Systematic review of the school entry medical examination
- Health Services Research Unit, Institute of Health Sciences, Oxford University, Old Road, Headington, Oxford OX3 7LF
- Dr Barlow.
- Accepted 1 October 1997
Abstract
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.
METHODS An 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.
RESULTS Only 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.
CONCLUSION Data 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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A systematic review of the UK literature from 1962 to date assessed the efficiency and effectiveness of the routine school entry medical (SEM) examination compared with the selective SEM
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There were 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
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There is insufficient evidence available to assess the effectiveness or efficiency of either the routine or selective SEM
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This review demonstrates the fragility of the evidence on which the SEM is based, and questions the ethical basis of this programme
