Application of the electronic scoliometer in school-based scoliosis screening among elementary school students and analysis of factors associated with suspected scoliosis.

BACKGROUND

Scoliosis imposes a growing health burden on school-age children in China, yet data specific to elementary school students aged 6-12 years remain scarce. This study aimed to compare the positive screening rate and screening efficiency of the electronic scoliometer (E-scoliometer) with those of the manual scoliometer (M-scoliometer), and to identify modifiable risk factors for suspected scoliosis in this younger age group.

METHODS

A school-based cross-sectional study was conducted among 11,587 students in grades 1-5 from 10 public elementary schools in Harbin, China (September 2024-May 2025), using multistage stratified cluster sampling. Classes were randomly allocated to the M-scoliometer group (n = 5,697 pupils) or the E-scoliometer group (n = 5,890). A stratified subsample of 3,600 students underwent posture assessment and parent-reported questionnaire survey. Associations were examined within two domains by binary logistic regression and then in a single joint generalized estimating equation (GEE) model providing mutual adjustment across domains and accounting for clustering of pupils within classes.

RESULTS

The overall positive screening rate was 1.61%, increasing significantly from Grade 1 (0.26%) to Grade 5 (2.89%; p < 0.001). The two devices yielded comparable positive screening rates (M-scoliometer 1.67% vs. E-scoliometer 1.56%; difference 0.11 percentage points, 95% CI - 0.36 to 0.57; p = 0.706), while the E-scoliometer reduced mean screening time by 54.2% (16.04 s vs. 35.00 s; p < 0.001). In the joint GEE model (59 events, 9 parameters, 6.56 events per variable, optimism-corrected AUC 0.910), flat back (OR = 7.36), picky eating (OR = 4.19), daily physical exercise < 1 h/day (OR = 3.86), mild wasting (OR = 3.80), shoulder height asymmetry (OR = 3.06) and higher grade (OR = 1.43 per grade) were associated with higher odds of suspected scoliosis, whereas regular adjustment of chair and desk height (OR = 0.18) and regular rotation of classroom seating (OR = 0.19) were associated with lower odds. The association with thumb-inward grip pen-holding posture did not persist under mutual adjustment (OR = 1.55, 95% CI 0.77-3.11) and is reported as hypothesis-generating.

CONCLUSION

The E-scoliometer yielded a positive screening rate comparable to that of the M-scoliometer with markedly superior efficiency, supporting its adoption in large-scale school-based programs. The factors identified were largely modifiable, suggesting that promoting daily physical activity, improving nutritional behaviors, and standardizing classroom furniture management and seating rotation merit consideration in school-based scoliosis prevention strategies for elementary school children.