Are yearly physical examinations in adolescents necessary?

Abstract

Background: Recommendations regarding the frequency of routine physical examinations for adolescents have varied from one examination every 2 to 3 years to yearly evaluations. Because none of these recommendations was based on studies regarding the usefulness of such examinations, it was pertinent to review the results of published studies. Methods: All series of routine school and preathletic examinations of adolescents published in the English literature from 1943 to 1995 were reviewed. Only reviews of examinations by physicians with or without supervised health professionals were included. Results: Findings included weight, blood pressure, visual acuity, innocent heart murmurs, scoliosis, referral for further testing, and serious abnormalities unknown before examination. A total of 20,047 examinations by 12 different groups of investigators was abstracted. Only 2 adolescents had major, previously unknown findings: 1 boy was blind in one eye and the other had mitral insufficiency. Elevated blood pressures were found in 0.1% to 1.6% of adolescents. Minor findings included acne, caries, myopia, and minor orthopedic problems, but they did not prevent participation in school or sports. Conclusions: Yearly physical examinations in adolescents are not cost-effective and have practically no value in finding important pathologic conditions. This conclusion would not apply to sexually active teenagers. The value of an examination for health education or detection of mental problems has never been tested in this population. For entrance to school and camps or for sports participation, the review of a questionnaire and screening examinations by allied health providers should be the method of choice unless future studies justify repeated yearly examination of adolescents.