Children at risk identified in an urban scoliosis school screening program: a new model

Abstract

School-based scoliosis screening programs, although controversial, remain well established. Our hypothesis was that with the addition of several inexpensive and simple measurements (height/weight, questionnaire), the overall impact of our screening program could be dramatically increased. Of the 1,058 children screened, 30 (2.8%) were positive for scoliosis. We found that 284 children (27%) were overweight and 468 (44%) children were overweight or at risk for overweight. Additionally, 61% of children did not have an identified primary health provider. These additional measurements did not change the efficacy of scoliosis screening but dramatically increased the number of children identified at risk for significant health problems.

Prevalence of scoliosis in patients with Fontan circulation

“…Idiopathic scoliosis occurs in 2–3% of the general population 1 2. The incidence of non-congenital scoliosis among patients with congenital heart disease (CHD) has been shown to be 10 times more common than in the general population 3.…”

Screening for scoliosis

“…Bunnell (1993Bunnell ( , 2005 recommends a redefinition of the term 'significant' scoliosis for screening, conducting selective screening of only immature females, the use of objective referral criteria, and rescreening rather than referring patients with borderline curves. Kapoor et al (2008) propose additional measurements, and a questionnaire, to improve programs for identifying other health problems, such as overweight and obesity. Ugras et al (2010) report the costeffectiveness of screening programs in Turkey.…”

“…Thus, critical opinions highlight inaccuracy (Wong et al, 1997;Karachalios et al, 1999;Fong et al, 2010), referral for unnecessary treatment and X-ray exposure (Wiegersma et al, 1998;Yawn et al, 1999;National Health and Medical Research Council (NHMRC), 2002;, cost/ benefit ineffectiveness (Ashworth et al, 1988;Yawn and Yawn, 2000), psychosocial stigma caused by labeling the patients (Dickson and Weinstein, 1999;NHMRC, 2002), and insufficient evidence for effectiveness of bracing (Dickson and Weinstein, 1999;, as well as for lower surgery rates in cases detected by screening (Bunnell, 1993;Wiegersma et al, 1998;Karachalios et al, 2000;Korfage et al, 2002). Supporters quote scientific value (Grivas et al, 2007b(Grivas et al, , 2008b(Grivas et al, , 2008c, low cost (Pruijs et al, 1996;Soucacos et al, 1997;Grivas et al, 2007a;Thilagaratnam, 2007;Ugras et al, 2010), advantages of a timely intervention and decreased surgery rate (Montgomery and Willner, 1993;Bunnell, 2005;Richards and Vitale, 2008), benefits of better health awareness (Pin et al, 1985), and opportunities for improving (Grivas et al, 2007b(Grivas et al, , 2008a(Grivas et al, , 2008bLeone et al, 2010) and implementing the procedure for other health problems (Kapoor et al, 2008).…”

Advantages of a two-step procedure for school-based scoliosis screening

“…These programs have been practiced widely in the United States and throughout the world for nearly 50 years. A large body of literature has been established during this time describing the beneficial results of spinal screening [1][2][3][4][5][6], most notably, a reduced need for spinal fusion [7][8][9][10][11]. However, epidemiologists and public policy-makers have focused their attention on scoliosis screenings concerned with the increasing difficulty of public health services to cope with the cost of the associated X-ray examinations [4,5].…”

“…Sono quasi 50 anni che questi programmi vengono applicati negli Stati Uniti ed in tutto il mondo e molti articoli della letteratura hanno dimostrato i loro effetti benefici [1][2][3][4][5][6], in primo luogo, la riduzione del numero di stabilizzazioni vertebrali [7][8][9][10][11]. Tuttavia, alcuni epidemiologi ed amministratori pubblici hanno puntato la loro attenzione sulla crescente difficoltà, da parte del Servizio Sanitario Nazionale, ad affrontare i costi degli esami radiografici previsti da questi programmi di screening [4,5].…”