A population-based study of school scoliosis screening
A population-based study of school scoliosis screening
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DOI：
10.1001/jama.282.15.1427
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发表时间：
1999-10-20
影响因子：
120.7
通讯作者：
Jacobsen, SJ
中科院分区：
文献类型：
--
作者：
Yawn, BP;Yawn, RA;Jacobsen, SJ
背景：虽然美国26个州强制实施了以学校为基础的青少年特发性脊柱侧凸筛查项目，但很少有关于此类项目有效性的项目结果数据。目的探讨以社区为基础的学校脊柱侧凸筛查方案的有效性。设计、环境和参与者对1979-1982年在明尼苏达州罗切斯特市公立或私立学校就读幼儿园或一年级的儿童进行回顾性队列研究。这些孩子被跟踪调查到19岁或离开学区。根据每年5至9年级脊柱侧凸筛查结果，并与社区医疗记录数据相关联，诊断和治疗脊柱侧凸的儿童人数；筛选方案的性能特点。结果在2242例筛查儿童中，92例（4.1%）转介进一步评估。其中，68例（74%）有脊柱侧凸的医学或脊椎指压治疗评估记录。学校筛查确定了9名接受脊柱侧凸治疗的儿童中的5名，但导致另外87名未接受治疗的儿童转诊。在该人群中，超过10度的脊柱侧凸累计发病率为1.8%(95%可信区间[CI]， 1.2%- 2.3%)，至少20度的脊柱侧凸累计发病率为1.0% (95% CI, 0.6%-1.5%)， 40度及以上的脊柱侧凸累计发病率为0.4% (95% CI, 0.1%-0.6%)；0.4%（0.5%的女孩和0.3%的男孩）因脊柱侧凸接受治疗。学校筛查项目对已治疗脊柱侧凸的阳性预测值为0.05 (95% CI, 0.048-0.052)，需要筛查448名儿童才能发现1名随后接受治疗的儿童。在连续几年的筛查中，阳性同意率从7%到30%不等。结论：在这一人群中，学校脊柱侧凸筛查确定了一些继续接受治疗的儿童，但转介了更多没有接受治疗的儿童。在决定是否进行学校脊柱侧凸筛查时应考虑这些数据。
Context Although school-based screening programs for adolescent idiopathic scoliosis are mandated in 26 states in the United States, few program outcomes data exist regarding the effectiveness of such programs.Objective To determine the effectiveness of a community-based school scoliosis screening program.Design, Setting, and Participants Retrospective cohort study of children who attended kindergarten or first grade at public or private schools in Rochester, Minn, during 1979-1982. Children were followed up until age 19 years or until they left the school district.Main Outcome Measures Number of children diagnosed and treated for scoliosis, based on results from scoliosis screenings performed annually in grades 5 through 9, linked to community medical records data; performance characteristics of the screening program.Results Of the 2242 children screened, 92 (4.1%) were referred for further evaluation. Of these, 68 (74%) had documented medical or chiropractic evaluation of scoliosis. School screening identified 5 of the 9 children treated for scoliosis but resulted in referrals for another 87 children who were not treated. The cumulative incidence of diagnosed scoliosis in this population was 1.8% (95% confidence interval [CI], 1.2%-2.3 %) for curves of more than 10 degrees, 1.0% (95% CI, 0.6%-1.5%) for curves of at least 20 degrees, and 0.4% (95% CI, 0.1%-0.6%) for curves of 40 degrees or more; 0.4% (0.5% of girls and 0.3% of boys) were treated for scoliosis. The positive predictive value of the school screening program for the identification of treated scoliosis was 0.05 (95% CI, 0.048-0.052), with 448 children needed to screen to identify 1 child who subsequently received treatment. The percent positive agreement across consecutive years of screening varied from 7% to 30%.Conclusion In this population, school scoliosis screening identified some children who went on to receive treatment but referred many more who did not. These data should be considered in making decisions regarding school scoliosis screening.