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USPSTF releases draft recommendation on adolescent idiopathic scoliosis
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The U.S. Preventive Services Task Force has issued a draft recommendation on adolescent idiopathic scoliosis that states that there is insufficient evidence to balance the benefits and harms of screening for the condition in children and adolescents aged 10 to 18 years old.
This new draft recommendation updates the 2004 USPSTF recommendation for the condition. At that time, the USPSTF gave the recommendation a D grade, saying it found fair evidence that treatment of adolescent idiopathic scoliosis leads to health benefits such as decreased pain and disability in a small proportion of persons. At the time, the USPSTF determined the harms of treatment of screen-detected adolescent idiopathic scoliosis, such as unnecessary brace wear or referral to specialty care, to be moderate and concluded that the harms of screening exceeded potential benefits.
According to the USPSTF, adolescent idiopathic scoliosis is the most common form of scoliosis, affecting approximately 1% to 3% of children and adolescents in the United States. The condition develops in children and adolescents aged 10 to 18 years and has no known cause.
Task force members say this draft finding signifies a call for more research on the topic.
“The major gap in knowledge is whether screening and early treatment of teens without symptoms leads to benefits that last into their adulthood,” Alex R. Kemper, MD, MPH, MS, task force member and associate chief for research, children’s primary care division, Duke University, said in a press release.
“This I statement is a call for more research to address the uncertainty in evidence about screening,” John W. Epling, Jr., MD, MSEd, task force member and professor of family and community medicine, Virginia Tech Carilion School of Medicine, said in the release. “In the meantime, primary care clinicians should use their clinical judgment when deciding which patients to screen.”
According to the task force, the AAP advocates screening for scoliosis in girls aged 10 and 12 years and once in adolescent boys aged 13 or 14 years as part of medical home preventive services, if performed by well-trained screening personnel.
The new USPSTF draft statement and evidence review has been posted for public comment on the USPSTF website, at www.uspreventiveservicestaskforce.org. Input will be accepted through June 26 at www.uspreventiveservicestaskforce.org/tfcomment.htm. – by Janel Miller
Disclosure: Neither Kemper nor Epling report any relevant financial disclosures.
Perspective
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Stuart Weinstein, MD
I’m encouraged by this statement. The previous recommendation was against any screening. This recommendation is an ‘I’ rating, which means there’s insufficient evidence. What I think the USPSTF said at this go-around is that scientific information between this report and the last report is markedly improved, showing that there is evidence that bracing treatment does work. So, while USPSTF can’t endorse screening programs, my interpretation of the report is that since early detection enables children to get treatment to hopefully avoid surgery, hence, a spinal examination should be incorporated into every primary care physician’s well-child checks.
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