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Screening for adolescent idiopathic scoliosis is more accurate when performed by healthcare professionals compared to untrained parents: a diagnostic accuracy study

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Abstract

Background

Many countries ended their professional scoliosis screening due to ongoing controversies. Discontinuation resulted in a shift of screening responsibility from trained healthcare professionals to untrained parents.

Purpose

To compare the diagnostic accuracy of picture-based scoliosis screening between parents and healthcare professionals.

Methods

In this cross-sectional diagnostic accuracy study, parents and healthcare professionals assessed pictures of 28 children (20 AIS & 8 non-scoliosis). Each child had two photographs (standing position & full-flexion during forward-bending test) that were presented simultaneously. Lumbar and thoracic curves were represented with a range in severity (10 to > 40°). The assessors had to answer whether they detected an abnormality that ought to be referred to a specialist. Measures of accuracy were calculated for both groups and various curve severities.

Results

All pictures were assessed by 101 parents and 122 healthcare professionals. The sensitivity for detecting scoliosis was significantly lower in untrained parents (63.8%, [95% CI: 61.7–65.9%]) compared to healthcare professionals (73.4%, [95% CI: 71.6–75.2%]; p < 0.001), while the specificity was not significantly different (63.6%, [95% CI: 60.2–66.9%] vs. 65.3%, [95% CI: 62.2–68.3%]; p = 0.49). Healthcare professionals consistently recognized the gibbus as a warning sign when referring patients, while untrained parents highlighted various regions, including the spine, gibbus and scapula regions.

Conclusion

The sensitivity of screening for scoliosis was significantly lower when it was performed by parents, while the false-positive rate was similar to healthcare professionals. The window of opportunity for conservative treatment may be missed when parents rather than professionals are responsible for screening.

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Availability of data and materials

The data and materials are available to strengthen the transparency and reliability of the study. The additional data could be requested by sending an email to the corresponding author.

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Acknowledgements

The authors thank JEEM Maeijer and M.R. Herrebrugh for their assistance in digitalizing analog radiographs.

Funding

No funding.

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Author notes

  1. M. C. Altena & D. H. R. Kempen

    Present address: Department of Orthopedic Surgery, Joint Research, OLVG, Amsterdam, The Netherlands

Authors and Affiliations

  1. Department of Orthopedic Surgery, Joint Research, OLVG, Amsterdam, The Netherlands

    J. L. Heemskerk, C. de Groot & N. W. Willigenburg

  2. Department of Orthopedic Surgery, Amsterdam UMC, Amsterdam, The Netherlands

    M. C. Altena & D. H. R. Kempen

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  1. J. L. Heemskerk
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  2. C. de Groot
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  3. N. W. Willigenburg
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  5. D. H. R. Kempen
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Contributions

All authors were involved in the design. JH and CG collected data. All authors reviewed and edited the manuscript.

Corresponding author

Correspondence to D. H. R. Kempen.

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Conflict of interest

All authors declare they have no commercial associations that might pose a conflict of interest in relation to the submitted manuscript. The authors received no specific funding for this work.

Ethical approval

Local ethical committee approval was granted for this study. OLVG Hospital protocol number: WO 16.017. Dutch register for clinical trials number: NL5777.

Consent to participate

All individuals provided informed consent before participation in the study.

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All authors approved the manuscript for publication.

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International Research Society on Spinal Deformities Congress.

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J. L. Heemskerk and C. de Groot are joint first authorship.

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Heemskerk, J.L., de Groot, C., Willigenburg, N.W. et al. Screening for adolescent idiopathic scoliosis is more accurate when performed by healthcare professionals compared to untrained parents: a diagnostic accuracy study. Eur Spine J 31, 2339–2347 (2022). https://doi.org/10.1007/s00586-022-07115-z

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  • DOI: https://doi.org/10.1007/s00586-022-07115-z

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