Scoliosis Screening
Donald M. Berwick MD1
1 Assistant Professor of Pediatrics, Harvard Medical School; and Associate Director, Institute for Health Research, Harvard Community Health Plan, One Fenway Plaza, Boston, MA 02215
Scoliosis screening reduces the frequency of scoliosis surgery in a population, and probably leads, through early bracing, to a reduction in the degree of at least some serious curves. Its costs, however, are far from negligible. Even in the best of hands, a screening program induces costs and concerns in follow-up for many more children than it helps, and, if poorly administered, these induced costs can far outweigh the advantages to the screened population.
For the moment, until inexpensive and noninvasive follow-up methods are developed, it is probably advisable that children in the age range of 10 to 14 years be screened competently at least once, but with strict attention to the following principles:
1. Follow-up of those with positive results on screening should be suited to the age, sex, and risk factors for the individual child, and should minimize expense, roentgenogram ex-posure, and concern wherever possible.
2. Screening should be done by well-trained personnel who are fully aware of both the signs of significant curvature and of the costs and risk of inappropriate referral.
3. Screening programs should systematically assess the psychological morbidity of the labeling process in their target populations, and should modify their procedures accordingly if that morbidity is high.
4. Programs should be solidly linked to sound, prompt, and circumspect referral patterns—either primary care or specialty consultants. The mere "detection" of positive screening findings without assuring competent follow-up does not consitute effective screening.
