MODULE

Screening and Diagnostic Testing

Dr. Putu Cintya Denny Yuliyatni, MPH
(Reference Greenberg, p. 127-136)

AIMS:
To be able to describe validity and reliability of certain test to apply in the individual and or
community context

LEARNING OUTCOMES:
1. To describe definition of accuracy, validity and reliability
2. To explain parameters used to indicate validity and reliability
3. To describe concept of test validity of the continues or multilevel outcome result
4. To choose ideal diagnostic test in certain situations related to individual and community
context

CURRICULUM CONTENTS:
1. Definition of diagnostic test and screening program
2. Accuracy, validity (sensitivity, specificity, predictive value, and likely hood ratio) and
reliability
3. Screening program

ABSTRACTS
All clinical information is subject to error. Accounting for the various errors that can arise in
diagnostic testing allows the physician to select tests and interpret the result of those tests
appropriately. The errors are false- negative, false-positive.
Sensitivity and specificity are characteristics of a diagnostic test. It is useful to consider
two other measures, positive predictive value (PV+) and negative predictive value (PV-),
which are use to interpret the results of a diagnostic test.
For multilevel or continuous outcome test results, a dividing line or cut off point can be
chosen to separate findings considered to be positive or negative. The performance of
diagnostic tests also can be assessed by use of likelihood ratios.

SELF DIRECTING LEARNING

Basic knowledge and its application that students must know include:
1. Accuracy
2. Sensitivity, specificity, predictive value, likelihood ratio
3. Cut off point
4. Screening program
SCENARIO & LEARNING TASK
Case 1
The result of screening test was as bellow;
Diabetic retinopathy
S
Sakit Tidak Sakit Total
K Positif 3.200 1.400 4.600
R Negatif 150 29.000 29.150
I Total 3.350 30.400 33.750

N
Learning Tasks 1
I
1. Calculate the sensitivity, specificity, and predictive value of diabetic retinopathy and Interpret
each
N of your calculation
 G
Sensitivitas  3200/3350 = 9,6%
 Specificity  29000/30400 = 9,5%
 PPV  3200/4600 = 6,95%
 NPV  29000/29150 = 9,9%
 Interpret SN  hasil screening untuk mendapatkan hasil positif diabetic retinopathy
sebesar 9,6% atau diantara 100 orang yang mengalami diabetic retinopahthy, 97 orang
dinyatakan positif
 Interpret SP  hasil screening untuk mendapatkan hasil negatif diabetic retinopathy
sebesar 9,5% atau diantara 100 orang sehat, 95 orang akan dinyatakan negatif oleh tes
screening
2. What is the prevalence of diabetic retinopathy among the population?
3. What is the relation between prevalence and predictive value? What is the relation with the
target group for screening program?
4. When you conduct screening test among elderly population, which prevention you have
done: primary, secondary, or tertiary?

Case 2
A detailer has come to dr. Arjuna for offering cheap rapid test for anemia. Dr. Arjuna asked 3
tests for trial. Fortunately, Mrs. Drupadi came for consultation of malaise and continuing
dizziness. Dr. Arjuna asked permission from mrs. Drupadi to take the blood sample for checking
anemia. At the same time, he also told her that he wanted to check the rapid test for anemia.
Using cyan-met HB, the result of hemoglobin was 12.5mg%, while the result of rapid test
respectively was 10.5 mg%; 10.2mg%; and 12.0mg%.

Learning Task 2
If the criteria of anemia was <11 mg%, how you conclude the result of the rapid test for anemia
that just being tried by dr. Arjuna?
Self Assessments:
1. What is the definition of sensitivity?
2. What is the definition of specificity?
3. If the prevalence increases, what other value will also increase?
4. If the prevalence of a certain disease is high, while the sensitivity and specificity are stable,
than ................... will be low.