title: Low hospital referral rates of school scoliosis screening positives in an urban district of mainland China.
abstract: Significant prevalence rates of adolescent scoliosis in China were suggested in previous studies. However, school screenings for adolescent scoliosis have been suspended due to low rates of positive detection under the past screening system in China. The present study was undertaken to screen for adolescent scoliosis in middle school students under a modern assessment system in a district of Shanghai. We performed a population-based, cross-sectional study of a middle school scoliosis screening program in the Jingan district. In 2015, schoolchildren were initially screened by visual inspection of clinical signs and the forward-bending test. Suspected cases were referred for radiography in hospital for scoliosis diagnosis. A total of 5327 middle school students (grades 6-8) were screened with 520 (9.76%) positives (the positive rates of girls and boys at 15.28% and 4.59%, respectively) and no statistically significant difference among grades. Only 301 positives (57.9%) followed the referral for hospital radiography. There were 102 cases (33.9%) that were diagnosed with scoliosis by radiography criteria (Cobb angle ≥10°) including mild scoliosis (Cobb 10-25) for 94 cases and moderate scoliosis (Cobb 25-40) for 8 cases, and false-positives (Cobb 0) for 39 cases. The putative prevalence rate was estimated as 1.9% from the referred students. Under an accurate and modern assessment system, school screenings can detect scoliosis at a significant rate, but awareness of scoliosis risks is needed for residents in China to take up referrals for hospital diagnosis after school screenings.
authors.affiliation: Department of Health Promotion, Shanghai Jingan Center for Disease Control and Prevention Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China Department of Internal Medicine, Jyobal Hospital, Tokiwa Foundation, Iwaki, Fukushima Medical Governance Research Institute, Tokyo, Japan Department of School Health, Shanghai Center for Disease Control and Prevention, Shanghai, China Global Public Health Unit, School of Social and Political Science, University of Edinburgh, Edinburgh, UK Research Institute of Innovative Medicine, Tokiwa Foundation, Iwaki, Fukushima, Japan Jing'an Preventive Medicine Association, the Jing'an Centre of Management and Service for Elderly Health, Shanghai, China.
authors.forename: Yawen
authors.initials: Y
authors.lastname: Guo
authors.forename: Qingwu
authors.initials: Q
authors.lastname: Jiang
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Tanimoto
authors.forename: Masahiro
authors.initials: M
authors.lastname: Kami
authors.forename: Chunyan
authors.initials: C
authors.lastname: Luo
authors.forename: Claire
authors.initials: C
authors.lastname: Leppold
authors.forename: Koichi
authors.initials: K
authors.lastname: Nishimura
authors.forename: Yongpin
authors.initials: Y
authors.lastname: He
authors.forename: Shigeaki
authors.initials: S
authors.lastname: Kato
authors.forename: Xiaocang
authors.initials: X
authors.lastname: Ding
mesh_terms: D000293:Adolescent; D002648:Child; D002681:China; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012600:Scoliosis / Q000175:diagnosis*; D014505:Urban Population / Q000706:statistics & numerical data