98 - Implementation of Targeted School Scoliosis Screening to Address Disparities in the Care of Patients with Adolescent Idiopathic Scoliosis: A Quality Improvement Project

Publication Number: 4096.98

Jessica Westfall, Akron Children's Hospital, Akron, OH, United States; Shray Kumar, Akron Children's Hospital, Akron, OH, United States; Alexandria Rundell, Akron Children's Hospital, Medina, OH, United States; Kenzie D. Lundqvist, Akron Children's Hospital, Akron, OH, United States; Richard P. Steiner, Akron Children's Hospital, Akron, OH, United States; Lorena Floccari, Akron Children's Hospital, Akron, OH, United States

Background: Adolescent idiopathic scoliosis (AIS) affects 2-3% of children under the age of 16 in the United States. Initiating scoliosis treatment early may help prevent curve progression and reduce the likelihood of surgical intervention. A prior study from this research team showed that patients from lower socioeconomic backgrounds and racial minorities are more likely to present with a surgical magnitude curve when referred for AIS evaluation, likely secondary to limited healthcare access.

Objective: This study aims to implement and evaluate targeted scoliosis screenings in high-risk patient populations with socioeconomic disparity. We hypothesized that implementation of targeted scoliosis screenings in socioeconomically disadvantaged areas could improve earlier detection and nonsurgical management in AIS.

Design/Methods: A multidisciplinary team at a freestanding children’s hospital in an urban location identified six local public middle schools at a higher level of socioeconomic deprivation using the Area Deprivation Index (ADI) with a large population of African American students. Screenings for AIS were performed by a single team of Advanced Practice Providers for students in the sixth grade at these schools. Scoliometer readings, demographic variables, and ADI were recorded. Students with scoliometer readings between 4 and 7 were referred to their primary care providers for further evaluation, while those with readings above 8 were referred to orthopedic specialists.

Results: Six hundred and seventy-one scoliometer readings were taken, with one hundred twenty-one students referred for further follow up. Students were mostly male (53%), predominantly Black/African American (58%) and White/Caucasian (33%), with a mean age of 12. Scoliometer readings differed among the schools (p < 0.001). A weak but statistically significant association was found between ADI and scoliometer readings, with larger scoliometer readings associated with higher (more deprived) ADI (state decile ADI r= 0.11, p= 0.004; national percentiles r = 0.09, p = 0.019). Scoliometer readings did not differ significantly between sexes (p= 0.144) or among racial groups (p = 0.084).

Conclusion(s): Higher ADI (indicating increased disparities) has a statistically significant correlation with larger scoliometer readings. Schools with student populations residing in areas with high levels of State or National ADI may benefit from targeted screening interventions for AIS. Future research is needed to track at-risk groups post-screening to assess final diagnosis and clarify links between ADI, race, and AIS.