Patient Characteristics at Their Initial Visit to a Scoliosis Clinic: A Cross-Sectional Study

Summary: A cross-sectional study was conducted in a metropolitan paediatric hospital to determine if scoliosis patients were referred and evaluated at the appropriate time for brace treatment. It was found that, depending on the criteria chosen, between 13% and 49% of patients were referred late as compared to 1% previously with school screening, while a high rate of unnecessary referrals still prevails. These findings suggest that current methods of scoliosis screening and referral are inappropriate in Canada. School scoliosis screening programs were abolished in 1979 by Health Canada for lack of evidence that they could improve the outcome. The consequences of this decision on the referral patterns of suspected cases to the treating physician remain unknown. Are subjects with idiopathic scoliosis (IS) being detected at the appropriate time considering that a multicentre trial has more recently demonstrated the efficacy of brace treatment?

A cross-sectional study was conducted on all patients referred over a one-year period for evaluation at the scoliosis clinic of a metropolitan paediatric hospital. Of 649 subjects identified, 199 (31%) had no significant deformity or a scoliotic attitude, while 294 (45%) were diagnosed as IS (Cobb angle > 10º). In the IS group, 49% were older than 14 years old, which is above the indicated age for screening, 36% were Risser 3 or greater and 27% were over 2 years post menarche, which is above recommended levels for brace treatment, and were then considered "late referrals". Furthermore, 13% of IS subjects had curves > 40º (Cobb angle) and 30% > 30º. Surgery was recommended at this initial visit for 5% of patients. Curves of 30º or more are about twice as likely in immature girls (28%) compared to boys (16%) and are more frequent between ages 12 and 14. Late referral is also associated with the menarche status (p<0 ,001). In summary, depending on the criteria chosen, between 13% and 49% of IS patients were referred late as compared to 1% previously with school screening, while a high rate unnecessary referrals still prevails.

These findings suggest that current methods of screening and referral for IS are inappropriate in Canada. Further investigation is necessary to understand the factors leading to this situation.