Objective: To assess the effectiveness of Quad test in the detection of fetal Down syndrome (DS) in routine practice among a large-scale population and, also, to compare the effectiveness of Quad test based on the Western reference model (WM) with ethnic correction and that based on Thai reference model (TM)Methods: Quad test was performed on 42,769 singleton pregnancies at 14 to 21 weeks of gestation, as a national policy with free-of-charge. The fetal risk of DS derived from Quad test was automatically computed based on WM and used in evaluating the effectiveness. Also, the fetal risk was calculated based on the TM.Results: Of 39,740 screened women with complete follow-ups, 74 fetuses were affected by DS. With WM, the detection and false positive rates were 81.1% and 7.2%, respectively, whereas the detection and false positive rates with TM were 87.8%, and 6.8%, respectively. According to the ROC curves, the performance of Quad test based on TM was slightly but significantly better than that based on WM (AUC of 0.959 vs 0.940, p=0.001).Conclusion: Quad test is highly effective in-service settings and suitable for developing countries and the effectiveness is even higher when based on ethnicity-specific reference model.

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Objective: To assess the effectiveness of Quad test in the detection of Down syndrome (DS) in routine practice among a large-scale population and to compare the effectiveness of Quad test based on the Western reference model (WM) and that based on Thai reference model (TM).Methods: Quad test was performed on 42,769 pregnancies at 14–21 weeks. The fetal risk of DS derived from Quad test was automatically computed based on WM and used in evaluating the effectiveness. Also, the fetal risk was calculated based on the TM.Results: Of 39,740 women with complete follow-ups including 74 fetuses with DS, with WM, the detection and false positive rates were 81.1% and 7.2%, respectively, whereas the detection and false positive rates with TM were 87.8%, and 6.8%, respectively. According to ROC curves, the performance of Quad test based on TM was slightly but significantly better than that based on WM (AUC of 0.959 vs. 0.940, p = 0.001).Conclusion: Quad test is highly effective in service settings and suitable for developing countries and the effectiveness is even higher when based on ethnicity-specific reference model.