title: Staged decision making was an attractive alternative to a plenary approach in panel diagnosis as reference standard.
abstract: OBJECTIVE
  To assess differences between three different decision-making approaches in the method of panel diagnosis as reference standard in diagnostic research.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands. Electronic address: L.C.M.Bertens-2@umcutrecht.nl.
authors.forename: Loes C M
authors.initials: LC
authors.lastname: Bertens
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands.
authors.forename: Yvonne
authors.initials: Y
authors.lastname: van Mourik
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands.
authors.forename: Frans H
authors.initials: FH
authors.lastname: Rutten
authors.affiliation: Division of Heart and Lungs, Department of Cardiology, University Medical Center Utrecht, The Netherlands.
authors.forename: Maarten-Jan M
authors.initials: MJ
authors.lastname: Cramer
authors.affiliation: Division of Heart and Lungs, Department of Pulmonology, University Medical Center Utrecht, The Netherlands.
authors.forename: Jan-Willem J
authors.initials: JW
authors.lastname: Lammers
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands.
authors.forename: Arno W
authors.initials: AW
authors.lastname: Hoes
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands.
authors.forename: Johannes B
authors.initials: JB
authors.lastname: Reitsma
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands.
authors.forename: Karel G M
authors.initials: KG
authors.lastname: Moons
mesh_terms: D000368:Aged; D032921:Consensus; D003657:Decision Making; D019937:Diagnostic Techniques and Procedures; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000453:epidemiology; D006801:Humans; D008297:Male; D015995:Prevalence; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000453:epidemiology
keywords: COPD; Diagnosis; Heart failure; Prevalence; Reference standards; Sensitivity and specificity