We used decision curve analysis (DCA) to inform this question. Sepsis survivors and clinicians decide together on follow-up care, based on patients’ risk and benefit preferences. Clinicians can either provide follow-up care to all sepsis survivors (treat-all) or provide no follow-up care (treat-none) or use the prognostic information assessed with DCA to intervene selectively using the SSIP score.
Importantly, as DCA does not mandate information on the costs or effectiveness of treatment or how patients value different health states, our analysis highlights that is possible to intervene selectively in sepsis survivors, using a systematic risk-based approach.
The SSIP score has 4 strata of risk
|Score||Risk of rehospitalisation or death within one year|
|Strata 1||0 – 4 points||30.5%|
|Strata 2||5 - 6 points||41.5%|
|Strata 3||7 - 10 points||53.8%|
|Strata 4||≥11 points||70.4%|
DCA is underpinned by two concepts, namely threshold probability and net benefit. Threshold probability of outcome refers to the empirical value above which a clinician would choose to treat, or a sepsis survivor would choose to receive treatment. In other words, the sepsis survivors make a conscious decision that benefit of their empiric treatment outweighs the harms associated with the treatment. The net benefit is the difference between the expected benefit and the expected harm. The expected benefit here is that sepsis survivors who will get ≥ 1 rehospitalizations or death within one-year choose to receive treatment (true positives). The expected harm is that sepsis survivors who will not experience this outcome choose to receive treatment (false positive) multiplied by those sepsis survivors’ threshold probabilities.