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

backgroundIn Germany, all preschoolers undergo a school entry examination (SEE). While most children are sufficiently served with standardized developmental tests only, for a small group of otherwise underserved children, the SEE should also include a subsidiary health checkup. The aim of the study was to validate selection criteria to differentiate these two groups of children.

methodsSecondary data from the SEEs of 2016 and 2017 that contained information on 3513 children were analyzed. Of these children, a subset was selected in which no severe developmental disorders were diagnosed prior to the SEE (n = 2744). The selection criteria identified in an earlier study (low or medium social status, missed the last pediatric routine check-up, migration background, three or more siblings, and raised by a single mother) were then applied to this subset to estimate their effectiveness in finding children at risk for a newly diagnosed severe developmental disorder. The sensitivity, specificity and positive and negative predictive values of the selection criteria were calculated.

resultsThe tested selection criteria identified children who would likely benefit from a subsidiary checkup in the context of SEEs with a sensitivity of 96% (95% CI: 94.5-98.9%). The negative predictive value and specificity of the criteria were 99% (98.6-99.7%) and 34% (32.1-35.8%), respectively. By using this approach, the number of children seen by a physician could be reduced to 53% of the age cohorts.

conclusionThe tested selection criteria are a viable way to differentiate children for whom SEEs should include a subsidiary health checkup from those who do not need it. Therefore, the time that physicians spend with SEEs could be reduced. Using the selection criteria to establish a stepped procedure in SEEs therefore offers a valid way to focus physicians' resources on the children who need them most.