A working group of the International Union Against Tuberculosis and Lung Disease has formulated simple clinical scoring systems for screening for tuberculosis in children (International Journal of Tuberculosis and Lung Disease1998;2:116–23). They propose different scoring systems for low and high prevalence countries, each system using five criteria; contact with tuberculosis, tuberculin reactivity, cough, underweight, and fever. In low prevalence countries contact history and skin test result are all-important whereas in high prevalence countries the five criteria are given almost equal weighting. The systems tend to give high positive predictive value but low sensitivity and specificity; their value in screening children for further investigation, especially in developing countries, needs to be determined in field conditions.

About one child in 10 with sickle cell disease will have a stroke by the age of 20, the incidence being highest in 2–5 year olds. In a US multicentre trial (New England Journal of Medicine1998;339:5–11. See also editorial, Ibid: 42–4) children were selected because of increased stroke risk by virtue of increased blood flow velocity in internal carotid or middle cerebral arteries on transcranial Doppler ultrasound. …