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How precise are clinical height measurements in scoliosis patients?

Background: The purpose of this study was to determine the accuracy of height measurements in patients with scoliosis at five pediatric institutions and the influence on treatment decisions. Clinical height measurements are used to monitor growth in children and adolescents and may impact treatment recommendations. To our knowledge, measurement variability of patient height in scoliosis clinics has not been evaluated. Methods: At the five participating centers, patient height was measured by clinical staff members using their institution’s standard clinic protocol and then by an attending Scoliosis Research Society member surgeon using one identical protocol among the five centers. To negate the possibility of the Hawthorne Effect, the clinical staff members who completed the initial height measurements were unaware of the subsequent SRS spine surgeon measurements or the protocol used for measurement. Results: The mean height difference in measurement between surgeons and clinical staff for all five centers was 0.7 cm (Center 1: 0.5 cm, Center 2: 0.5 cm, Center 3: 0.9 cm, Center 4: 0.6 cm, Center 5: 1.2 cm). Twenty-three percent (21/92) of patients had measurements that were more than 1 cm different between the clinical staff and surgeon measurement. Conclusions: Our study found a mean 7 mm clinical height measurement variation between surreptitious measurements by SRS surgeons and standard clinical protocol. This variability can lead to inappropriate treatment decisions if growth is used as an indication for brace treatment. With such variability in clinical height measurement, one may want to consider using criteria for bracing independent of height measurement.