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Good Studies Evaluate the Disease While Great Studies Evaluate the Patient: Development and Application of a Desirability of Outcome Ranking Endpoint for Staphylococcus aureus Bloodstream Infection.

Publication ,  Journal Article
Doernberg, SB; Tran, TTT; Tong, SYC; Paul, M; Yahav, D; Davis, JS; Leibovici, L; Boucher, HW; Corey, GR; Cosgrove, SE; Chambers, HF; Evans, SR ...
Published in: Clin Infect Dis
May 2, 2019

BACKGROUND: Desirability of outcome ranking (DOOR) is an innovative approach in clinical trials to evaluate the global benefits and risks of an intervention. We developed and validated a DOOR endpoint for Staphylococcus aureus bloodstream infection (BSI) through a survey to infectious diseases clinicians and secondary analysis of trial data. METHODS: We administered a survey of 20 cases of S. aureus BSI, asking respondents to rank outcomes by global desirability. Correlations and percentage of pairwise agreement among rankings were estimated to inform development of a DOOR endpoint, which was applied to 2 prior S. aureus BSI trials. The probability that a patient randomly assigned to experimental treatment would have a better DOOR ranking than if assigned to control was estimated. Results were also analyzed using partial credit, which is analogous to scoring an academic test, assigning 100% to the most desirable outcome, 0% to the least, and "partial credit" to intermediate ranks. RESULTS: Forty-two recipients (97%) completed the survey. The DOOR endpoint fitting these rankings (r = 0.89; 95% confidence interval, 0.67 to 0.94) incorporated survival plus cumulative occurrence of adverse events, cure, infectious complications, and ongoing symptoms. Tailored versions of this endpoint were applied to 2 S. aureus BSI trials, and both demonstrated no benefit of the experimental treatment using DOOR and partial credit analysis. CONCLUSIONS: Using S. aureus BSI as an exemplar, we developed a DOOR endpoint that can be used as a template for development of DOOR endpoints for other diseases. Future trials can incorporate DOOR to allow for global assessment of patient experience.

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Published In

Clin Infect Dis

DOI

EISSN

1537-6591

Publication Date

May 2, 2019

Volume

68

Issue

10

Start / End Page

1691 / 1698

Location

United States

Related Subject Headings

  • Survival Analysis
  • Surveys and Questionnaires
  • Staphylococcus aureus
  • Staphylococcal Infections
  • Risk Factors
  • Randomized Controlled Trials as Topic
  • Multicenter Studies as Topic
  • Microbiology
  • Methicillin-Resistant Staphylococcus aureus
  • Humans
 

Citation

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Doernberg, S. B., Tran, T. T. T., Tong, S. Y. C., Paul, M., Yahav, D., Davis, J. S., … Antibacterial Resistance Leadership Group, . (2019). Good Studies Evaluate the Disease While Great Studies Evaluate the Patient: Development and Application of a Desirability of Outcome Ranking Endpoint for Staphylococcus aureus Bloodstream Infection. Clin Infect Dis, 68(10), 1691–1698. https://doi.org/10.1093/cid/ciy766
Doernberg, Sarah B., Thuy Tien Tram Tran, Steven Y. C. Tong, Mical Paul, Dafna Yahav, Joshua S. Davis, Leonard Leibovici, et al. “Good Studies Evaluate the Disease While Great Studies Evaluate the Patient: Development and Application of a Desirability of Outcome Ranking Endpoint for Staphylococcus aureus Bloodstream Infection.Clin Infect Dis 68, no. 10 (May 2, 2019): 1691–98. https://doi.org/10.1093/cid/ciy766.
Doernberg SB, Tran TTT, Tong SYC, Paul M, Yahav D, Davis JS, Leibovici L, Boucher HW, Corey GR, Cosgrove SE, Chambers HF, Fowler VG, Evans SR, Holland TL, Antibacterial Resistance Leadership Group. Good Studies Evaluate the Disease While Great Studies Evaluate the Patient: Development and Application of a Desirability of Outcome Ranking Endpoint for Staphylococcus aureus Bloodstream Infection. Clin Infect Dis. 2019 May 2;68(10):1691–1698.
Journal cover image

Published In

Clin Infect Dis

DOI

EISSN

1537-6591

Publication Date

May 2, 2019

Volume

68

Issue

10

Start / End Page

1691 / 1698

Location

United States

Related Subject Headings

  • Survival Analysis
  • Surveys and Questionnaires
  • Staphylococcus aureus
  • Staphylococcal Infections
  • Risk Factors
  • Randomized Controlled Trials as Topic
  • Multicenter Studies as Topic
  • Microbiology
  • Methicillin-Resistant Staphylococcus aureus
  • Humans