Factors Associated with Presentation of Severe Adolescent Idiopathic Scoliosis

Abstract

Background: Adolescent idiopathic scoliosis (AIS) is a common referral to pediatric orthopaedic surgeons. Timely treatment with appropriate bracing decreases the risk of curve progression and need for surgical intervention. Despite pediatrician screening, patients still present to orthopaedic surgeons with curve magnitudes too significant for appropriate nonoperative bracing. Methods: This retrospective cross-sectional study included patients aged 10 to 18 years diagnosed with AIS between 2011-2021 at a major metropolitan tertiary care center. Patients were excluded if initial radiographs were obtained more than 1 week after clinical diagnosis. Scoliosis severity was classified based on initial radiographs. Sociodemographic factors were recorded, including patient addresses, which were cross-referenced with the diversitydatakids.org Child Opportunity Index (COI) database, which analyzes the quality of resources in a geographic area. Results: Gender, health insurance provider, race/ethnicity, and COI were all found to have a statistically significant relationship with CA and age at initial presentation. The odds of presenting with severe (versus mild and moderate) scoliosis was 2.3 times higher for patients who identified as black/African American compared to those who identified as white. Additionally, the odds of initially presenting with severe scoliosis were almost 40% higher in females compared to males. Furthermore, each stepwise increase in COI was associated with a 17%-19% decrease in odds of presenting with severe scoliosis, depending on standardization. Conclusions: There are sociodemographic disparities in the identification and initiation of treatment for AIS. Specifically, the odds of presenting with severe scoliosis are increased in patients who identify as black/African American or female and/or come from areas with lower access to resources (as defined by COI). Appropriate and timely referral to a pediatric orthopaedic surgeon for AIS treatment thus requires 1) educating primary care providers, pediatricians, and scoliosis screeners on how to appropriately identify scoliosis and the risks associated with late identification/referral and 2) public health initiatives to address access to care for patients at risk for late scoliosis identification.