Screening for scoliosis - New recommendations, old dilemmas, no straight solutions

Table 1 Major current and historical recommendations about screening for scoliosis

Institution, yr	Recommendation	Standard of development	Characteristics
Current recommendations:
United States Preventive Services Task Force, 2018[34]	No recommendation1 suggestion for practice: “(…) If the service is offered, patients should understand the uncertainty about the balance of benefits and harms”	Systematically developed; Screening programme criteria-based	Methods and standards following the USPSTF Procedure Manual; Systematic review addressing six key questions2; Previous recommendation (2004): Against screening
AAP Bright Futures Guidelines, 2017/ 2019[36]	Recommended (examination of the back)	Endorsement of the SRS/AAOS/ POSNA/AAP 2015 position (below)	Examinations for scoliosis and “other abnormalities” during all (11-21 yr) Adolescence Health Supervision Visits
SOSORT, 2016 (published 2018)[35]	Recommended (school screening programmes)	Consensus-based	Delphi method; Panel of experts and scoliosis conservative treatment practitioners; 2007 SOSORT screening consensus paper[45] recommended as “a reference for specific insights”
United Kingdom National Screening Committee, 2016[32]	Not recommended (national population-based screening programme)	Systematically developed; United Kingdom National Security Council (2015) screening programme criteria-based	Based on systematic evidence review[43]; Criteria addressing the condition, the test, the intervention in terms of a clinically, socially and ethically acceptable screening programme1; Recommendation sustained (2006, 2012)
SRS/AAOS/ POSNA/AAP, 2015[33,46]	Recommended (to be conducted in a medical home setting)	Opinion-based; narrative, including information on new evidence	Readers encouraged “to reach their own decisions” as the statement is not based on a systematic review; position confirmed[40] after the USPSTF 2018 recommendation
SRS International Task Force, 2013[31]	Recommended (school screening)	Consensus-based; research synthesis-guided	Expert consensus (Delphi method, seven surgeons, epidemiologist) on test technical efficacy, clinical, program, treatment, and cost effectiveness, using a dedicated systematic review[47] and other available critical literature reviews
Historical (and discontinued) recommendations:
National Health and Medical Research Council, Australia, 2002[48]	Not recommended (rescinded guideline, not updated, archived[48])	Systematically developed	Based on critical review against criteria of screening tests characteristics, treatment effectiveness, burden of suffering; No current guidelines or guidelines in development
Canadian Task Force on Preventive Health Care3, 1994[49]	No recommendation: insufficient evidence to recommend for or against (historical guideline, not updated[49])	Systematically developed	Based on critical review of the evidence of benefits and harms of screening and treatment; No current guidelines or guidelines in development

¹The current evidence is insufficient to assess the balance of benefits and harms of the service. Evidence is lacking, of poor quality, or conflicting, and the balance of benefits and harms cannot be determined”[34];

²For more details see Table 8;

³Formerly Canadian Task Force on the Periodic Health Examination. AAOS: American Academy of Orthopedic Surgeons; POSNA: Pediatric Orthopedic Society of North America, AAP: American Academy of Pediatrics; AIS: Adolescent idiopathic scoliosis; SOSORT: Scientific Society on Scoliosis Orthopaedic and Rehabilitation Treatment; SRS: Scoliosis Research Society.