Barlow J, Stewart-Brown S, Fletcher J
Health Services Research Unit, Oxford University.
Arch Dis Child. 1998 Apr;78(4):301-11. doi: 10.1136/adc.78.4.301.
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.
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.
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.
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.
总结并批判性评价1962年至1996年间在英国开展的关于入学体检（SEM）有效性和效率的研究。
通过对大量数据库进行电子检索，并结合参考文献列表检索以及灰色文献来源检索，共获得64项研究。
只有1篇综述和16项原始研究符合该综述的广泛纳入标准。结果显示，不仅在常规SEM和选择性SEM之间，而且在两种类型的SEM检查中，新出现问题和持续存在问题的识别与转诊方面都存在显著差异。接受SEM检查的儿童数量也有很大差异。纳入该综述的研究均未定义将儿童确定为筛查阳性所使用的方法或标准。没有研究对转诊后的儿童进行随访以估计筛查的阳性预测值或收益，也没有对整个队列进行随访以识别假阴性病例。
目前尚无关于常规SEM和选择性SEM在准确识别有新的或持续健康问题儿童方面的有效性和效率的数据。此处综述的研究表明了入学体检所依据证据的脆弱性，并对该项目的伦理基础提出了质疑。
