Published online December 31, 2007
PEDIATRICS Vol. 121 No. 1 January 2008, pp. 9-14 (doi:10.1542/10.1542/peds.2006-3673)
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ARTICLE

Estimating the Effectiveness of Screening for Scoliosis: A Case-Control Study

Eveline M. Bunge, MSca, Rikard E. Juttmann, MD, PhDa, Frans C. van Biezen, MDb, Huub Creemers, MDc, Alice A. J. M. Hazebroek-Kampschreur, MD, PhDd, Bert C. F. Luttmer, MDe, P. Auke Wiegersma, MD, PhDf, Harry J. de Koning, MD, PhDa for the Netherlands Evaluation Study on Screening for Scoliosis (NESCIO) Group

a Departments of Public Health
b Orthopedics, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, Netherlands
c Youth Health Care Section, Municipal Health Service, Geleen, Netherlands
d Municipal Health Service, Rotterdam, Netherlands
e Youth Health Care Section, Municipal Health Service, Assen, Netherlands
f Department of Social Medicine, University Medical Center Groningen, Groningen, Netherlands

OBJECTIVE. The aim of this study was to test the hypothesis that screening for scoliosis is effective in reducing the need for surgical treatment.

METHODS. The study was a case-control study. A total of 125 consecutive patients who were treated surgically for idiopathic scoliosis between January 2001 and October 2004 and who were born on or after January 1, 1984, were invited; 108 agreed to participate. A total of 216 control subjects were selected randomly and anonymously, matched with respect to age and gender. For 279 adolescents, exact screening exposure and outcomes could be analyzed. Case subjects were recruited from 4 university and 6 nonuniversity Dutch hospitals; control subjects were recruited from all 37 municipal health services in the Netherlands.

RESULTS. Screen-detected patients received diagnoses at a significantly younger age than did otherwise-detected patients (10.8 ± 2.6 vs 13.4 ± 1.7 years). In total, 32.8% of the surgically treated patients had been screened between 11 and 14 years of age, compared with 43.4% of the control subjects. The odds ratio for being exposed to screening was 0.64. In total, 28% of the patients were diagnosed as having scoliosis before 11 years of age.

CONCLUSIONS. Our results showed no evidence that screening for scoliosis reduced the need for surgery. Abolishing screening seems justified, especially because the effectiveness of early treatment with bracing is still strongly debated. A randomized, controlled trial on the effectiveness of treating patients with idiopathic scoliosis with bracing is urgently needed.

Key Words: scoliosis • screening • case-control study • effectiveness

Abbreviations: IS—idiopathic scoliosis • RCT—randomized, controlled trial • OR—odds ratio • CI—confidence interval • MHS—municipal health service

Accepted Jun 29, 2007.


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 PediatricsHome page
B. S. Richards, J. H. Beaty, G. H. Thompson, and R. B. Willis
Estimating the Effectiveness of Screening for Scoliosis
Pediatrics, June 1, 2008; 121(6): 1296 - 1297.
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 PediatricsHome page
E. M. Bunge and H. J. de Koning
Estimating the Effectiveness of Screening for Scoliosis: In Reply
Pediatrics, June 1, 2008; 121(6): 1297 - 1298.
[Full Text] [PDF]