Diagnostic performance of school-based scoliometric screening for adolescent idiopathic scoliosis: a real-world retrospective study from a Turkish population.

Abstract

The present study aimed to evaluate the performance of a school-based screening strategy using the Adams forward bending test and scoliometry with ATR ≥ 5° for referral. PPV and the false-positive proportion were determined using radiographic confirmation as the reference standard, providing real-world regional data from Türkiye. This study was designed as a Retrospective observational study using real-world data. Students referred to Tatvan State Hospital following positive school-based scoliometric screening were retrospectively analyzed. Demographic data, scoliometric findings, and radiographic measurements were extracted from hospital records. The primary outcome of the study was the positive predictive value (PPV) and the secondary outcome was the false-positive rate. A total of 170 students were included. The mean age was 12.52 ± 1.14 years. Radiographic scoliosis was identified in 15 students (8.8%). The PPV of scoliometric screening was 8.8% (95% CI: 5.0-14.1), with a false-positive rate of 91.2%. Female students demonstrated a significantly higher rate of spinal imaging positivity compared to males and female sex was significantly associated with scoliosis (OR = 4.57, p = 0.049). No significant age difference was observed between groups. School-based scoliometric screening demonstrated low PPV and high false-positive rates. These findings suggest that scoliometry should be considered a preliminary risk stratification tool rather than a definitive diagnostic method, and that refinement of screening thresholds may improve diagnostic efficiency and reduce unnecessary imaging.