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USPSTF 2018: evidence insufficient to recommend for or against idiopathic scoliosis screening (I recommendation)
Clinical Question
Should primary care clinicians screen for adolescent idiopathic scoliosis in children and adolescents aged 10 years to 18 years?
Bottom line
The United States Preventive Services Task Force (USPSTF) concludes that current evidence is insufficient to recommend for or against screening for adolescent idiopathic scoliosis (AIS) in asymptomatic children and adolescents aged 10 years to 18 years (I recommendation). This updated recommendation is a change from the previous recommendation in 2004 (D recommendation). 2b
Reference
Study design: Practice guideline
Funding: Government
Setting: Population-based
Synopsis
In this updated review the USPSTF evaluated current evidence assessing the accuracy of screening tests, and the benefits and harms of screening and treatment for asymptomatic AIS in children and adolescents aged 10 to 18 years. The prevalence of AIS in this age group is 1% to 3%. No eligible randomized clinical trials directly compared screening with no screening. Currently available screening tests can accurately detect AIS. The task force found adequate evidence that treatment with bracing may decrease curvature progression, but no high-quality studies of bracing have evaluated long-term patient-oriented outcomes such as back pain, pulmonary disorders, or quality of life. Inadequate evidence found minimal, if any, benefit to exercise. No studies that evaluated surgery were found. Potential harms of screening include psychosocial issues due to labeling and anxiety (eg, overtreatment with bracing), unnecessary referrals due to false-positive results, and the potential risk of radiation exposure. Overall, the task force considered the potential harms of screening and subsequent treatment as minimal. The American Academy of Pediatrics and the American Academy of Orthopedic Surgeons recommend screening for scoliosis twice in girls, at 10 years and 12 years of age, and once in boys at 13 or 14 years of age.
Reviewer
David C. Slawson, MD
Professor and Vice Chair of Family Medicine for Education and Scholarship
Atrium Health
Professor of Family Medicine, UNC Chapel Hill
Charlotte, NC
Comments
I think it’s reassuring to know that we do not necessarily need to screen teenagers for scoliosis. I know a few of my patients ‘ parents do request for this.
It’s niceties kind of have this fact up my sleeve to be able to discuss this fact with them.
I get the kids to bend forward and touch their toes. I only do xrays if there is asymmetry
They have overlooked a family/ patient's right to know that they have the condition. We get visits from children why does my chest stick out, why is my hip higher, why do I have trouble with clothes? This can be more worrying than knowing that there is a back curvature. So I will continue to do simple screening (look at bent over back) so families and children will know more about themselves. The effectiveness of medical management should be a separate issue.
good poem
I understand that prevalence is low for scoliosis but if we miss those 1% cases where a difference can be made in a timely manner with bracing then Pts do suffers lifelong. I have 3 adult pts who were missed as kids and very significant scoliosis which is causing issues in adult life. I still feel it is important to screen kids on physical with simple bending down and watching the back as they come up and if really required then do Xrays as to lessen the risk of radiation.