Desirability of outcome ranking (DOOR) and response adjusted for duration of antibiotic risk (RADAR)

Scott R. Evans; Daniel Rubin; Dean Follmann; Gene Pennello; W. Charles Huskins; John H. Powers; David Schoenfeld; Christy Chuang-Stein; Sara E. Cosgrove; Vance G. Fowler; Ebbing Lautenbach; Henry F. Chambers

doi:10.1093/cid/civ495

Desirability of outcome ranking (DOOR) and response adjusted for duration of antibiotic risk (RADAR)

Scott R. Evans, Daniel Rubin, Dean Follmann, Gene Pennello, W. Charles Huskins, John H. Powers, David Schoenfeld, Christy Chuang-Stein, Sara E. Cosgrove, Vance G. Fowler, Ebbing Lautenbach, Henry F. Chambers

Pediatric and Adolescent Medicine

Research output: Contribution to journal › Article › peer-review

92 Scopus citations

Abstract

Clinical trials that compare strategies to optimize antibiotic use are of critical importance but are limited by competing risks that distort outcome interpretation, complexities of noninferiority trials, large sample sizes, and inadequate evaluation of benefits and harms at the patient level. The Antibacterial Resistance Leadership Group strives to overcome these challenges through innovative trial design. Response adjusted for duration of antibiotic risk (RADAR) is a novel methodology utilizing a superiority design and a 2-step process: (1) categorizing patients into an overall clinical outcome (based on benefits and harms), and (2) ranking patients with respect to a desirability of outcome ranking (DOOR). DOORs are constructed by assigning higher ranks to patients with (1) better overall clinical outcomes and (2) shorter durations of antibiotic use for similar overall clinical outcomes. DOOR distributions are compared between antibiotic use strategies. The probability that a randomly selected patient will have a better DOOR if assigned to the new strategy is estimated. DOOR/RADAR represents a new paradigm in assessing the risks and benefits of new strategies to optimize antibiotic use.

Original language	English (US)
Pages (from-to)	800-806
Number of pages	7
Journal	Clinical Infectious Diseases
Volume	61
Issue number	5
DOIs	https://doi.org/10.1093/cid/civ495
State	Published - Sep 1 2015

Keywords

Antibiotic use strategies
DOOR
RADAR

ASJC Scopus subject areas

Microbiology (medical)
Infectious Diseases

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10.1093/cid/civ495

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Evans, S. R., Rubin, D., Follmann, D., Pennello, G., Huskins, W. C., Powers, J. H., Schoenfeld, D., Chuang-Stein, C., Cosgrove, S. E., Fowler, V. G., Lautenbach, E., & Chambers, H. F. (2015). Desirability of outcome ranking (DOOR) and response adjusted for duration of antibiotic risk (RADAR). Clinical Infectious Diseases, 61(5), 800-806. https://doi.org/10.1093/cid/civ495

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Desirability of outcome ranking (DOOR) and response adjusted for duration of antibiotic risk (RADAR)

Abstract

Keywords

ASJC Scopus subject areas

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