| Background and purpose Scoliosis is a structural deformity of the spine in the 3D,and The abnormal alignment of the spine column in the sagittal,coronal,and axial planes.Adolescent idiopathic scoliosis(AIS),the most common type of scoliosis,is a kind of spinal deformity with the prevalence rate is about 2%.Scoliosis is difficult to detect because of no obvious symptoms in the early stage,but the condition can deteriorate rapidly during the peak height velocity in the adolescent.AIS not only cause spinal deformity and negative impact on patients’ psychology,but also reduces family quality of life and increases the economic burden of family and society.Early detection and intervention can help delay or cure the disease,so many countries and regions are carrying out adolescent scoliosis screening.Although our country has issued scoliosis screening standard and guidelines,but still has some problems such as unsuitable for school screening or low specificity of methods,which may lead to excessive X-ray exposure and unnecessary psychological burden.The objective of this research is to explore a high sensitivity and specificity of screening pathway for adolescent scoliosis screening in schools to provide a suitable pathway and scientific basis.Research object and method In this Case-control study,the subjects were 10~15 year-old schoolchildren in Guangzhou in 2019~2020,who were referred for diagnosis of scoliosis(Cobb angle ≥10 °)and non-scoliosis(Cobb angle < 10 °)after screening.136 patients with scoliosis were selected as case group,and 171 adolescents without scoliosis were selected as control group.All subjects were examined by three screening methods: visual measurement,Adam’s forward bending test and Angle of Trunk Rotation(ATR)measurement,according to 5 simulated screening pathways(and different positive criteria): 1.Adam’s forward bending test;2.measurement of trunk rotation angle((1)≥ 5°,(2)≥7°);3.visual measurement(“yes”≥2)→measurement of ATR(≥ 5°);4.visual measurement→measurement of ATR(≥ 5°);5.Adam’s forward bending test →ATR measurement(≥7°)→ visual measurement((1)"yes" ≥2 and(2)"Yes" ≥3),a series of evaluation indexes such as sensitivity and specificity of different screening paths were calculated to select the optimal screening pathway,a total of 2967 adolescents aged 10~15 years old from 14 primary and secondary schools in Guangzhou were screened for scoliosis using this pathway from September to December 2020,and 264 adolescents from one of the schools were screened using 5 pathways,and the time cost of 5 pathways was calculated.Research result 1.The sensitivity,specificity,false negative rate and false positive rate of pathway1 were 83.82%,93.57%,16.18% and 6.43%,the Youden index was 77.39%,the +LR was 13.03,the-LR was 0.17,the coincidence rate and Kappa value were 89.25% and 0.91,the PPV was 91.20%,the NPV was 87.91%.2.The sensitivity,specificity,false negative rate and false positive rate of pathway2(1)were 91.91%,82.46%,8.09%,and 17.54%,the Youden Index was 74.37%,the +LR was 5.24,the-LR was 0.10,the coincidence rate and Kappa value were 86.64% and 0.87,the PPV was 80.65%,the NPV was 92.76%.The sensitivity,specificity,false negative rate and false positive rate of pathway2(2)were 63.97%,95.91%,36.03% and 4.09%,the Youden index was 59.88%,the +LR was 15.63,the-LR was 0.38,the coincidence rate and Kappa value were 81.76% and 0.85,the PPV was 92.55%,the NPV was 77.00%.3.The sensitivity,specificity,false negative rate and false positive rate of pathway3 were 97.06%,80.12%,2.94% and 19.88%,the Youden index was 77.18%,the +LR was 4.88,the-LR was 0.04,the coincidence rate and Kappa value were 87.62% and 0.88,the PPV was 79.52%,the NPV was 97.16%.4.The sensitivity,specificity,false negative rate and false positive rate of pathway4 were 99.26%,48.54%,0.74% and 51.46%,the Youden index was 47.80%,the +LR was 1.93,the-LR was 0.02,the coincidence rate and Kappa value were 71.01% and 0.65,the PPV was 60.54%,the NPV was 98.81%.5.The sensitivity,specificity,false negative rate and false positive rate of pathway5(1)were 94.12%,81.87%,5.88% and 18.13%,the Youden index was 75.99%,the +LR was 5.19,the-LR was 0.07,the coincidence rate and Kappa value were 87.30% and 0.88,the PPV was 80.50%,NPV was 94.59%.The sensitivity,specificity,false negative rate and false positive rate of pathway5(2)were 90.44%,87.13%,9.56% and 12.87%,the Youden index was 77.58%,the +LR was 7.03,the-LR was 0.11,the coincidence rate and Kappa value were 88.60% and 0.89,the PPV was 84.83%,NPV was 91.98%.6.After Comprehensive Evaluation,the pathway5(1)that from Adam’s forward bending test to trunk rotation angle measurement(≥7°)to visual measurement(≥3 items)was the best,which was used in school screening,the detection rate was 2.53%.And the time cost of the five paths was: the total time of Path 1 was 82′56.4″,with the average time of 18.85″;the total time of Path 2 was 100′35.8 ″,with the average time of 22.84 ″;the total time of Path 3 was 84′26.2″with an average time of 19.19″;the total time of Path 4 was 89′16.6″with an average time of 20.29″;the total time of Path 5 was 83′41.3″with the average time of 19.02″.Conclusion Pathway Adam’s forward bending test → ATR measurement(≥7°)→ visual measurement(“yes”≥3),had the highest accuracy,compared with the other 4 pathways.+LR,coincidence rate,Kappa value and PPV were the largest in the parallel pathways,and the time cost is the smallest in the parallel pathways. |
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