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Article: A population-based cohort study of 394,401 children followed for 10 years exhibits sustained effectiveness of scoliosis screening

TitleA population-based cohort study of 394,401 children followed for 10 years exhibits sustained effectiveness of scoliosis screening
Authors
KeywordsRetrospective cohort
Sustainability
Scoliosis screening
Adolescent idiopathic scoliosis
Clinical effectiveness
Health services
Issue Date2015
PublisherElsevier BV. The Journal's web site is located at http://www.elsevier.com/locate/spinee
Citation
Spine Journal, 2015, v. 15, n. 5, p. 825-833 How to Cite?
Abstract© 2015 Elsevier Inc. All rights reserved. Background context: The value of scoliosis screening has been recently shown in a multicenter randomized controlled trial. However, the long-term sustainability of the clinical effectiveness of scoliosis screening as a routine health service remains unknown. Purpose: The aim of this study was to assess the sustainability of the clinical effectiveness of school scoliosis screening. Study design/setting: A large population-based cohort study with a 10-year follow-up was conducted. Patient sample: A total of 394,401 students who were in the fifth grade during the five academic years from 1995/1996 to 1999/2000 formed five consecutive annual cohorts. The students were eligible for the Hong Kong scoliosis screening program, with their screening history and medical records until their nineteenth birthdays being assessed. Outcome measures: The outcome measures considered in the study were development of adolescent idiopathic scoliosis by the 19 years of age and the Cobb angle. Methods: The clinical effectiveness of scoliosis screening was assessed by referral rate for radiographic diagnosis, sensitivity, specificity, and predictive values. Results: A total of 306,144 students (78%) participated in scoliosis screening, which used a two-tier system. The prevalence of curves of 20 or greater was 1.8% (95% confidence interval [CI], 1.7-1.8%), whereas the referral rate for radiography, the sensitivity, and the positive predictive value (PPV) for curves of 20 or greater were 4.1% (95% CI, 4.0-4.2%), 91% (95% CI, 90-92%), and 40% (95% CI, 39-41%), respectively. Across the five consecutive annual cohorts, the prevalence and sensitivity for curves of 20 or greater increased by 0.23% (95% CI, 0.21-0.25%; p<.001) and 0.76% (95% CI, 0.43-1.04%; p<.001) per year, respectively; however, the PPV was reduced by 1.71% (95% CI, 1.09-2.33%; p<.001) per year. Conclusions: This report describes the first large population-based study with a long-term follow-up indicating that a scoliosis screening program can have sustained clinical effectiveness in identifying patients with adolescent idiopathic scoliosis needing clinical observation. As the prevalence of adolescent idiopathic scoliosis increases, scoliosis screening should be continued as a routine health service in schools or by general practitioners if there is no scoliosis screening policy.
Persistent Identifierhttp://hdl.handle.net/10722/220866
ISSN
2015 Impact Factor: 2.66
2015 SCImago Journal Rankings: 1.153

 

DC FieldValueLanguage
dc.contributor.authorFong, Daniel Y T-
dc.contributor.authorCheung, Kenneth M C-
dc.contributor.authorWong, Yat Wa-
dc.contributor.authorWan, Yuen Yin-
dc.contributor.authorLee, Chun Fan-
dc.contributor.authorLam, Tsz Ping-
dc.contributor.authorCheng, Jack C Y-
dc.contributor.authorNg, Bobby K W-
dc.contributor.authorLuk, Keith D K-
dc.date.accessioned2015-10-22T09:04:39Z-
dc.date.available2015-10-22T09:04:39Z-
dc.date.issued2015-
dc.identifier.citationSpine Journal, 2015, v. 15, n. 5, p. 825-833-
dc.identifier.issn1529-9430-
dc.identifier.urihttp://hdl.handle.net/10722/220866-
dc.description.abstract© 2015 Elsevier Inc. All rights reserved. Background context: The value of scoliosis screening has been recently shown in a multicenter randomized controlled trial. However, the long-term sustainability of the clinical effectiveness of scoliosis screening as a routine health service remains unknown. Purpose: The aim of this study was to assess the sustainability of the clinical effectiveness of school scoliosis screening. Study design/setting: A large population-based cohort study with a 10-year follow-up was conducted. Patient sample: A total of 394,401 students who were in the fifth grade during the five academic years from 1995/1996 to 1999/2000 formed five consecutive annual cohorts. The students were eligible for the Hong Kong scoliosis screening program, with their screening history and medical records until their nineteenth birthdays being assessed. Outcome measures: The outcome measures considered in the study were development of adolescent idiopathic scoliosis by the 19 years of age and the Cobb angle. Methods: The clinical effectiveness of scoliosis screening was assessed by referral rate for radiographic diagnosis, sensitivity, specificity, and predictive values. Results: A total of 306,144 students (78%) participated in scoliosis screening, which used a two-tier system. The prevalence of curves of 20 or greater was 1.8% (95% confidence interval [CI], 1.7-1.8%), whereas the referral rate for radiography, the sensitivity, and the positive predictive value (PPV) for curves of 20 or greater were 4.1% (95% CI, 4.0-4.2%), 91% (95% CI, 90-92%), and 40% (95% CI, 39-41%), respectively. Across the five consecutive annual cohorts, the prevalence and sensitivity for curves of 20 or greater increased by 0.23% (95% CI, 0.21-0.25%; p<.001) and 0.76% (95% CI, 0.43-1.04%; p<.001) per year, respectively; however, the PPV was reduced by 1.71% (95% CI, 1.09-2.33%; p<.001) per year. Conclusions: This report describes the first large population-based study with a long-term follow-up indicating that a scoliosis screening program can have sustained clinical effectiveness in identifying patients with adolescent idiopathic scoliosis needing clinical observation. As the prevalence of adolescent idiopathic scoliosis increases, scoliosis screening should be continued as a routine health service in schools or by general practitioners if there is no scoliosis screening policy.-
dc.languageeng-
dc.publisherElsevier BV. The Journal's web site is located at http://www.elsevier.com/locate/spinee-
dc.relation.ispartofSpine Journal-
dc.rights© 2015. This manuscript version is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/-
dc.rightsCreative Commons: Attribution 3.0 Hong Kong License-
dc.subjectRetrospective cohort-
dc.subjectSustainability-
dc.subjectScoliosis screening-
dc.subjectAdolescent idiopathic scoliosis-
dc.subjectClinical effectiveness-
dc.subjectHealth services-
dc.titleA population-based cohort study of 394,401 children followed for 10 years exhibits sustained effectiveness of scoliosis screening-
dc.typeArticle-
dc.description.naturepostprint-
dc.identifier.doi10.1016/j.spinee.2015.01.019-
dc.identifier.scopuseid_2-s2.0-84937969411-
dc.identifier.hkuros245567-
dc.identifier.volume15-
dc.identifier.issue5-
dc.identifier.spage825-
dc.identifier.epage833-
dc.identifier.eissn1878-1632-

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