Advantages of a two-step procedure for school-based scoliosis screening

• Published in: Radiologia medica 2010-03, Vol.115 (2), p.238-245
• Main Authors: Leone, A., Aulisa, A., Perisano, C., Re, T., Galli, M.
• Format: Article
• Language: English
• Subjects: Adolescent; Child; Costs and Cost Analysis; Diagnostic Radiology; Female; Humans; Imaging; Interventional Radiology; Italy - epidemiology; Male; Mass Screening - economics; Mass Screening - methods; Medicine; Medicine & Public Health; Musculoskeletal Radiology/Radiologia Muscolo-Scheletrica; Neuroradiology; Radiography; Radiology; School Health Services - economics; School Health Services - organization & administration; Scoliosis - diagnosis; Scoliosis - diagnostic imaging; Scoliosis - economics; Scoliosis - epidemiology; Sensitivity and Specificity; Ultrasound
• ISSN: 0033-8362; 1826-6983
• DOI: 10.1007/s11547-009-0429-z

Purpose To verify if a “two step” school-based scoliosis screening procedure could reduce childhood radiation exposure and, if so, to estimate the subsequent reduction in radiogenic cancer fatalities and in socio-economic burden. Material and methods Data from two different scoliosis screening programs (A and B) performed on a total of 8,995 children (age range 9–14) were examined. Children in program A (5,731 children) were screened using a “two-step” procedure in which school physicians performed the first clinical examination and uncertain cases were referred to an orthopaedist. The school physicians were previously instructed by orthopaedists in the recognition of a number of simple clinical signs. Children in program B (3,264 children) were screened using a “one-step” procedure in which the initial clinical examination was performed directly by an orthopedist. In both programs, suspected cases of scoliosis were then ascertained by the orthopaedist with Radiography. To evaluate the lifetime attributable risk of cancer mortality the guidelines of the International Commission on Radiological Protection Publication 60 were followed. The economic cost of the performed X-ray examination was calculated assuming the current National Health Service’s reimbursement to hospitals of euro 35 per X-Ray exam. The statistic significance of the difference in these estimates between the two programs was assessed using the proportions z-test. The issues of the relative sensitivity and specificity of the two programs were also examined. Results In programs A and B, 86 (1.5 %) and 95 (2.91 %) X-ray examinations were performed respectively (z=4.452, p