We found no systematic reviews and no RCTs evaluating detection methods. One observational study (224 people) compared traditional scalp inspection with wet combing with conditioner. Wet combing found more cases of louse infection in a school population than scalp inspection (49/224 (22%) versus 33/224 (15%); RR 1-5, CI -1-0-2-1; NNT 14, CI 0-5-1). However, inspection claimed to identify a further 13 cases that were not confirmed either by

Figure 38.1 Head lice are difficult to see against human skin
Figure 38.2 Detection combing for head lice using a plastic detection comb

combing or by follow up examination 2 weeks later.34 An unpublished randomised trial has found that dry detection combing is more sensitive than either scalp inspection or shampooing followed by straining the rinse water to find lice washed from the hair (Dr Cynthia Guzzo, personal communication, 2001). One RCT of treatments found dry combing with a detection comb to be more effective than visual inspection in identifying positive cases before treatment (25/25 (100%) versus 12/25 (48%); RR 2-08, CI 1-3-3-1; NNT 2, CI 0-3-0-7).21

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