Breaking down the Desirability of Outcome Ranking (DOOR): unpacking the methodology behind the Dalbavancin as an Option for Treatment of Staphylococcus aureus Bacteraemia (DOTS) trial

<h2>Abstract</h2> Desirability of Outcome Ranking (DOOR) outcomes such as the primary outcome of the DOTS (Dalbavancin as an Option for Treatment of <i>Staphylococcus aureus</i> Bacteremia) trial can improve statistical efficiency (requiring smaller sample sizes) compared to binary outcomes, and potentially improve clinical decision making by integrating treatment effects on all relevant clinical outcomes. However, standardised outcome components may not accurately capture the true hypothesised treatment effect, and bespoke DOOR outcomes may not be generalisable. Investigators should carefully consider different DOOR components when selecting trial outcomes and when performing sample size calculations.