Department of Nursing Studies, The University of Hong Kong, Pokfulam, Hong Kong SAR, China.
Spine (Phila Pa 1976). 2010 May 1;35(10):1061-71. doi: 10.1097/BRS.0b013e3181bcc835.
A meta-analysis that systematically reviewed the evaluation studies of a scoliosis screening program reported in the literature.
To evaluate the best current evidence on the clinical effectiveness of school screening for adolescent idiopathic scoliosis.
The use of school scoliosis screening is controversial, and its clinical effectiveness has been diversely reported.
Data sources included 3 databases, namely, PubMed, Google scholar, CINAHL database, and the references from identified reviews and studies. Studies were included if: (1) they adopted a retrospective cohort design; (2) were screened using either the forward bending test (FBT), angle of trunk rotation, or Moiré topography; (3) reported results of screening tests and radiographic assessments; (4) screened adolescents only; (5) reported the incidence of curves with a minimum Cobb angle of 10 degrees or greater; and (6) reported the number of referrals for radiography. Reviews, comments, case studies, and editorials were excluded.
Thirty-six studies, including 34 from the 775 initially identified studies and 2 from the references, met the selection criteria. The pooled referral rate for radiography was 5.0%, and the pooled positive predictive values for detecting curves > or =10 degrees , curves > or =20 degrees , and treatment were 28.0%, 5.6%, and 2.6%, respectively. There was substantial heterogeneity across studies. Meta-regression showed that programs using the FBT alone reported a higher referral rate (odds ratio [OR] = 2.91) and lower positive predictive values for curves > or =10 degrees (OR = 0.49) and curves > or =20 degrees (OR = 0.34) than programs using other tests. Only one small study followed students until skeletal maturity and reported the sensitivity of screening; however, the specificity was not reported. No severe publication bias was noted.
The use of the FBT alone in school scoliosis screening is insufficient. We need large, retrospective cohort studies with sufficient follow-up to properly assess the clinical effectiveness of school scoliosis screening.
这是一项系统综述，对文献中报道的脊柱侧凸筛查计划的评估研究进行了荟萃分析。
评估目前关于青少年特发性脊柱侧凸学校筛查的临床效果的最佳证据。
使用学校脊柱侧凸筛查存在争议，其临床效果也有不同的报道。
数据来源包括 3 个数据库，即 PubMed、Google Scholar、CINAHL 数据库，以及从已确定的综述和研究中获取的参考文献。如果符合以下标准，则纳入研究：（1）采用回顾性队列设计；（2）使用前屈试验（FBT）、躯干旋转角度或云纹拓扑学进行筛查；（3）报告筛查试验和影像学评估结果；（4）仅筛查青少年；（5）报告最小 Cobb 角为 10 度或更大的曲线发生率；（6）报告转诊行影像学检查的数量。排除综述、评论、病例报告和社论。
共纳入 36 项研究，其中 34 项来自最初确定的 775 项研究，2 项来自参考文献。放射学检查的转诊率为 5.0%，检出 Cobb 角≥10 度、≥20 度的曲线以及需要治疗的曲线的阳性预测值分别为 28.0%、5.6%和 2.6%。研究间存在较大异质性。元回归显示，仅使用 FBT 的筛查计划报告的转诊率较高（比值比[OR] = 2.91），对 Cobb 角≥10 度（OR = 0.49）和 Cobb 角≥20 度（OR = 0.34）的曲线的阳性预测值较低。仅有一项小型研究对患者进行了骨骼成熟度随访，并报告了筛查的敏感性，但特异性并未报告。未发现严重的发表偏倚。
在学校脊柱侧凸筛查中仅使用 FBT 是不够的。我们需要有足够随访的大型回顾性队列研究，以正确评估学校脊柱侧凸筛查的临床效果。
