Routine screening of children returning home from the tropics

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# Authors' definition of asymptomatic children is not the one usually accepted {#article-title-2} 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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