Screening physical examinations in 25,000 Israeli schoolchildren

Physical examinations in childhood and adolescence have been recommended by various professional organizations. In order to assess the value of periodic physical examinations in identifying previously undetected conditions, we analyzed the results of school screening examinations of approximately 25,000 Israeli students.

Entire student populations in the 1st, 5th, 7th, and 10th grades in the Tel Aviv-Yafo public school system were offered physical examinations during the 1996-1997 and 1997-1998 school years. Nine physicians performed these examinations. Referrals to the primary care physician were made for abnormal findings. The frequencies of the leading referrals were determined, and comparisons were made according to gender and grade.

A total of 24,846 students were examined. The overall referral rate was 7.8 per 100 examinations. Leading referrals included "overweight", "heart murmur", and "spinal structural abnormalities" at all grade levels, and "nevi" in grades 5, 7, and 10. Referral rates increased between various grade levels for "spinal structural abnormalities", "nevi", and "varicocele", and decreased for "short stature" and "overweight". Of the 196 diagnoses documented after referral, 182 (93%) fell into three categories, namely, spinal, hernia and scrotal, and short stature.

A wide range of physical findings were detected or referred at each of the grade levels in this large population of schoolchildren. Many of these were triggers for preventive health counseling, while approximately 1% of the examinations yielded important findings requiring intervention. These results provide a measure of justification for the American Academy of Pediatrics' recommendations for periodic physical examinations in childhood and adolescence.