We also performed a decision curve analysis.27 Briefly, assessment of the adequacy of clinical prediction models can be extended by determining clinical utility. By using decision curve analysis, we can make a clinical judgment about the relative value of benefits (treating a true positive) and harms (treating a false positive) associated with a clinical prediction tool. The standardised net benefit was plotted against the threshold probability for considering a patient high risk for age alone and for the best discriminating models applicable to more than 50% of patients in the validation cohort.