Desirability of Outcome Ranking (DOOR)

Desirability of Outcome Ranking (DOOR)1 and partial credit2 are novel methods for analysis of clinical trials. Patients are classified according to overall clinical outcome, taking into account benefits and harms using ordinal categories. The number and definition of levels is tailored to clinical disease. The benefits of using an ordinal ranking method is that it yields a more informative and pragmatic benefit:risk evaluation and aims to evaluate if new strategies are truly BETTER in the global sense than the standard strategies by considering the interventions in their totality.

Via a survey of expert Infectious Diseases clinicians, the DOOR method was used to develop a global patient outcome for Staphylococcus aureus bloodstream infections (SA-BSI). When comparing SA-BSI outcomes, clinicians place value not only on cure, but also on AEs, infectious complications, and symptom resolution. A poster (ID Week 2016 DOTS survey poster_10_14) and accompanying document containing proposed case studies (DOTS Case Studies) are located via their respective links. This ordinal outcome can be used for future trials comparing treatment strategies for SA-BSI, with the goal of improved differentiation between management approaches. This exercise demonstrates the process for translating benefits and risks into a syndrome-specific DOOR algorithm; this process can be repeated for other clinical syndromes.


  1. Evans SR, Rubin D, FollmannD et al. Desirability of Outcome Ranking (DOOR) and Response Adjusted for Duration of Antibiotic Risk (RADAR). ClinInfect Dis 2015;61:800-6.
  2. Evans SR, FollmannD. Using Outcomes to Analyze Patients Rather than Patients to Analyze Outcomes: A Step toward Pragmatism in Benefit:riskEvaluation. Statistics in Biopharmaceutical Research. 2016.