A Meta-analysis of the Clinical Effectiveness of School Scoliosis Screening

摘要

Introduction: The use of school scoliosis screening is controversial, and its clinical effectiveness has been diversely reported.rnObjectives: To evaluate the best current evidence on the clinical effectiveness of school screening for adolescent idiopathic scoliosis.rnMaterials and Methods: Retrospective cohort studies that evaluated school scoliosis screening were obtained from searching the electronic databases: PubMed, Google scholar, and CINAHL, as well as reading the references from identified reviews and studies.rnResults: Thirty-six studies, including thirty-four from the 775 initially identified studies and two from the references, met the selection criteria. The pooled referral rate for radiography was 5.0%, and the pooled positive predictive value (PPV) for detecting curves ≥10°, curves ≥20°, and treatment were 28.0%, 5.6%, and 2.6%, respectively. There was substantial heterogeneity across studies. Meta-regression showed that programs using the FBT alone reported a higher referral rate (odds ratio [OR] = 2.91) and lower PPV for curves ≥10° (OR = 0.49) and curves ≥20° (OR = 0.34) than programs using other tests. Only one small study followed students until skeletal maturity and reported the sensitivity of screening; however, the specificity was not reported. No severe publication bias was noted. Conclusion: There was substantial heterogeneity across studies due to the use of different screening tests and different study sizes. The use of the FBT alone in school scoliosis screening is insufficient.rnSignificance: This study informs the need of large, retrospective cohort studies with sufficient follow-up to properly assess the clinical effectiveness of school scoliosis screening.