Estimating the effectiveness of screening for scoliosis: a case-control study.
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.
Bunge
Eveline M
EM
Department of Public Health, Erasmus Medical Center, University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands. e.bunge@erasmusmc.nl
Juttmann
Rikard E
RE
van Biezen
Frans C
FC
Creemers
Huub
H
Hazebroek-Kampschreur
Alice A J M
AA
Luttmer
Bert C F
BC
Wiegersma
P Auke
PA
de Koning
Harry J
HJ
D000293:Adolescent; D000367:Age Factors; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D016001:Confidence Intervals; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008403:Mass Screening / Q000379:methods*; D009426:Netherlands; D016017:Odds Ratio; D012016:Reference Values; D018570:Risk Assessment; D012600:Scoliosis / Q000175:diagnosis* / Q000534:rehabilitation / Q000601:surgery*; D012720:Severity of Illness Index; D012737:Sex Factors; D013123:Spinal Fusion / Q000379:methods*; D016896:Treatment Outcome