title: Maximally efficient two-stage screening: Determining intellectual disability in Taiwanese military conscripts.
abstract: OBJECTIVE
  The purpose of this study was to apply a two-stage screening method for the large-scale intelligence screening of military conscripts.
  
  
  METHODS
  We collected 99 conscripted soldiers whose educational levels were senior high school level or lower to be the participants. Every participant was required to take the Wisconsin Card Sorting Test (WCST) and the Wechsler Adult Intelligence Scale-Revised (WAIS-R) assessments.
  
  
  RESULTS
  Logistic regression analysis showed the conceptual level responses (CLR) index of the WCST was the most significant index for determining intellectual disability (ID; FIQ ≤ 84). We used the receiver operating characteristic curve to determine the optimum cut-off point of CLR. The optimum one cut-off point of CLR was 66; the two cut-off points were 49 and 66. Comparing the two-stage window screening with the two-stage positive screening, the area under the curve and the positive predictive value increased. Moreover, the cost of the two-stage window screening decreased by 59%.
  
  
  CONCLUSIONS
  The two-stage window screening is more accurate and economical than the two-stage positive screening. Our results provide an example for the use of two-stage screening and the possibility of the WCST to replace WAIS-R in large-scale screenings for ID in the future.
authors.affiliation: Department of Psychiatry, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan;
authors.forename: Chia-Chang
authors.initials: CC
authors.lastname: Chien
authors.forename: Shu-Fen
authors.initials: SF
authors.lastname: Huang
authors.forename: For-Wey
authors.initials: FW
authors.lastname: Lung