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Complex And Simple Appendicitis: REstrictive or Liberal postoperative Antibiotic eXposure (CASA RELAX) using Desirability of Outcome Ranking (DOOR) and Response Adjusted for Duration of Antibiotic Risk (RADAR): study protocol for a randomized controlled trial
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    Comments on "Complex And Simple Appendicitis: REstrictive or Liberal postoperative Antibiotic eXposure (CASA RELAX) using Desirability of Outcome Ranking (DOOR) and Response Adjusted for Duration of Antibiotic Risk (RADAR)"
    • Alireza Sadeghi, General Practitioner Shiraz University of Medical Sciences

    To the editor;
    I have recently studied the article written by Dr. Daniel Dante Yeh et al. published in “Trauma Surgery & Acute Care Open” (1). The study presents a protocol, developed to compare liberal versus restrictive strategies for antibiotic therapy in patients with complicated and uncomplicated appendicitis. Undeniably, the authors have contemplated the study, potential sources of bias, and statistical procedures, which promise brilliant results.
    Intending to improve the methodological quality of this study, I decided to share my humble ideas. The authors have defined exclusion and inclusion criteria precisely, however, other factors may appear as confounders. For example, I believe that it is noteworthy to clear the authors’ decision on enrollment of patients who are allergic to computed tomography (CT) contrast media, renal insufficient, and suspicious of tumors on CT scan. Also, the protocol did not state whether the treating surgeon is part of the core study team.
    Although, it is commonly considered that the randomization design in clinical trials should make groups and results comparable in an unbiased assessment of the outcomes, factors that were formerly recognized in the literature that could be associated with poor response or adherence to the treatment should foretaste in the quantitative analysis of the study; these factors could include basic laboratory findings, patients’ socioeconomic status (2), etc. The definition of the type of...

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    Conflict of Interest:
    None declared.