SOSORT consensus paper: school screening for scoliosis. Where are we today?

Early detection of idiopathic scoliosis has been a major and growing commitment of orthopaedists since the early 1960s. A large body of literature, reporting a great deal of clinical experience, has accrued since then [1-364].G. Dean MacEwen, MD, played an important role in the early development of school screening by implementing programs in all schools in the state of Delaware in the 1960s [43,44,149,162,179,180,237].The start of screening for scoliosis began in 1963 in Aitken, a town with a population of about 10.000 in central Minnesota [181].Consequently, the state of Minnesota pioneered spinal screening in the United States by implementing in 1973 a centrally-directed, statewide but voluntary program, based on clinical examination [184].In USA, as of 2003, 21 States had legislated school screening; 11 States recommended school screening without legislation and the remaining either had volunteer screenings or recommended not to conduct screening in the schools, Figure 1.The 21 legislated States are: 2002-Virginia, 1996-Utah, 1987-Arkansas, 1985-Texas, 1984-Alabama, Indiana, 1983-Georgia, Nevada, 1982-Connecticut, Kentucky, Maryland, Pennsylvania, 1981-Maine, Rhode Island, 1980-California, Massachusetts, 1979-Washington, Florida, 1978-Delaware, New Jersey, New York.In the USA, not all legislated screening programs are the same today. We can not take a broad-brush approach to whether or not a state has screening, but must look further at screening protocol details, including age and gender screened, screener education and support, scoliometer usage, reporting and follow-up methodologies etc, to evaluate the effectiveness of a program. Some states have ratios of one school nurse for every 700 students, while others have 2000/1 ratios and use health aides and volunteer parents to perform scoliosis screening. Unfortunately, in the USA there is a lack of national standards and adequate reports for scoliosis screening mechanisms, making collection of evidence-based ou