In May this year, Maryland became the first state to repeal a law requiring schools to screen for scoliosis in students. Pediatricians from the Maryland Chapter of the American Academy of Pediatrics Committee on School Health were able to persuade Maryland’s legislature and governor to abandon a long-standing scoliosis screening requirement, after the U.S. Preventive Services Task Force in 2004 recommended against routine screening of asymptomatic adolescents for idiopathic scoliosis. The Association of County Health Officers also strongly supported the appeal.

In its 2004 recommendation, the Preventive Services Task Force noted that the accuracy of the most common screening test—the forward-bending test with or without a scoliometer—is "variable" in identifying students with scoliosis. The task force also found evidence of poor follow-up of adolescents who are identified with idiopathic scoliosis in community settings and said that even with treatment there is only modest evidence of health benefits such as decreased pain and disability. In fact, the task force found that treatment of adolescents whose idiopathic scoliosis is detected through screening "leads to moderate harms, including unnecessary brace wear and unnecessary referral for specialty care."

The Preventive Services Task Force refers throughout its recommendation to "idiopathic scoliosis," a condition defined in the MedlinePlus medical dictionary as "a lateral curvature of the spine arising spontaneously from an obscure or unknown cause."

Assuming that most cases of idiopathic scoliosis detected through screening will not progress to a clinically significant form of scoliosis and that scoliosis needing aggressive treatment such as surgery will usually be detected without screening, the task force concluded that the harms of screening adolescents exceed the potential benefits.

Removal of the mandate for scoliosis screening as of October 1 next school year will free school nurses in Maryland to give more attention to the needs of students with chronic health conditions such as diabetes and asthma, said Anne Arundel County Department of Health pediatrician Dr. Lani Wheeler. Health officials and school nurses know that many cases of asthma are not adequately managed, even in districts with strong school health programs. Anne Arundel, for example, has full-time nurses in all secondary schools and shared nurses who divide their time between limited numbers of elementary schools, along with health aides in all schools.

Regarding the new stance on scoliosis screening as an example of evidence-based school health practice, Wheeler welcomed removal of the requirement, saying, ‘We think school nurses should prioritize their efforts to improve the health of students, especially those with chronic conditions that are not under good control, such as asthma."

The U.S. Preventive Services Task Force is a group of physicians and clinicians assembled by the Agency for Healthcare Research and Quality (AHRQ) in the federal Department of Health and Human Services (HHS). The task force notes that its 2004 recommendation on scoliosis screening was based on a targeted review of the literature published on the topic between 1994 and 2002, with the research limited to randomized controlled trials, meta-analyses, systematic reviews, well-designed observational studies, and editorials and commentaries concerning the critical key questions. The review was conducted by the RTI-International-University of North Carolina Evidence-Based Practice Center.

The full text of the recommendation is available on the AHRQ website at www.preventiveservices.ahrq.gov under the topic heading "Idiopathic Scoliosis in Adolescents."