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Article: Referral criteria for school scoliosis screening: Assessment and recommendations based on a large longitudinally followed cohort

TitleReferral criteria for school scoliosis screening: Assessment and recommendations based on a large longitudinally followed cohort
Authors
Keywordsadolescent idiopathic scoliosis
moiré
positive predictive value
schoolbased scoliosis screening program
sensitivity
topography
Issue Date2010
PublisherLippincott, 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?
AbstractStudy 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.
Persistent Identifierhttp://hdl.handle.net/10722/142436
ISSN
2014 Impact Factor: 2.297
ISI Accession Number ID
Funding AgencyGrant Number
Central Policy Unit of the Government of the Hong Kong Special Administrative Region
Research Grants Council of the 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).

References

 

DC FieldValueLanguage
dc.contributor.authorLee, CFen_HK
dc.contributor.authorFong, DYTen_HK
dc.contributor.authorCheung, KMCen_HK
dc.contributor.authorCheng, JCYen_HK
dc.contributor.authorNg, BKWen_HK
dc.contributor.authorLam, TPen_HK
dc.contributor.authorMak, KHen_HK
dc.contributor.authorYip, PSFen_HK
dc.contributor.authorLuk, KDKen_HK
dc.date.accessioned2011-10-28T02:46:01Z-
dc.date.available2011-10-28T02:46:01Z-
dc.date.issued2010en_HK
dc.identifier.citationSpine, 2010, v. 35 n. 25, p. E1492-E1498en_HK
dc.identifier.issn0362-2436en_HK
dc.identifier.urihttp://hdl.handle.net/10722/142436-
dc.description.abstractStudy 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.en_HK
dc.languageengen_US
dc.publisherLippincott, Williams & Wilkins. The Journal's web site is located at http://www.spinejournal.comen_HK
dc.relation.ispartofSpineen_HK
dc.subjectadolescent idiopathic scoliosisen_HK
dc.subjectmoiréen_HK
dc.subjectpositive predictive valueen_HK
dc.subjectschoolbased scoliosis screening programen_HK
dc.subjectsensitivityen_HK
dc.subjecttopographyen_HK
dc.subject.meshMass Screening - methods-
dc.subject.meshPredictive Value of Tests-
dc.subject.meshReferral and Consultation-
dc.subject.meshSchool Health Services-
dc.subject.meshScoliosis - diagnosis - prevention and control-
dc.titleReferral criteria for school scoliosis screening: Assessment and recommendations based on a large longitudinally followed cohorten_HK
dc.typeArticleen_HK
dc.identifier.emailFong, DYT: dytfong@hku.hken_HK
dc.identifier.emailCheung, KMC: cheungmc@hku.hken_HK
dc.identifier.emailYip, PSF: sfpyip@hku.hken_HK
dc.identifier.emailLuk, KDK: hcm21000@hku.hken_HK
dc.identifier.authorityFong, DYT=rp00253en_HK
dc.identifier.authorityCheung, KMC=rp00387en_HK
dc.identifier.authorityYip, PSF=rp00596en_HK
dc.identifier.authorityLuk, KDK=rp00333en_HK
dc.description.naturelink_to_subscribed_fulltext-
dc.identifier.doi10.1097/BRS.0b013e3181ecf3feen_HK
dc.identifier.pmid21102278-
dc.identifier.scopuseid_2-s2.0-78650545166en_HK
dc.identifier.hkuros196991en_US
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-78650545166&selection=ref&src=s&origin=recordpageen_HK
dc.identifier.volume35en_HK
dc.identifier.issue25en_HK
dc.identifier.spageE1492en_HK
dc.identifier.epageE1498en_HK
dc.identifier.isiWOS:000284578400022-
dc.publisher.placeUnited Statesen_HK
dc.identifier.scopusauthoridLee, CF=36015342400en_HK
dc.identifier.scopusauthoridFong, DYT=35261710300en_HK
dc.identifier.scopusauthoridCheung, KMC=7402406754en_HK
dc.identifier.scopusauthoridCheng, JCY=9942890200en_HK
dc.identifier.scopusauthoridNg, BKW=7101727344en_HK
dc.identifier.scopusauthoridLam, TP=7202523234en_HK
dc.identifier.scopusauthoridMak, KH=8623141300en_HK
dc.identifier.scopusauthoridYip, PSF=7102503720en_HK
dc.identifier.scopusauthoridLuk, KDK=7201921573en_HK

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