Effectiveness and Cost Burden of School Screening for Adolescent Idiopathic Scoliosis: A Systematic Review and Meta-Analysis.

Abstract

Systematic review and meta analysis of school based AIS screening programmes. To determine the prevalence, diagnostic performance, clinical impact, and cost burden of routine school screening for adolescent idiopathic scoliosis. The rationale for routine screening is that curves detected before skeletal maturity respond to bracing, reduce progression, and avert costly fusion, yet controversy persists regarding false positives, radiation exposure, and programme affordability across health care systems. Databases searched were PubMed, Embase, Scopus, Web of Science, and Cochrane Central from inception to February 2025. Inclusion criteria were asymptomatic pupils aged ten to sixteen screened at school and reporting prevalence, test accuracy, treatment, or cost. Data were pooled with random effects models, heterogeneity was assessed by I squared, and currency was expressed as United States dollars. Thirty four studies covering two point eight million pupils met inclusion. Prevalence was 0.66 percent for curves over ten degrees, 0.33 percent over twenty, and 0.02 percent over forty. Screening tests gave sensitivity 74 to 100 percent and specificity 80 to 99 percent, negative predictive value approached 100 percent, positive predictive value four to eighty percent. Screen detected adolescents showed mean Cobb 28 degrees versus 40 in usual care, with 73 percent lower fusion odds. Numbers needed to screen to start bracing ranged 448 to 2,234. Costs were 0.47 to 55 dollars per pupil, and most economic models predicted net savings despite heterogeneity. School-based screening reliably detects AIS at milder stages, is associated with lower surgical rates, and can be economically defensible under well-designed, multi-step protocols. Nevertheless, wide variations in prevalence, screening methods, and cost frameworks highlight the need for standardised programmes and contemporary economic evaluations to optimise benefit while minimising unnecessary referrals and radiation exposure.