Paeds Cases · professional-practice-and-evidence
Counselling a positive newborn screen — OSCE
OSCE on translating a positive newborn screen into a positive predictive value and a confirmatory plan with a family.
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Target exams
MRCPCH ClinicalRACP DCERCPSC Pediatrics
Prompt
Parents of a well 10-day-old baby have been told by phone that the newborn bloodspot screen for a rare metabolic condition is positive; the test has a sensitivity of 99 percent and a specificity of 99 percent, and the condition affects 1 in 10,000 babies; they are frightened and asking whether their baby is sick.
Station brief (8–10 minutes)
The parents have received a phone call telling them their baby's newborn screen is positive for a rare metabolic condition. Help them understand what the result actually means, using the positive predictive value, and agree a plan for confirmation. Address their fear honestly, explain why a positive screen is not a diagnosis, and avoid conveying a diagnosis before the reference-standard test. Do not invent jurisdiction-specific programme thresholds or a specific survival statistic. [4]
References5ShowHide
- [1]Griner PF, Mayewski RJ, Mushlin AI, Greenland P Selection and interpretation of diagnostic tests and procedures. Principles and applications. Annals of internal medicine, 1981.PMID 6452080
- [4]Akobeng AK Understanding diagnostic tests 1: sensitivity, specificity and predictive values. Acta paediatrica, 2007.PMID 17407452
- [5]Akobeng AK Understanding diagnostic tests 2: likelihood ratios, pre- and post-test probabilities and their use in clinical practice. Acta paediatrica, 2007.PMID 17306009
- [9]Whiting PF, Rutjes AW, Westwood ME, et al. QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Annals of internal medicine, 2011.PMID 22007046
- [13]Esserman LJ, Thompson IM, Reid B, et al. Addressing overdiagnosis and overtreatment in cancer: a prescription for change. Lancet oncology, 2014.PMID 24807866