A systematic review 1 including 12 series with a total of 20 047 adolescents was abstracted in DARE.
Routine school examinations: 3 series with 7 953 adolescents.
No serious abnormalities were detected. The percentage of adolescents referred for further testing varied from 3.8 to 4% in the study described as the most detailed evaluation (985 adolescents), but most of the abnormalities were already known. Minor conditions revealed by screening included acne, reduced visual acuity, short stature, obesity and dental caries.
Prevalence rates for individual conditions were as follows:
increased blood-pressure, 0 to 0.4% in males and 0.2% in females;
abnormal heart disease, 0.2% congestive heart disease and 0.7% rheumatic heart disease;
abnormal heart murmur, 0.5% in males and 1.0% in females;
hernia, 0 to 0.3%;
undescended testis, 0 to 0.5%;
and serious positive findings, 4% known before examination for one study, 3.8% unknown before examination for another study and not stated for the third study.
Presports examinations: 9 series with 12 094 adolescents.
Two major previously undetected abnormalities, i.e. one mitral valve insufficiency and one unilateral blindness, were found. The percentage of adolescents referred for further testing varied from 1.2 to 13.5%. All the students in the study reporting the highest referral rate were eventually allowed to participate in sports.
The authors conclude that yearly physical examinations in adolescents are not cost-effective and have practically no value in finding important pathological conditions. This conclusion would not apply to sexually active teenagers. The value of an examination for health education, or for the detection of mental problems, has never been tested in this population. For entrance to schools or camps for sports participation, questionnaires and screening examinations by allied health providers should be used unless future studies justify yearly examination of adolescents.
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