Evaluation of scoliosis screening at Simon Fraser Health District

This study evaluates scoliosis screening carried out by the Simon Fraser Health District among grade seven students from September 1976 to June 1980. The results of screening were reviewed to determine if the evidence of four years of screening substantiates the continuation of the program. The program was initiated with the belief that detection of scoliosis at an early stage would allow bracing treatment as an alternative to major spinal surgery for correction of scoliosis curvatures. The criteria for evaluation of screening programs in general and specifically for scoliosis screening were selected after a search of the literature. Four principal criteria were utilized to evaluate this screening program: the acceptability of the test to the parents, children and physicians affected by screening, the acceptability of the treatment, the validity of the test and the availability of resources to carry out the program. Class lists, record cards and previous reports of the program were sources of data on the results of the screening program. Additional data was gathered during telephone interviews of parents and through questionnaires to physicians. Outcomes of the 169 screening positives identified from the screening population of 8010 boys and girls, primarily grade seven students, were examined and it was found that results were available for 167 of the 169 students screened positive. Of these, 40 (24 percent) were orthopedically positive (curve over 10°by Cobb method), 4 boys and 36 girls for a male to female ratio of 1:9. Active treatment by brace and/or surgery was recommended for 12 children, all female. There were three refusals in the nine cases in which bracing was recommended (33.3 percent) and three of the nine children for whom surgery was recommended also refused (33.3 percent). Six children were braced, but three of these eventually required surgical correction. A total of six children had spinal surgery. Of the 38 curves for which X-ray information is known, 25 were less than 20° initially and 13 were greater than 20°. None of the curves initially under 20° required treatment. A fourfold table was presented using an estimate of scoliosis prevalence to derive total diseased in the screening population. Sensitivity of the screening test was estimated at 26.2 percent, specificity at 98.4 percent, overreferral at 75.1 percent, underreferral at 1.5 percent and the positive predictive value at 24.9 percent. Overall predictive validity was 97 percent. Prevalence of scoliosis in SFHD was estimated at 0.6 percent compared to prevalence reported in the literature of 2 percent to 4 percent in similar populations using the same orthopedic standard for a positive curve. Costs for the screening program to the health district were approximately $17,800 for four years. The costs of referral services excluding surgery for diagnostic (true) positives were estimated at $12,250 and costs for the false positives (orthopedically negative) were $6,325. The conclusion reached was that although, scoliosis screening has had community acceptance, the acceptability of treatment was questionable, the validity of the test was not supported and that considerable resources were consumed. The absence of a central referral clinic was identified as a resource deficiency. It was recommended that the program be discontinued at this health district. Furthermore it was recommended that scoliosis screening not be introduced to other areas of the province because of the difficulties forseen in orthopedic evaluation and orthotic service, as well as because of doubts about validity of the test and acceptability of treatment. Some suggestions were made for modifications should the program be continued at SFHD and for future studies.Medicine, Faculty ofPopulation and Public Health (SPPH), School ofGraduat