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Evaluation of a Screening Test.pptx

The document evaluates screening tests, focusing on key metrics such as sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). It explains how these measures assess the accuracy of tests in identifying disease presence or absence, highlighting the importance of disease prevalence on predictive values. Additionally, it discusses the implications of false positives and negatives, as well as the concepts of validity and accuracy in testing.

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saadshakir
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3 views

Evaluation of a Screening Test.pptx

The document evaluates screening tests, focusing on key metrics such as sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). It explains how these measures assess the accuracy of tests in identifying disease presence or absence, highlighting the importance of disease prevalence on predictive values. Additionally, it discusses the implications of false positives and negatives, as well as the concepts of validity and accuracy in testing.

Uploaded by

saadshakir
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
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Evaluation of a

screening test
PRESENTER:Saad Shakir
Roll no :- 130
MODERATOR: Dr.
Sanjay Kambar
Screening test Diseased Non diseased Total
results

Positive true false TP+FP


positive(TP) positive(FP) PPV
*
Negative false true FN+TN NPV
negative(FN) negative(TN)
*
Total TP+FN FP+TN TP+FP+FN+T
N
sensitivity* specificity*
1.(TP) true positive denotes those individuals found positive on the
test who have the condition or the disorder being studied.

2.(FP) false positive include those who have a positive test result but
do not have the disease.

3.(FN) false negative includes those with negative test results but
have the disease.

4.(TN) true negative are those with negative results and not have
any disease.
Measures to evaluate a screening test
• Specificity=TN/(TN+FP)x100
• Sensitivity=TP/(TP+FN)x100
• Predictive value of a
positive
test=TP/(TP+FP)x100
• Predictive value of a
negative
test=TN/(TN+FN)x100
• Percentage of false
negative=FN/(FN+TP)x100
1.Specificity
• Specificity of a test refers to its ability to correctly identify those
who do not have the disease (true negatives).

• A test with high specificity minimizes false positives, meaning it


is good at ruling in a disease when the test result is positive.

• This is why highly specific tests are useful for confirmatory


testing (SpIN: Specificity rules IN disease).
Specificty=TN/(TN+FP)x100
• For example, 90% specificity means 90% of the non diseased
person will give true negative result where as 10% of non disease
will be wrongly classified as diseased.

• Another example, EEG sensitivity is 90% specificity 85% where


as CAT sensitivity is 97.5% specificity 95%.

• Hence CAT test is both more sensitive and more specific than EEG
in the diagnosis of brain tumors.
2.Sensitivity
• It is a statistical index of diagnostic accuracy.

• It is defined as the ability of a test to identify correctly all those


who have the disease that is true positive.

• 90% sensitivity means 90% of the diseased people screened by the


test will give a true positive result and the remaining 10% give a false
negative result.

Sensitivity=TP/(TP+FN)x100
Predictive accuracy
• Productive accuracy reflects the diagnostic power of the test

• The projective accuracy depends on sensitivity, specificity and disease


prevalence.

• The predictive value of a positive test indicates the probability that


a patient with the positive test result has in fact the disease.

• The more prevalent a disease is in a given population the more


accurate will be the predictive value of a positive screening test

• The productive value of a positive result falls as disease


prevalence declines
Positive Predictive Value (PPV)
and Negative Predictive Value
•(NPV)
These are measures of a diagnostic test’s accuracy.

• They indicate how well a test predicts the presence or absence of


a disease.
• Positive Predictive Value (PPV) is the probability that a person who
tests positive actually has the disease. It is calculated as:
PPV = TP/TP+FP

• Example: If a test for a disease has a PPV of 90%, it means that 90% of
those who test positive truly have the disease, while 10% are false positives.

• Influencing Factors: PPV depends on the test’s specificity and the


prevalence of the disease in the population. If a disease is rare, PPV tends to
be low, even if the test is highly accurate
• Negative Predictive Value (NPV) is the probability that a person
who tests negative truly does not have the disease. It is calculated as:
NPV =TN/TN+FN

• Example: If a test has an NPV of 95%, it means that 95% of those


who test negative are truly disease-free, while 5% are false negatives.

• Influencing Factors: NPV is affected by the test’s sensitivity


and disease prevalence. When a disease is rare, NPV is usually
high.
• PPV is important when ruling in a disease, while NPV is
important when ruling out a disease.

• PPV is higher when disease prevalence is high, and NPV is


higher when disease prevalence is low.

• Both values depend on the sensitivity and specificity of the test.


 Example:Predictive value of positive gram stain cervical smear
test for Gonorrhea with constant sensitivity of 50% and specificity
of 90% at 3 levels of prevalence:
• For prevalence of 5% the predictive value was 21%

• For 15% of prevalence the value was 47%

• For 25% of prevalence the value was 63%

• As the sensitivity of the test is only 50% half the cases are not
detected which greatly reduces the impact of detection programme on
disease transmission
False negatives and false
• False negative patients may ignore the signs and symptoms of the
and positives
disease could be detrimental if the disease in question is a serious one
this
and the screening test is unlikely to be repeated again in short time.

• The lower the sensitivity larger will be the number of false


negatives.
• In false positive normal healthy people may be subjected to
diagnostic tests until their freedom from the disease is
further
established.
• A higher specificity test will have fewer false
positives.
• False positives burden the diagnostic facilities and also bring discredit
screening
to programmes
VALIDIT
Y
• Validity refers to how well a test measures what it is intended
to measure.
• A test is valid if it correctly identifies those with and without the
disease. Validity depends on sensitivity (ability to detect true positives)
and specificity (ability to detect true negatives).
• Example: A blood test for diabetes is valid if it correctly
detects diabetic patients (high sensitivity) and correctly
identifies non- diabetics (high specificity).
• If the test gives too many false positives or false negatives, its
validity is low.
ACCURACY
• Definition: Accuracy is the overall correctness of a test. It
measures how often the test gives the correct result (both positive
and negative).Accuracy is calculated as:
Accuracy = {TP + TN}/{TP + TN + FP + FN}

• Example: If a COVID-19 test gives correct results 95 times out of


100 tests, it has 95% accuracy.
• A test can be accurate but not valid (e.g., a thermometer that always
shows normal temperature is accurate but invalid for detecting
fever).

• A test can be valid but not very accurate if it has high sensitivity
or specificity but still has many incorrect results.
Yield and combination of
• Yield is the amount of previously unrecognised disease that is diagnosed as
tests
result
a of screening
effort.
• For example by limiting diabetes screening programme to persons over
years we can increase the yield of the screening
40
test.
• High risk populations are usually selected for screening thus increasing
yield.
• Combination of two or more tests can be combined to enhance specificity
sensitivity
or of screening
test.
• Syphilis is first screened by RPR test which has high sensitivity but
false positive, so people positive with RPR are submitted to FTA ABS
yeilds
which is more specific.
THANK YOU….

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