Fong Daniel Y T, Cheung Kenneth M C, Wong Yat-Wa, Wan Yuen-Yin, Lee Chun-Fan, Lam Tsz-Ping, Cheng Jack C Y, Ng Bobby K W, Luk Keith D K
School of Nursing, The University of Hong Kong, 21 Sassoon Rd, Hong Kong.
Department of Orthopaedics and Traumatology, The University of Hong Kong, Queen Mary Hospital, 5/F Professorial Block, Pokfulam, Hong Kong.
Spine J. 2015 May 1;15(5):825-33. doi: 10.1016/j.spinee.2015.01.019. Epub 2015 Jan 20.
The value of scoliosis screening has been recently shown in a multicenter randomized controlled trial. However, the long-term sustainability of the clinical effectiveness of scoliosis screening as a routine health service remains unknown.
The aim of this study was to assess the sustainability of the clinical effectiveness of school scoliosis screening.
STUDY DESIGN/SETTING: A large population-based cohort study with a 10-year follow-up was conducted.
A total of 394,401 students who were in the fifth grade during the five academic years from 1995/1996 to 1999/2000 formed five consecutive annual cohorts. The students were eligible for the Hong Kong scoliosis screening program, with their screening history and medical records until their nineteenth birthdays being assessed.
The outcome measures considered in the study were development of adolescent idiopathic scoliosis by the 19 years of age and the Cobb angle.
The clinical effectiveness of scoliosis screening was assessed by referral rate for radiographic diagnosis, sensitivity, specificity, and predictive values.
A total of 306,144 students (78%) participated in scoliosis screening, which used a two-tier system. The prevalence of curves of 20° or greater was 1.8% (95% confidence interval [CI], 1.7-1.8%), whereas the referral rate for radiography, the sensitivity, and the positive predictive value (PPV) for curves of 20° or greater were 4.1% (95% CI, 4.0-4.2%), 91% (95% CI, 90-92%), and 40% (95% CI, 39-41%), respectively. Across the five consecutive annual cohorts, the prevalence and sensitivity for curves of 20° or greater increased by 0.23% (95% CI, 0.21-0.25%; p<.001) and 0.76% (95% CI, 0.43-1.04%; p<.001) per year, respectively; however, the PPV was reduced by 1.71% (95% CI, 1.09-2.33%; p<.001) per year.
This report describes the first large population-based study with a long-term follow-up indicating that a scoliosis screening program can have sustained clinical effectiveness in identifying patients with adolescent idiopathic scoliosis needing clinical observation. As the prevalence of adolescent idiopathic scoliosis increases, scoliosis screening should be continued as a routine health service in schools or by general practitioners if there is no scoliosis screening policy.
最近一项多中心随机对照试验表明了脊柱侧弯筛查的价值。然而，脊柱侧弯筛查作为一项常规健康服务，其临床效果的长期可持续性仍不明确。
本研究旨在评估学校脊柱侧弯筛查临床效果的可持续性。
研究设计/地点：进行了一项为期10年随访的大型基于人群的队列研究。
在1995/1996至1999/2000这五个学年中，共有394,401名五年级学生组成了连续五个年度队列。这些学生符合香港脊柱侧弯筛查计划的条件，并对其筛查历史和直到19岁的病历进行了评估。
本研究考虑的观察指标为19岁时青少年特发性脊柱侧弯的发生情况和Cobb角。
通过影像学诊断转诊率、敏感度、特异度和预测值评估脊柱侧弯筛查的临床效果。
共有306,144名学生（78%）参与了脊柱侧弯筛查，该筛查采用两级系统。20°及以上侧弯的患病率为1.8%（95%置信区间[CI]，1.7 - 1.8%），而20°及以上侧弯的影像学转诊率、敏感度和阳性预测值（PPV）分别为4.1%（95% CI，4.0 - 4.2%）、91%（95% CI，90 - 92%）和40%（95% CI，39 - 41%）。在连续五个年度队列中，20°及以上侧弯的患病率和敏感度分别每年增加0.23%（95% CI，0.21 - 0.25%；p <.001）和0.76%（95% CI，0.43 - 1.04%；p <.001）；然而，PPV每年降低1.71%（95% CI，1.09 - 2.33%；p <.001）。
本报告描述了第一项进行长期随访的大型基于人群的研究，表明脊柱侧弯筛查计划在识别需要临床观察的青少年特发性脊柱侧弯患者方面可具有持续的临床效果。随着青少年特发性脊柱侧弯患病率的增加，如果没有脊柱侧弯筛查政策，脊柱侧弯筛查应作为学校的常规健康服务或由全科医生继续开展。
