Introduction: The use of school scoliosis screening is controversial, and its clinical effectiveness has been diversely reported.
Objectives: To evaluate the best current evidence on the clinical effectiveness of school screening for adolescent idiopathic scoliosis.
Materials and Methods: Retrospective cohort studies that evaluated school scoliosis screening were obtained from searching the electronic databases: PubMed, Google scholar, and CINAHL, as well as reading the references from identified reviews and studies.
Results: Thirty-six studies, including thirty-four from the 775 initially identified studies and two from the references, met the selection criteria. The pooled referral rate for radiography was 5.0%, and the pooled positive predictive value (PPV) for detecting curves ≥10°, curves ≥20°, 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 PPV for curves ≥10° (OR = 0.49) and curves ≥20° (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.
Conclusion: There was substantial heterogeneity across studies due to the use of different screening tests and different study sizes. The use of the FBT alone in school scoliosis screening is insufficient.
Significance: This study informs the need of large, retrospective cohort studies with sufficient follow-up to properly assess the clinical effectiveness of school scoliosis screening.