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Routine screening of children returning home from the tropics

BMJ 1999; 319 doi: (Published 10 July 1999) Cite this as: BMJ 1999;319:121

Authors' definition of asymptomatic children is not the one usually accepted

  1. Blaise Genton, Senior consultant (,
  2. Mario Gehri, Senior consultant
  1. Travel Clinic, Medical University Policlinic, 1005 Lausanne, Switzerland
  2. Department of Paediatrics, University Hospital, Lausanne
  3. Bradford Health Authority, Shipley BD18 3LD
  4. Department of Paediatrics, University Hospital Nijmegen St Radboud, PO Box 9101, 6500 HB Nijmegen, Netherlands
  5. Beatrix Kinderkliniek, State University Hospital Groningen, PO Box 30.001, 9700 RB Groningen, Netherlands
  6. Haskoning BV, Consultants, PO Box 151, 6500 AD Nijmegen, Netherlands

    EDITOR—Information on routine screening of children coming back from the tropics is scarce, but we do not agree with Brouwer et al's conclusion that routine screening of children without symptoms is worth while.1

    Firstly, their definition of asymptomatic children (those seen at their scheduled appointment) is not the one usually accepted (those without symptoms). Parents of children with symptoms or signs not severe enough to seek immediate medical advice may have waited for their scheduled appointment to have the complaint investigated. In fact, 71 (28%) of the 253 so called asymptomatic children had symptoms. If a diagnosis was made in all these children, a diagnosis would have been found in only 28 (99−71) (15%) of the 182 (253−71) truly asymptomatic children; if a diagnosis was made in only half of the “asymptomatic” children with symptoms, a diagnosis would have been found in 64 (99−35) (35%) of the 182 truly asymptomatic children—still less than the figure given (39%). Only 98 (74%) of the 132 cases in which a diagnosis was made were treatable, which further decreases the value of screening.

    Secondly, to assess the usefulness of a standard protocol for routine screening it would be necessary to estimate the positive predictive values of clinical criteria and laboratory variables for finding a diagnosis. As the authors state, the clinical examination was not very helpful. We doubt that the urea and creatinine concentrations led to any of the diagnoses found. We find that …

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