TUGAS

TUTORIAL EPIDEMIOLOGI M1.U3

Screening And Diagnostic Test

INRIZA YULIANDARI
NIM: 20/466123/PKU/18750

PEMINATAN INTERNATIONAL HEALTH

FAKULTAS KEDOKTERAN, KESEHATAN MASYARAKAT, DAN
KEPERAWATAN
UNIVERSITAS GAJAH MADA
YOGYAKARTA
2020
1|I n r i z a Y u l i a n d a r i 2 02 0 / I n t e r n a t i o n a l H e a l t h
 M1.U3
Screening And Diagnostic Test

Activity 1
In a hypothetical study, 1000 patients attending a hospital general outpatient
department were tested for diabetes using the following two tests:
 fasting blood sugar (FBS)
 glucose tolerance test (GTT)

There were 100 patients who had a positive GTT, and they were classified as true cases
of diabetes. There were also 140 patients with an FBS of at least 6 mmol/l (the cut-off
point to distinguish people with diabetes from those who do not have diabetes). Among
these 140 patients, only 98 were true cases of diabetes (i.e. only 98 had a positive GTT
as well).

1. What are the sensitivity, specificity, and positive and negative predictive values
of the FBS test in this study population?

Berdasarkan perhitungan pada hypothetical study tersebut, maka tes FBS

dengan cut-off point 6mmol/l, memiliki sensitivitas 98% dan spesifisitas 95,3%
dengan nilai prediksi positif 70% dan nilai prediksi negatif 99,76%

2|I n r i z a Y u l i a n d a r i 2 02 0 / I n t e r n a t i o n a l H e a l t h
 2. When the cut-off point for the FBS was raised to 7 mmol/l, the sensitivity of the
test decreased to 95% and the specificity increased to 98% in the hypothetical
study population.

Calculate the positive predictive value and false negative error rate of FBS at this
cut-off point.

Berdasarkan perhitungan tersebut, maka tes FBS yang cut-off point

dinaikkan menjadi 7mmol/l, yang memiliki sensitivitas 95% dan spesifisitas 98%
memiliki nilai prediksi positif 84% dan nilai prediksi negatif 99,43%, dengan false
negatif error rate sebesar 5%.

3|I n r i z a Y u l i a n d a r i 2 02 0 / I n t e r n a t i o n a l H e a l t h
 3. The FBS test and GTT were used in a hypothetical community survey to screen
for diabetes. Among 1000 people surveyed, 40 people had a positive GTT for
diabetes and were classified as true cases of diabetes. An FBS cut-off value of 6
mmol/l was used to distinguish between people with and without diabetes; you
can assume that at this cutoff point the FBS had a sensitivity of 98% and
specificity of 95%.

What are the positive predictive value and false negative error rate of FBS in this
survey?

Berdasarkan perhitungan tersebut, maka tes FBS pada hypothetical

community survey dengan cut-off point 6mmol/l, yang memiliki sensitivitas 98%
dan spesifisitas 95% memiliki nilai prediksi positif 44,8% dan nilai prediksi negatif
99,8%, dengan false negatif error rate sebesar 2,5%.

4|I n r i z a Y u l i a n d a r i 2 02 0 / I n t e r n a t i o n a l H e a l t h
 4. Why is the positive predictive value different from that observed in the
hypothetical hospital-based study?

Nilai prediksi positif antara hypothetical community survey dan hypothetical

study mengalami perbedaan karena masing-masing total pasien pada GTT+ dan
GTT- juga berbeda, meskipun nilai cut-off, sensitivitas, dan spesifisitasnya sama.

Assume that if the cut-off point of FBS is increased to 7.5 mmol/l, the sensitivity
is 90% and the specificity is 99% for diagnosing diabetes.

5. What are the positive predictive value and the false negative error rate of FBS if
the cut-off point of 7.5 mmol/l is used to screen for diabetes in this community?

Berdasarkan perhitungan tersebut, maka tes FBS dengan cut-off point

7,5mmol/l, yang memiliki sensitivitas 90% dan spesifisitas 99% memiliki nilai
prediksi positif 78,2% dan nilai prediksi negatif 99,5%, dengan false negatif error
rate sebesar 10%.

5|I n r i z a Y u l i a n d a r i 2 02 0 / I n t e r n a t i o n a l H e a l t h
 6. If you were asked to fix the cut-off point of FBS for a survey of your community
would you select 6 mmol/l or 7 mmol/l? Give reasons for your answer.

Berdasarkan perhitungan tersebut, cut-off point 7mmol/l memiliki nilai prediksi

positif yang paling tinggi yaitu 84%, sehingga program skrining dapat dilakukan secara
lebih produktif dan efisien (dengan memperhatikan populasi dengan prevalensi
penyakit yang sama). Tetapi, kita tidak bisa menentukan secara langsung berdasarkan
perhitungan tersebut, karena adanya perbedaan nilai sensitivitas dan spesifisitas pada
kedua cut-off point.

6|I n r i z a Y u l i a n d a r i 2 02 0 / I n t e r n a t i o n a l H e a l t h
 Activity 2
A physical examination was used to screen for breast cancer in 2500 women with biopsy
proven adenocarcinoma of the breast and in 5000 age and race matched control women.
The results of the physical examination were positive (mass was palpated) in 1800 cases
and 800 control women.

Calculate the sensitivity, specificity and positive predictive value of the physical
examination.

Berdasarkan perhitungan tersebut, maka didapat nilai sensitivitas 72% dan

spesifisitas 84% , dengan nilai prediksi positif 69,2%.

7|I n r i z a Y u l i a n d a r i 2 02 0 / I n t e r n a t i o n a l H e a l t h
 Activity 3
A study was carried out in Hospital X to investigate the reliability of nutrition screening
tool. Two Dietisien were asked to determine the risk of malnutrition among 100 patients
pre-surgery in Hospital X by using Nutritional Risk Screening 2002 (NRS). The
classification is divided into risk and not risk. The comparison of their classification is
shown in following table:

Classification of malnutrition risk by NRS 2002

Dietisien 2
Dietisien 1 Risk Not Risk Total
Risk 40 20 60
(a) (b)
Not Risk 10 30 40
(c) (d)
Total 50 50 100

1. The simple, overall percent agreement between two dietisien out of the total is…

Berdasarkan perhitungan tersebut, percent agreement antara kedua dietisien

tersebut bernilai 0,7.

2. The overall percent agreement between the two dietitian, removing the result of
NRS 2002 that both dietisien classified as not risk is

Berdasarkan perhitungan tersebut, dengan menghilangkan kelompok dietisien

yang sama-sama tidak berisiko, maka percent agreement antara kedua dietisien
tersebut bernilai 0,571.

8|I n r i z a Y u l i a n d a r i 2 02 0 / I n t e r n a t i o n a l H e a l t h
 3. The value kappa is:

Berdasarkan perhitungan tersebut, nilai kappa adalah 0,4.

4. This kappa represents which kind agreement? ( excellent or intermediate to good or

poor)

Berdasarkan perhitungan tersebut, nilai kappa adalah 0,4. Karena nilai 0,4
berada dalam rentang 0,4 - 0,75 , maka agreement tersebut termasuk dalam
intermediate to good agreement.

9|I n r i z a Y u l i a n d a r i 2 02 0 / I n t e r n a t i o n a l H e a l t h