Journal of the Formosan Medical Association
Volume 109, Issue 3 , Pages 209-218, March 2010

Selecting a Cutoff Point for a Developmental Screening Test Based on Overall Diagnostic Indices and Total Expected Utilities of Professional Preferences

  • Hua-Fang Liao

      Affiliations

    • School and Graduate Institute of Physical Therapy, National Taiwan University, Taipei, Taiwan
    • Physical Therapy Center, Department of Rehabilitation Medicine, National Taiwan University Hospital, Taipei, Taiwan
    • ,
  • Ling-Yee Cheng

      Affiliations

    • Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, Taiwan
    • ,
  • Wu-Shiun Hsieh

      Affiliations

    • Departments of Pediatrics, College of Medicine, National Taiwan University, Taipei, Taiwan
    • ,
  • Ming-Chin Yang

      Affiliations

    • Graduate Institute of Health Care Organization Administration, College of Public Health, National Taiwan University, Taipei, Taiwan
    • Corresponding Author InformationCorrespondence to: Dr Ming-Chin Yang, Room 637, 17 Xuzhou Road, Taipei, Taiwan

Received 12 January 2009; received in revised form 18 June 2009; accepted 1 July 2009.

Background/Purpose

A cutoff point in a test with sounded validity and professional preferences can help to make an accurate clinical decision. This study aimed to determine a cutoff point between two strategies for a developmental screening checklist (referred to as Taipei II). Cutoff point A was set as one or more item failed and cutoff point B was set as two or more items failed or one or more marked item failed.

Methods

This study was based on the total expected utilities of professional preferences and overall diagnostic indices. A self-administered questionnaire was developed to collect the estimated utility from professionals involved in early childhood interventions (n = 81) regarding four screening outcomes (probabilities of true positive, false positive, true negative, or false negative) and costs. The total expected utilities were calculated from the probabilities of four screening outcomes and utility values.

Results

The diagnostic odds ratio was higher for strategy B (695 and 209, respectively) than that of strategy A (184 and 150, respectively) when using the Taipei II on children under 3 years of age and age 3 and over. Strategy B also had a higher median total expected utilities score than strategy A (0.78 vs. 0.72 for children < 3 and 0.76 vs. 0.67 for children ≥ 3).

Conclusion

If only one cutoff point can be chosen, the authors suggest that clinicians should choose cutoff point B when using the Taipei II for screening. However, two cutoff points of Taipei II, a combination of strategy A and B, can also be used clinically.

Key Words:  child , developmental delay disorders , screening , Utility theory

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PII: S0929-6646(10)60044-7

doi:10.1016/S0929-6646(10)60044-7

Journal of the Formosan Medical Association
Volume 109, Issue 3 , Pages 209-218, March 2010

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