Stud Health Technol Inform. 2008;140:245-8. Suggestions for improvement of School Screening Upgrading School screening for Idiopathic Scoliosis Theodoros B. GRIVAS 1 , Elias S. VASILIADIS 1 , Joseph P. O’BRIEN 2 1 Scoliosis Clinic, Orthopaedic Department, “Thriasio” General Hospital, G. Genimata Avenue, Magula, 19600, Athens, Greece. 2 National Scoliosis Foundation (NSF), Boston, USA Abstract. There is skepticism and the worth of school screening for the purposes of health care has been challenged. Numerous reasons are raised by the negativists to abandon these programs, even though the value of school screening is well documented in the literature. The aim of the present study is to update the evidence based recommendations for the improvement of school screening effectiveness, in order to support its continuation. All the relative research papers which originated from our scoliosis school screening program were analyzed. Specific suggestions for a) the organization, b) the optimal age of screening according to the geographical latitude, c) the best examined position, d) the standardization of referrals, e) the follow up of younger referrals with trunk asymmetry and f) the reduction of the financial cost are made. Today there is evidence that the incidence of surgery can significantly be reduced in areas where idiopathic scoliosis can be detected at an early stage through these programs. The introduction of these recommendations to all the existing school screening programs is strongly suggested, to reduce the negative impact they may have on families and on the health system and to improve their effectiveness. Keywords. Idiopathic scoliosis, school screening, improvement of school screening Introduction There are numerous problems that prevent school screening for IS from being universally accepted. The low prevalence of IS, the high false positive referrals and the excessive cost, both direct and indirect, are raised by the negativists as reasons to abandon school screening programs. To our knowledge, there is no study in the literature to provide suggestions on how to improve the weak points of scoliosis school screening. The American Academy of Orthopaedic Surgeons, Scoliosis Research Society, Pediatric Orthopaedic Society of North America and American Academy of Pediatrics in their most recently published joint information statement on scoliosis screening do not support any recommendation against scoliosis screening, given the available literature [1]. Scoliosis screening has proven effective in many ways, and it is considered beneficial among the Orthopaedic community [2]. Furthermore, it provides the opportunity for early diagnosis and conservative treatment, which is often missed in the absence of screening [3]. The initial goal of scoliosis school screening was to detect IS at an early stage when deformity is likely to go unnoticed [3]. In an effort to enhance the effectiveness of school screening programs, the International Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT) recommended as a new goal to identify those children who will be at risk for developing scoliosis [2] and those children who have curves likely to require conservative treatment [4]. This would require better organization, selective