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SCREENING
Agustiana Dwi I V, SKM., M.Biomed
 Objectives
❖Discuss principles of screening
❖Describe elements of screening tests
❖Calculate sensitivity ,specificity, Positive
predictive value, negative predictive value

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 Screening
❖“the presumptive identification of
unrecognised disease or defect by the
application of tests, examinations or other
procedures that can be applied rapidly.”
[United States Commission on Chronic
Illness (1957)]
Diagnostic Screening
 Diagnosis  screening
❖Screening >> those who do not suspect
that they may have a disease
❖Screening test can also used as
diagnostic test
❖Diagnostic >> confirmation of precence or
absence of a disease
 Screening test

Questio
ns

Laborato Examina
ry test screening tion

X-rays
 Purpose of screening
❖Identifying person at increased risk for the
precence of the disease

❖To reduce mortality and morbidity with

early detection
 Kinds of screening
❖ Mass screening -> all population

❖ Selectif scrining:->spesific popuation groups

❖ Single disease screening-> spesific disease

❖ Multiphase scrining -> some disease in individual

Criteria for population based
screening

Feasibillity of Cost
Knowledge Diagnosis
of disease
screening
and treatment consideratio
procedures n
 Knowledge of the disease
❖The condition must be important problem
❖There should be early symptomatic stage
❖The natural history of the condition should
be understood
Feasibillity of screening procedures
❖Should be suitable test for or examination
❖The test should be acceptable for the
population
 Diagnosis and treatment
❖For patient with recognized disease >>
should be accepted treatment
❖Facilities for diagnosis and treatment
should be available
 Cost consideration
❖The cost of case finding should be
economically balanced to medical
expenditure
 The Screening Test
❖Ideally should be inexpensive, easy to
administer (low risk) and with minimal
discomfort
❖There should be a Gold Standard based
on the evidence
❖Results should be accurate/valid and
reliable/reproducible/precise

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ACCURACY OF SCREENING
TEST
 Accurate/Valid
❖Defined as:
▪ The degree to which a variable actually
represents what it is supposed to represent.
❖Best way to assess
▪ Compare with a reference
❖Threatened by systematic error (bias)
▪ Due to observer, subject and/or instrument

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 Reliable/Precise
❖Defined as
▪ The degree to which a variable has nearly the
same value when measured several times
❖Best way to assess
▪ Repeated measures
❖Threatened by random error
▪ Due to observer, subject and/or instrument

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 The fraction of those
Sensitivity with the disease
correctly identified as
positive by the test.

The fraction of those

Specificity without the disease
correctly identified as
negative by the test.

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Positive The fraction of people
predictive with positive tests
value who actually have
(+ PV) the condition.

Negative The fraction of people

predictive with negative tests
value who actually don't have
(-PV) the condition.

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 Patient with Patient
the disease without the
disease
Test is A B
positive
True Positive False Positive
Test is C D
negative
False True Negative
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Negative 20
 calculation

❖Sensitivity = a / (a+c)

❖Specificity = d / (b+d)

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❖P PV = a/(a+b)

❖NPV = d/(c+d)
❖Terdapat 34 orang mengikuti skrining
anemia dengan laboratory rapid test untuk
kadar Hb terdapat 25 orang mengalami
gejala klinis anemia dengan 15 penderita
mendapatkan tes positif. Terdapat 9 orang
yang tidak mengalami gejala penyakit,1 di
antaranya mendapat hasil positif. Hitung
sensitivitas,spesitifitas,PPV dan NPV !
Diketahui:

N = 34 Mengalami gejala klinis = 25

15 orang negatif
positi : 25 - 15 = 10

Tidak Mengalami gejala klinis = 9

1 Orang mendapat tes positif
Tes Negatif = 9 -1 = 8
Ditanya
Sensitivitas. Spesifisitas. PPV dan NPV
❖Dilakukan skrining untuk Diabetes
Mellitus dan didapatkan data bahwa
sensitivitas 0,6 dengan jumlah penderita
yang mendapatkan hasil tes positif 6
orang Berapa penderita yang
mendapatkan tes negatif ?
❖Kegiatan Skrining untuk mengidentifikasi
Diabetes Mellitus didapatkan keterangan :
❖Populasi = 10000
❖Prevalensi DM= 5 %
❖Sensitivitas = 70 %
❖Spesifisitas = 80 %
❖Berapakah PPV, NPV, dan jumlah hasil
tes positif dari penderita?
❖PPV = 350 / 2250 = 15,56 %
❖NPV = 7600 / 7750 = 98,06%
❖ Infectivity - the ability of disease agents to cause infection.
Calculated from

Calculated from : the number of infected individuals divided by

the number of individuals exposed.

❖ Pathogenesity - the ability of disease agents to cause clinical

disease. Calculated from

Calculated from : the number of clinical cases divided by the

number of infected individuals.
❖Virulence - the ability of disease to cause death.
This indicator showsthe ability of an infectious
agent causes severety of the disease.

Calculated from the sum of dead cases

divided by the number of clinical cases
❖ Selama pandemic covid 19 Jumlah ODP (Orang Dalam Pengawasan) sebanyak 500
orang. Pada tes laboratorium, dari 500 orang tersebut, terdapat 300 orang positif
terinfekfsi virus sars-cov 2 (penyebab COVID-19). Sebanyak 300 orang yang
positif tersebut 175 diantaranya berstatus PDP selama isolasi mandiri sehingga
harus menjalani perawatan . Sebanyak 120 dari PDP, meninggal dunia pada kasus
tersebut. Hitunglah : Infektivitas, patogenitas dan virulensi dari sars-cov 2 (agen
dari COVID 19) !;

❖ Infectivitas = 300/ 500 = 60%

❖ patogenitas = 175 / 300 = 58.3 %
❖ Virulensi = 120 / 175 = 68.57%