Systematic review of the school entry medical examination
Health Services Research Unit, Institute of Health
Sciences, Oxford University, Old Road, Headington, Oxford OX3 7LF
Correspondence to: Dr Barlow.
Accepted 1 October 1997
AIMS
To summarise and critically evaluate
research conducted in the UK between 1962 and 1996, on the
effectiveness and efficiency of the school entry medical (SEM) examination.
METHODSAn electronic search of a large number of
databases, in conjunction with a search of reference lists, and sources
in the grey literature produced a total of 64 studies.
RESULTSOnly one overview and 16 primary studies
met the review's broad inclusion criteria. The results showed
significant differences in the identification and referral of new and
ongoing problems not only between the routine and
selective SEM but also within the two types of SEM
examination. There were also large differences in the numbers of
children selected for SEM examination. No study included in the review
defined either the methods or the criteria used to identify children as
screen positive. No study provided follow up of children after referral
to estimate the positive predictive value or yield of the screening, or
follow up of the whole cohort to identify false negative cases.
CONCLUSIONData on the effectiveness and
efficiency of both the routine and selective SEM examination in
accurately identifying children with new or ongoing health problems are
not available at the present time. The studies reviewed here
demonstrate the fragility of the evidence on which the school entry
medical is based, and call into question the ethical basis of this programme.
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© 1998 by Archives of Disease in Childhood
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