AIMS—To summarise and critically evaluateresearch conducted in the UK between 1962 and 1996, on theeffectiveness and efficiency of the school entry medical (SEM) examination. METHODS—An electronic search of a large number ofdatabases, in conjunction with a search of reference lists, and sourcesin the grey literature produced a total of 64studies. RESULTS—Only one overview and 16 primary studiesmet the review's broad inclusion criteria. The results showedsignificant differences in the identification and referral of new andongoing problems not only between the routine andselective SEM but also within the two types of SEMexamination. There were also large differences in the numbers ofchildren selected for SEM examination. No study included in the reviewdefined either the methods or the criteria used to identify children asscreen positive. No study provided follow up of children after referralto estimate the positive predictive value or yield of the screening, orfollow up of the whole cohort to identify false negative cases. CONCLUSION—Data on the effectiveness andefficiency of both the routine and selective SEM examination inaccurately identifying children with new or ongoing health problems arenot available at the present time. The studies reviewed heredemonstrate the fragility of the evidence on which the school entrymedical is based, and call into question the ethical basis of this programme.
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