Desirability of Outcome Ranking (DOOR) and Response Adjusted for Duration of Antibiotic Risk (RADAR).

Journal Article (Journal Article)

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.

Full Text

Duke Authors

Cited Authors

  • Evans, SR; Rubin, D; Follmann, D; Pennello, G; Huskins, WC; Powers, JH; Schoenfeld, D; Chuang-Stein, C; Cosgrove, SE; Fowler, VG; Lautenbach, E; Chambers, HF

Published Date

  • September 1, 2015

Published In

Volume / Issue

  • 61 / 5

Start / End Page

  • 800 - 806

PubMed ID

  • 26113652

Pubmed Central ID

  • PMC4542892

Electronic International Standard Serial Number (EISSN)

  • 1537-6591

Digital Object Identifier (DOI)

  • 10.1093/cid/civ495


  • eng

Conference Location

  • United States