V

POPULASI perkembangan dari sehat menjadi sakit yang

berbeda derajat beratnya

Populasi total

AT RISK!!
Sakit
Mencari pengobatan
Rawat inap
Meninggal

SKRINING
UJI DIAGNOSTIK

A study
accurate test

Comparing with
GOLD
STANDAR

Program

Dx dini penyakit di
komunitas

Terapi
Mencegah
penularan
Mencegah
kecacatan

PENELITIAN SKRINING
(UJI DIAGNOSTIK)

Skema Uji DIAGNOSTIK

Healthy Sample

Negative

Confirm Dx
Not sick
TRUE
NEGATIVE

Positive

SCREENING TEST

Confirm Dx
Sick,
FALSE
NEGATIVE

Sick,
TRUE
POSITIVE

Not Sick
FALSE
POSITIVE

AKURASI
1. VALIDITAS
Sensitivitas
Spesifisitas
Nilai Prediktif
Likelihood
Ratio

2. RELIABILITAS

Persentase
(%)

 Sensitivitas
Kemampuan tes untuk
menunjukkan secara benar orangorang yang benar-benar sakit

TP
TP + FN

Spesifisitas
Kemampuan tes menunjukkan
secara benar orang-orang yang
benar-benar tidak sakit

TN
TN + FP

STANDAR BAKU
S
K
R
I
N
I
N
G

POSITIVE

NEGATIVE

TOTAL

DISEASE

NO DISEASE

TRUE
POSITIVE

FALSE
POSITIVE

(TP)

(FP)

FALSE
NEGATIVE

TRUE
NEGATIVE

(FN)

(TN)

TP + FN

FP + TN

JUMLAH
TP + FP

FN + TN

NILAI PREDIKTIF
1. Positif
2. Negatif
PV positif:
Proporsi orang yang benar-benar
sakit setelah mendapatkan hasil tes
positif
=

TP
TP + FP

PV
Negatif

Proporsi orang yang benar-benar

tidak sakit setelah mendapatkan
hasil tes negatif

TN
TN + FN

Faktor-faktor yang
mempengaruhi nilai prediktif
Sensitivitas dan spesifisitas
Prevalensi penyakit yang asimtomatis
semakin tinggi prevalensi
penyakit, nilai prediktif positif akan
semakin tinggi

TES DENGAN DATA

KONTINYU (INTERVAL)

CUT OFF POINTS

Tes dengan > 2 kategori hasil
Contoh: Glaukoma

Tes X :
1. GLAUCOMA
2. Tidak GL.

Test Y:
1. TIO > 26
2. TIO 22 26
3. TIO < 22

Lanjutan ..Cutoff points

SENS?

SENS?
SPEC?

SPEC?

Healthy

Sick
22
Intra Occular Pressure

26

MENINGKATKAN AKURASI
SEQUENTIAL (2-STAGE) TESTING
Melakukan tes tambahan pada hasil yang sudah
positif
Meningkatkan spesifisitas

SIMULTANEOUS TESTING
Melakukan dua tes secara bersamaan pada populasi
Meningkatkan sensitivitas

RELIABILITAS
Kemampuan alat untuk menunjukkan
hasil yang konsisten ketika digunakan
lebih dari satu kali pada individu yang
sama pada situasi yang sama

Jika suatu tes

Valid
: pasti reliabel
Reliabel
: tidak selalu valid
Tidak reliabel : pasti tidak valid

Contoh :
Roni dengan hasil BSN/GTT (standar) telah didiagnosis diabetes

Tes Urine:
Px 1 (-)
Px 2 (+)
Px 3 (+)
Px 4 (-)

TIDAK RELIABEL

Tes Urine:
Px 1 (-)
Px 2 (-)
Px 3 (-)
Px 4 (-)

RELIABEL TAPI
TIDAK VALID

Faktor-faktor:
Variasi tes
Stabilitas reagen
Fluktuasi sample atau spesimen

Variasi pengamat
Inter observer
Intra observer

PROGRAM SKRINING

 Population-based screening is where a test

is offered systematically to all individuals in
the defined target group within a framework
of agreed policy, protocols, quality
management, monitoring and evaluation.
Opportunistic case-finding occurs when a
test is offered to an individual without
symptoms of the disease when they present
to a health care practitioner for reasons
unrelated to that disease

WHO PRINCIPLES OF EARLY DISEASE

DETECTION
Condition
The condition should be an important health problem.
There should be a recognisable latent or early symptomatic stage.
The natural history of the condition, including development from latent to
declared disease should be adequately understood.
Test
There should be a suitable test or examination.
The test should be acceptable to the population.
Treatment
There should be an accepted treatment for patients with recognised disease.
Screening Program
There should be an agreed policy on whom to treat as patients.
Facilities for diagnosis and treatment should be available.
The cost of case-findings (including diagnosis and treatment of patients
diagnosed) should be economically balanced in relation to possible expenditure
on medical care as a whole.
Case-findings should be a continuing process and not a once and for all project.

Skema PROGRAM SKRINING

Penduduk sehat

Negatif

SEHAT

Positif

Tes Skrining

Konfirmasi Dx
Sakit,
TRUE
POSITIVE

Tidak sakit
FALSE
POSITIVE

CRITERIA TEST TO BE MET

is highly sensitive and is highly specific.

is validated and safe.
has a relatively high positive predictive value and has a
relatively high negative predictive value.
is acceptable to the target population including important sub
groups such
as target participants who are from culturally and linguistically
diverse
backgrounds, people from disadvantaged groups, and people
with a disability.
There are established criteria for what constitutes positive and
negative test results,
where a positive test result means that the person needs
further investigations, and a negative test result means the
person is rescreened at the usual interval, where applicable.

TES MANA YANG HARUS DIPILIH?

SENSITIVITAS DAN SPESIFISITAS
SUMBER DAYA YANG TERSEDIA
DAMPAK

TES MANA TIDAK TERBUKTI

EFEKTIF?
http://www.racgp.org.au/redbook/15

PROGRAM SKRINING
SEDERHANA
Skrining depresi usila GDS 15
Obesitas IMT
????