Scoliosis Screening for School Children in Hong Kong: Exemplar to the World

Abstract

Screening for adolescent idiopathic scoliosis (AIS) has been a global controversy, since the implementation of the first scoliosis screening program in more than 60 years ago. The supporters consider screening for AIS is important because AIS if it is left untreated may progress to the extent that requires invasive spinal surgery. Scoliosis screening allows the detection of children with AIS early enough for applying conservative treatments such as bracing. The opposers are mainly concerned of the low prevalence of AIS, uncertainty of the clinical effectiveness of existing screening protocols, and the lack of evidence in support of conservative treatments for controlling curve progression. In Hong Kong, a scoliosis screening program has been implemented as a voluntary part in the annual government health assessment service for children. It was established in 1995, as a joint venture between the Department of Orthopaedics & Traumatology of The University of Hong Kong and the Department of Health. The screening protocol comprises two tiers of three screening tests for students studying Grade 5-9. We have conducted a series of studies on the Hong Kong scoliosis screening program to assess its clinical effectiveness and costs, in response to the current concerns of mass scoliosis screening. Specifically, over a hundred thousands of children had their screening and medical history up to 19 years of age collected. Based on this cohort, the screening accuracy was high with sensitivity of 88% (95% CI=86% to 90%), and positive predictive value of 44% (95% CI=42% to 45%). The corresponding specificity and negative predictive value were above 95%. These were higher than other screening protocols elsewhere. The total cost for screening, diagnosis, and treatment for each screened children was US$55, which was comparable if not cheaper than that in other places. Based on the largest cohort of children followed until their 19 year-old, the 2-tier scoliosis screening program in Hong Kong is both clinical and cost effective in detecting AIS. Its protocol and experience can be shared not only in the Greater China, but it may also be applicable to other parts of the world.