School screening for scoliosis. One experience in California using clinical examination and moiré photography

Abstract

In 1980 the legislature of the state of California mandated that school screening programs for scoliosis be implemented. This law resulted in variations in methods and efficacy of the programs. One such program using clinical examination and moiré photography was administered to adolescent girls in two secondary schools in Santa Clara County. The findings of 10% of the clinical examinations were ruled to be "positive," 18% on moiré photography alone and 8% on both examinations. The correlation between the two diagnostic procedures was poor (r = .16). Follow-up was done to determine the outcome of the "positive" cases. In all, 25% of the children classified as having scoliosis had no medical follow-up one year from the request by the screening program team. The documented false-positive rate was 15% based on the screening examination. Definitive radiographic evaluation was reported in very few of the positive cases. Our experience shows the weakness of local programs that have no subject follow-up. It is suggested that public education may be a more effective solution than mass school screening mandates.