Accuracy and Utility of School Screening for Scoliosis in Hong Kong

Abstract

School screening for adolescent idiopathic scoliosis (AIS) remains controversial and evaluation was mostly performed on small cohort or without long follow-up. Therefore, we aimed to evaluate the school screening in Hong Kong, started in 1995, based on a large cohort of children who were followed up until the age of 19.Scoliosis screening in Hong Kong was voluntary and composes of FBT, measure of ATR and Moire topography. Children who failed the tests were assessed by radiography. These screening results for the cohort of students who were studying Grade 5, aged 9-14, in 1995 or 1996 were extracted.The cohort included 157444 students and 115161 (56669 boys and 58602 girls) were screened at least once between 1995 and 2005. Of which 2414 failed and were referred for radiography. The sensitivity, i.e. the proportion of AIS by age of 19 detected by screening, was 64.7% (95% CI = 62.9% to 66.4%) for curves >=10°, and 55.3% (95% CI = 52.8% to 57.8%) f or curves >=20°. The positive predictive value, i.e. the proportion of true positives by 19, was 76.4% (95% CI = 74.6% to 78.1%) for curves >=10°, and 36.3% (95% CI = 34.4% to 38.3%) for c urves >=20°. 8% (95% CI = 7% to 9%) of children referred were eventually treated.In this large cohort, scoliosis screening had moderate accuracy with more than half AIS detected by screening. Moreover, most referred children were true AIS cases.