Screening Test

and
Validity of a Screening Test

Rahim Jandani
Lecture ION
Acknowledged Muhammad Yaqoob
Institute of Nursing,
Dow University of Health Sciences
May 20, 2020

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Screening

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Validity of a Screening Test

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Screening test
 A key component of many secondary
preventions, involves the testing of groups of
individuals who are at risk for certain
conditions but are as yet asymptomatic
 The purpose is to classify these individuals
with respect to the likelihood of having the
disease

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Aims of Screening
Clinical Perspective
 Early detection and treatment

Public Health Perspective

 To sort out efficiently and effectively those
who probably have the disease from those
who probably do not have

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Characteristics of A Successful
Screening Program
Valid (Accurate)
 A high probability of correct classification of person tested

Reliable (precise)
 Results consistent from place to place, time to time, and person
to person

Capable of large group administration

 Fast in both the administration of the test and the obtaining of
results
 Inexpensive in both personnel required and in the materials and
procedures used

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Characteristics of A Successful
Screening Program
Innocuous
 Few if any side effects, and the test minimally
invasive
High yield
 Able to detect enough new cases to warrant
the effort and expense (yield defined as the
amount of previously unrecognized disease
that is diagnosed and treated as a result of
screening)

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 Validity
 Sensitivity, specificity, and
predictive value quantify Gold Standard
validity of a screening test
 Results from a screening
D+ D− Total
test are compared to those
from a “gold standard” Test
 Classify each observation: TP+FP
T+ TP (a) FP (b)
 TP = true positives (a+b)
 TN = true negatives FN+TN
T− FN (c) TN (d)
 FP = false positives (c+d)
 FN = false negatives

Total TP+FN FP+TN N

(diseased) (non-diseased) (a+b+c+d)

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Definitions
Sensitivity
 Probability that a truly diseased person will be test positive
(a/a+c) (*0.99 or 99%)

Specificity
 Probability that a truly healthy (non- diseased) person will be
test negative (d/ d+b) (*0.99 or 99%)

Apparent prevalence
 Percentage of test positive persons out of total population tested
(a+b/a+b+c+d)

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Definitions
True prevalence
 Percentage of the truly diseased persons from the total
population tested (a+c/a+b+c+d)

Positive predicted value

 Percentage of persons that are test positive and truly are
diseased (a/a+b)

Negative predicted value

 Percentage of persons that are test negative and are truly not
diseased (d/c+d)

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 Example:
Conditions: N = 1,000,000; Prevalence = .001
D+ D− Total
T+
T−
Total 1000 1,000,000

True prevalence = 1000

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Example:
Number of non-cases,

D+ D− Total
T+
T−
Total 1000 999,000 1,000,000

Number of non-cases
= 999,000

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 Example:
Suppose test Sensitivity = .99
i.e., it will pick up 99% of the cases
D+ D− Total
T+ 990
T−
Total 1000

TP = 990

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Example:
It follows that:
D+ D− Total
T+ 990
T− 10
Total 1000

False Negatives

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 Example:
Suppose test Specificity = .99
i.e., it will correctly identify 99% of the noncases
D+ D− Total
T+
T− 989,010
Total 999,000

TN = 989,010

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Example:
It follows that:

D+ D− Total
T+ 9,990
T− 989,010
Total 999,000

False Positives

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 Example:
It follows that the Positive predicted value is :
D+ D− Total
T+ 990 9,990 10,980
T− 10 989,010 989,020
Total 1000 999,000 1,000,000

PPV = TP / (TP + FP) = 990 / 10,980 = 0.090

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 Example:
It follows that the Negative Predictive Value is:

D+ D− Total
T+ 990 9,990 10,980
T− 10 989,010 989,020
Total 1000 999,000 1,000,000

NPV= TN / (TN + FP) = 989010 / 999000 = 0.99

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 Reference
Hitchcock. J & Schubert. P(2003). Community Health
Nursing: Caring in Action.(2nd ed.) Delmar

Stanhope. M & Lancaster. J (2004). Community and

Public Health Nursing(6th Ed). Mosby

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