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Risk-based approach to school entry examinations in Germany - a validation study.

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Validated selection criteria can identify preschoolers needing extra health checks during school entry examinations (SEE). This approach efficiently targets resources to at-risk children, reducing unnecessary physician workload.

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Area of Science:

  • Pediatric Health
  • Public Health Policy
  • Developmental Pediatrics

Background:

  • Germany mandates school entry examinations (SEE) for all preschoolers.
  • Most children require only standard developmental tests.
  • A subset of underserved children may benefit from a subsidiary health checkup during SEE.

Purpose of the Study:

  • To validate selection criteria for identifying children needing a subsidiary health checkup during SEE.
  • To differentiate children who require additional health assessments from those who do not.

Main Methods:

  • Analysis of secondary data from 3513 school entry examinations (SEE) in 2016-2017.
  • Application of previously identified selection criteria (social status, missed pediatric checkups, migration background, siblings, single-parent household) to a subset of 2744 children without prior severe developmental disorders.
  • Calculation of sensitivity, specificity, and predictive values of the criteria.

Main Results:

  • The selection criteria demonstrated high sensitivity (96%) in identifying children likely to benefit from a subsidiary checkup.
  • The criteria achieved a high negative predictive value (99%) and moderate specificity (34%).
  • Implementing these criteria could reduce the number of children requiring a physician's attention during SEE by 47%.

Conclusions:

  • The validated selection criteria effectively differentiate children needing a subsidiary health checkup within the SEE framework.
  • This approach optimizes physician resource allocation by focusing on high-risk children.
  • A stepped procedure using these criteria enhances the efficiency and effectiveness of preschool health screenings.