Screening 1

SCREENING
By
DILEEP KUMAR (Post R.N BSc.N, C.H.N)
Ilmiya Institute of Nursing, Karachi
Screening
1. The examination of apparently healthy people to classify them as likely or unlikely
to have the disease under consideration is called as screening.
2. Screening means search for unrecognized disease of defect by means of rapidly
applied tests, examination or other procedures in apparently healthy individuals.
OR
3. Screening means checking people who think or feel they are healthy to find if they
have certain health problems or risk factors they did not know about before. It can
be done by:
 asking questions, for example, about smoking
 examining the person, for example, checking blood pressure
 doing tests, for example, a blood test for iron levels
A person who has a positive screening test will usually need further tests to identify
specific health problems. For example, a urine dipstick test might show protein, but
you need to do further tests to know if the person really has kidney disease.
Screening procedures may include cytological tests, blood tests, x- rays, urinalysis,
amniocentesis (a test during pregnancy that removes a small amount of fluid from the
sac around the baby to look for birth defects and chromosome problems.),
examination for scoliosis (Scoliosis is a disorder that causes an abnormal curve of the
spine, or backbone), and variety of other procedures
Types of screening
1. Mass (untargeted) screening
Means screening a whole population or a subgroup (defined by geographical location,
age groups or gender), for example, cervical screening for all women of reproductive
age, screening adults for risk factors for chronic diseases
2. Targeted (High risk or selective) screening
It is screening a group of people who are more likely to have a particular problem
(high risk groups), for example, screening for diabetes in a person who has a close
family member with diabetes.
3. Opportunistic (case finding) screening
It is screening individuals when they have an opportunity, means patient consult with
another problem and find some relation for example, when they attend the health
centre for some other reason such as a cold or a minor injury, for example: offer a
Screening 2
diabetes check to an adult who has a family history of diabetes, when checking blood
pressure, ask about smoking and alcohol consumption
4. Multiphase screening
Application of two or more screening tests in combination to a large number of people
at one time than to carry out separate screening tests for single diseases
Problems identified by screening should be followed by appropriate action, such as:
brief intervention, referral, treatment, and family consultation
Properties of screening test
 Acceptable to community
 Inexpensive
 Require little time to be conduct
 Capable of wide application
 Reliability (Precision)
 Validity (Accuracy)
SCREENING VS DIAGNOSTIC TEST

Screening Diagnostic test

 Done on apparently healthy  Done on those apparently unhealthy
 Applied to groups  Applied to single patient
 Test results are arbitrary and final  Diagnosis is not final and is the based
on sum of all evidences

 Less accurate  More accurate

 Less expensive  More expensive

 Not a basis for treatment  Used as basis for treatment

 The initiative comes from the  Initiative comes from patient with a
investigator complaint

Criteria for Screening of a Disease

 The disease to be screened should be an important health problem
 There should be recognizable latent or early asymptomatic stage
 Natural history of disease should be known
 A test is available which can recognize the disease prior to onset of symptoms
 Facilities for confirmation of diagnosis are available
 Effective treatment is present
 There is good evidence that early detection reduced morbidity and mortality
 The expected benefits are more than cost and risks.
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 Validity: provide a good indication of who does and does not have disease
o Sensitivity of the test
o Specificity of the test
 Reliability: (precision): gives consistent results when given to same person under
the same conditions
 Yield: Amount of disease detected in the population, relative to the effort
o Prevalence of disease/predictive value
Validity of screening test (Accuracy):
It expresses the ability of the test to separate or distinguish those who have the disease
from those who do not. It refers to the closeness with which measured values agree
with “true” values.
It has two components; Sensitivity and Specificity
Sensitivity:
The ability of a test to identify correctly all those who have the disease (true positives)

Specificity:
The ability of the test to identify correctly who do not have the disease (true
negatives)

Table – 1. Sensitivity & Specificity

Predictive Value of a Positive Test (PPV):

Likelihood (Chances) that a person with a positive test has the disease
Predictive Value of a Negative Test (NPV):
Likelihood(Chances) that a person with a negative test does not have the disease
Screening 4
Table – 2. Positive predictive value and Negative predictive value

PROCESS OF SCREENING TEST