Systematic review of the school entry medical examination.
OBJECTIVE
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.


CONCLUSIONS
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.
Barlow
J
J
Health Services Research Unit, Oxford University.
Stewart-Brown
S
S
Fletcher
J
J
D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D016208:Databases, Factual; D005069:Evaluation Studies as Topic; D005500:Follow-Up Studies; D006801:Humans; D008403:Mass Screening; D018579:Patient Selection; D010808:Physical Examination; D012017:Referral and Consultation; D012572:School Health Services / Q000191:economics / Q000458:organization & administration*; D006113:United Kingdom