SKRINING

SAWITRI
V
POPULASI  perkembangan dari sehat menjadi sakit yang
berbeda derajat beratnya

Populasi total

AT RISK!!

Sakit

Mencari pengobatan

Rawat inap
Meninggal
 SKRINING
UJI DIAGNOSTIK Program

A study  Dx dini penyakit di

accurate test komunitas

Terapi
Comparing with
GOLD STANDAR Mencegah penularan
Mencegah kecacatan
PENELITIAN SKRINING
(UJI DIAGNOSTIK)
 Skema Uji DIAGNOSTIK

“Healthy Sample”

Negative Positive
SCREENING TEST

Confirm Dx
Confirm Dx

Not sick Sick, Sick, Not Sick

TRUE FALSE TRUE FALSE
NEGATIVE NEGATIVE POSITIVE POSITIVE
AKURASI
1. VALIDITAS
Sensitivitas
Spesifisitas Persentase
(%)
Nilai Prediktif
Likelihood Ratio

2. RELIABILITAS
• Sensitivitas
Kemampuan tes untuk menunjukkan
TP
secara benar orang-orang yang benar-
benar sakit TP + FN

• Spesifisitas
Kemampuan tes menunjukkan TN
secara benar orang-orang yang TN + FP
benar-benar tidak sakit
 STANDAR BAKU
DISEASE NO DISEASE JUMLAH
S POSITIVE TRUE FALSE
K POSITIVE POSITIVE
TP + FP
R (TP) (FP)
I
N NEGATIVE FALSE TRUE
I NEGATIVE NEGATIVE
FN + TN
N (FN) (TN)
G
TOTAL
TP + FN FP + TN N
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

• Test Y:
• Tes X :
– 1. TIO > 26
– 1. GLAUCOMA
– 2. Tidak GL. – 2. TIO 22 – 26
– 3. TIO < 22
Lanjutan …..Cutoff points

SENS? SENS?
SPEC? SPEC?

Healthy

Sick

22 26
Intra Occular Pressure
 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 (+) TIDAK RELIABEL
Px 3 (+)
Px 4 (-)

Tes Urine:
Px 1 (-)
RELIABEL TAPI
Px 2 (-) TIDAK VALID
Px 3 (-)
Px 4 (-)
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 Positif
Tes Skrining

Konfirmasi Dx
“SEHAT”
Sakit, Tidak sakit
TRUE FALSE
POSITIVE 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
• ????