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Article: Referral criteria for school scoliosis screening: Assessment and recommendations based on a large longitudinally followed cohort
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TitleReferral criteria for school scoliosis screening: Assessment and recommendations based on a large longitudinally followed cohort
 
AuthorsLee, CF1
Fong, DYT1
Cheung, KMC1
Cheng, JCY3
Ng, BKW2
Lam, TP3
Mak, KH
Yip, PSF1
Luk, KDK1
 
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
 
CitationSpine, 2010, v. 35 n. 25, p. E1492-E1498 [How to Cite?]
DOI: http://dx.doi.org/10.1097/BRS.0b013e3181ecf3fe
 
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.
 
ISSN0362-2436
2013 Impact Factor: 2.447
 
DOIhttp://dx.doi.org/10.1097/BRS.0b013e3181ecf3fe
 
ISI Accession Number IDWOS:000284578400022
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).

 
ReferencesReferences in Scopus
 
DC FieldValue
dc.contributor.authorLee, CF
 
dc.contributor.authorFong, DYT
 
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.authorLuk, KDK
 
dc.date.accessioned2011-10-28T02:46:01Z
 
dc.date.available2011-10-28T02:46:01Z
 
dc.date.issued2010
 
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.
 
dc.description.naturelink_to_subscribed_fulltext
 
dc.identifier.citationSpine, 2010, v. 35 n. 25, p. E1492-E1498 [How to Cite?]
DOI: http://dx.doi.org/10.1097/BRS.0b013e3181ecf3fe
 
dc.identifier.doihttp://dx.doi.org/10.1097/BRS.0b013e3181ecf3fe
 
dc.identifier.epageE1498
 
dc.identifier.hkuros196991
 
dc.identifier.isiWOS:000284578400022
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).

 
dc.identifier.issn0362-2436
2013 Impact Factor: 2.447
 
dc.identifier.issue25
 
dc.identifier.pmid21102278
 
dc.identifier.scopuseid_2-s2.0-78650545166
 
dc.identifier.spageE1492
 
dc.identifier.urihttp://hdl.handle.net/10722/142436
 
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.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.subjectadolescent idiopathic scoliosis
 
dc.subjectmoiré
 
dc.subjectpositive predictive value
 
dc.subjectschoolbased scoliosis screening program
 
dc.subjectsensitivity
 
dc.subjecttopography
 
dc.titleReferral criteria for school scoliosis screening: Assessment and recommendations based on a large longitudinally followed cohort
 
dc.typeArticle
 
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<contributor.author>Ng, BKW</contributor.author>
<contributor.author>Lam, TP</contributor.author>
<contributor.author>Mak, KH</contributor.author>
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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