Staged decision making was an attractive alternative to a plenary approach in panel diagnosis as reference standard.

OBJECTIVES To assess differences between three different decision-making approaches in the method of panel diagnosis as reference standard in diagnostic research. STUDY DESIGN AND SETTING Within a diagnostic study, the prevalence of heart failure (HF) and chronic obstructive pulmonary disease (COPD) was compared using three approaches of decision making in panel diagnosis. These were (1) a plenary discussion among experts followed by a consensus decision (plenary); (2) a predefined decision rule based on final diagnoses made by each member individually (individual); and (3) a staged procedure in which first the final diagnosis per individual member is generated followed by a plenary discussion of those cases with disagreement (staged). RESULTS Prevalence of HF and COPD according to plenary approach was 46% and 28%, respectively. Individual approach diagnosed 28% of patients with HF and 31% with COPD and revealed 28 and 8 discordant diagnoses, respectively, compared with plenary approach. Staged approach revealed a prevalence of 43% and 28% for HF and COPD, respectively, with eight discordant diagnoses for HF and none for COPD. CONCLUSION The staged approach is an attractive choice as it produces very similar results to the full plenary approach, while having the advantage of being less time consuming. Additionally, it provides insights into the decision-making process of the panel, and the "difficult-to-diagnose" patients can easily be identified.