Do We Need School Screening for Scoliosis?
Screening for curvature of the spine called scoliosis is often done in the schools by a trained nurse. Children between the ages of 12 and 13 are checked for any signs of a scoliosis. In Canada, the screening program was stopped. There wasn't enough proof that the money spent on the program saved money in the end.
In this study, results of school screening are compared with what happens without screening. The researchers reviewed patient charts for all adolescent patients sent to the orthopedic clinic for a spine problem. There were 489 patients included.
They compared the referral patterns for scoliosis from before (when screening was still done) to after screening was stopped. The results showed two main findings. First, after screening was discontinued, half of the patients sent to the clinic were normal and didn't have scoliosis at all. One-third of the patients were referred too late. Their scoliosis had already gotten so bad, they needed treatment with braces right away.
They compared these results to a study done of 713 patients referred to a children's clinic from a school screening program. Late referral was very rare in the screened group. About 40 per cent in the screening group did not have scoliosis.
The authors point out that without scoliosis screening in the schools, more children are sent to the doctor without cause. At the same time, those children who really need treatment, don't get sent to the doctor until it's too late.
However, re-starting a school screening program may not be the best answer for under-referral and late referral. One solution to the problem might be better training for family doctors about scoliosis. Clinical practice guidelines including when to refer to a specialist might be helpful while still reducing the cost.
References: Marie Beauséjour, MASc, et al. Patient Characteristics at the Initial Visit to a Scoliosis Clinic. A Cross-Sectional Study in a Community Without School Screening. In Spine May 20, 2007. Vol. 32. No. 12. Pp. 1349-1354.
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