Health Services | ||||||
| dc.subject.mesh | Scoliosis - diagnosis - prevention and control | ||||||
| dc.subject | adolescent idiopathic scoliosis | ||||||
| dc.subject | moiré | ||||||
| dc.subject | positive predictive value | ||||||
| dc.subject | schoolbased scoliosis screening program | ||||||
| dc.subject | sensitivity | ||||||
| dc.subject | topography | ||||||
| dc.title | Referral criteria for school scoliosis screening: Assessment and recommendations based on a large longitudinally followed cohort | ||||||
| dc.type | Article |
Author Affiliations
- The University of Hong Kong
- Prince of Wales Hospital Hong Kong
- Chinese University of Hong Kong