Patient Characteristics at the Initial Visit to a Scoliosis Clinic

In Brief Study Design. A cross-sectional study was conducted of all patients referred for an initial visit to the orthopedic outpatient clinic of a metropolitan pediatric hospital in Canada for suspected adolescent idiopathic scoliosis (AIS). Objective. To document the appropriateness of current referral patterns for AIS in comparison to those that were prevailing before discontinuation of school screening in Canada. Summary of Background Data. The consequences of the discontinuation of school scoliosis screening programs on the referral patterns of AIS patients remain unknown. Methods. The clinical and radiologic charts of the 636 consecutive patients referred for scoliosis evaluation over a 1-year period were reviewed. Patients were classified according to defined criteria of appropriateness of referral based on skeletal maturity and curve magnitude. Results. Of the 489 suspected cases of AIS, 206 (42%) had no significant deformity (Cobb angle <10°) and could be considered as inappropriate referrals. In subjects with confirmed AIS, 91 patients (32%) were classified as late referrals with regards to brace treatment indications. Conclusions. These findings suggest that current referral mechanisms for AIS are leading to a suboptimal case-mix in orthopedics in terms of appropriateness of referral. We compared the current referral patterns in orthopedics with those documented before discontinuation of school scoliosis screening programs. The current case-mix is displaying lack of appropriateness with 42% of suspected cases considered as inappropriate referrals and 32% of confirmed adolescent idiopathic scoliosis patients referred late with regards to brace treatment indications.