NCHR Comment on the USPSTF’s Draft Recommendations for Adolescent Idiopathic Scoliosis: Screening

National Center for Health Research’s Public Comments on
the USPSTF’s Draft Recommendation Statement on
Adolescent Idiopathic Scoliosis: Screening

Thank you for the opportunity to express our views on the draft recommendations for screening for adolescent idiopathic scoliosis. The National Center for Health Research is a nonprofit research center that analyzes and reviews research on a range of health issues, with particular focus on which prevention strategies and treatments are most effective for which patients and consumers. We do not accept funding from pharmaceutical companies and have no financial ties to this issue.

We support the efforts of the U.S. Preventive Services Task Force (USPSTF) to re-evaluate its recommendations as new research emerges. We agree with the USPSTF that the research does not support screening of asymptomatic children for adolescent idiopathic scoliosis.

While the current recommendation is based on more studies than the 2004 recommendation, these studies still provide inadequate evidence necessary to support the use of screening. To recommend population level screening, there needs to be sufficient evidence that screening leads to meaningful health outcomes and that the benefits outweigh the risks for the screening and treatment. Currently evidence is still lacking for the screening methods that are common in the U.S. and treatment options for asymptomatic children for adolescent idiopathic scoliosis.

We agree with the USPSTF’s assessment that there is inadequate evidence to support screening for adolescent idiopathic scoliosis. However, we are concerned that the change of grade from a “D” to “I” will be interpreted as if there is now more evidence to support screening instead of less confidence in the data surrounding its use. The draft recommendation states that “the evidence now reflects a decrease in the certainty of net benefit (from fair to low), leading it to issue an I statement.” We are concerned that the interpretation of the grade will go from “discourage use of this screen” to “we don’t know how beneficial the screen is” so it will not hurt to use it. The evidence clearly does not support this. If the USPSTF makes the change from “D” to “I,” it is essential that they clearly and carefully explain the recommendations to make sure that the change is interpreted correctly.

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