Program cuts down on unneeded scoliosis referrals

NEW YORK Mon Feb 18, 2013 1:58pm EST

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NEW YORK (Reuters Health) - Educating pediatricians about scoliosis seems to cut down on the number of children who are unnecessarily sent to specialists for curves of the spine, according to a new study.

Researchers found the number of referrals to orthopedic surgeons in one group of pediatricians fell by over 20 percent in the two years after the program was started, compared to the two years before.

"If you're training a certain group of people to treat scoliosis, I think that's good," said Dr. David Feldman, chief of pediatric orthopedic surgery at NYU Hospital for Joint Diseases in New York.

"The question is if that's sustainable," said Feldman, who was not involved with the new study.

Scoliosis, which is a curve of the spine greater than 10 degrees, affects up to 3 percent of children. Mild cases may just need to be monitored by a doctor, but some children need to wear a back brace, or - in extreme cases - need surgery.

The U.S. Preventive Services Task Force, a government-backed group of clinicians, found that routine screening of youths for scoliosis could lead to unnecessary bracing and other specialty care. Those potential harms, they said, outweighed the benefits of screening, but some states still require it.

In the Pediatric Physicians' Organization at Children's, a group of 72 doctors' offices affiliated with Boston Children's Hospital, the researchers found less than 5 percent of the children referred to orthopedic specialists ended up with a back brace, and less than 1 percent had surgery.

The researchers, who could not be reached for comment by deadline, thought starting a training program would teach pediatricians which children should and shouldn't be sent to specialists. That, they write in the journal Pediatrics on Monday, would cut down on the number of unnecessary referrals and save money.

In mid-2009, the researchers held informational sessions to teach pediatricians within the group of doctors at the 72 offices about scoliosis. They also gave the pediatricians tools to decide which children should see specialists, and gave them updates on how many of their patients were being referred.

In the two years before the training, there were about 5 visits to specialists for every 1,000 children per year. In the two years after the training program, that number fell to about 4 visits for every 1,000 children per year.

The researchers estimate the training may have stopped about 131 referrals.

'VERY USEFUL'

The researchers write that they believe the drop in the number of referrals is due to their program, because visits to specialists increased for all other conditions during that time.

Feldman told Reuters Health that it's important that doctors are able to differentiate between scoliosis and other types of malformations, and that they're not postponing treatment for children that need to wear braces.

"I'm concerned about this, but done in the right setting I think it can be very useful," he said.

But the study did have limitations, including that the researchers could not separate children who were referred to specialists by the pediatricians from children who may have been screened for scoliosis at school.

Also, the researchers write that there was a 13 percent increase in the number of x-rays taken by pediatricians to examine the children's spines after the program. They cannot tell whether that is too many.

Feldman added that it's unknown whether this type of program could be applied across the country, or whether it's just effective in this one group of pediatricians.

SOURCE: bit.ly/Y2Ni0Y Pediatrics, online February 18, 2013.

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