arXiv AI

Standalone LLM and a Pre-specified Agentic Pipeline for Explaining ICU Mortality Predictions: a Feasibility Study on the eICU Demo Dataset

The study evaluates a standalone large language model (LLM) versus a four‑step agentic pipeline for generating explanations of ICU mortality predictions on the eICU Demo dataset. XGBoost achieved an AUROC of 0.855 and an AUPRC of 0.332. In a 38‑case explanation subset, the standalone LLM produced one explanation with outcome leakage, while the agentic pipeline produced none; among 14 overlapping SHAP cases, the standalone LLM had higher SHAP alignment and direction consistency, whereas the agentic pipeline showed better guideline grounding, value specificity, and plausibility.

arXiv AI
Aug 3

Reasoning in Real World Clinical Care: Why Large Language Models Are Not Yet Safe for Autonomous Clinical Decision Support

arXiv:2607. 28677v1 Announce Type: new Abstract: LLM now pass medical licensing examinations and, in curated cases, can rival physicians at diagnostic reasoning.

By Shayndhan Sivanathan, Shravan Nageswaran, Mehdi Zadem, Ryaan Sultan, Nicolas von Mallinckrodt, Max Solovyev, Alexey Matyushkin, Sumon Sadhu, Gabriele C DeLuca, Sanjeeva Jeyaretna, James Hillis, Manoj Ramachandran, Prakash Jayakumar
arXiv AI
Aug 19

Institution-Specific LLM Prompting Recovers PHI That De-identification Systems and Their Gold Standards Both Miss

The study evaluates whether large language models (LLMs) with in‑context learning can better identify institution‑specific protected health information (PHI) in electronic health records than existing de‑identification systems. Using 100 pediatric oncology notes from Texas Children’s Hospital, eight LLMs were compared to two purpose‑built systems and pattern‑based baselines under three progressively specific prompts. The best LLM achieved an F1 score of 0.918, recovering 79% of previously missed PHI categories and reaching a recall of 0.981 after iterative prompt refinement, demonstrating that calibrated single‑pass prompting can close the institutional PHI gap while balancing precision and recall.

By Daniel Palacios, Matthew Brady Neeley, Angel Adetomike Otto, Shalini Dhamodharan, John P. Woodhouse, Chi-fan Lin, Mark Zobeck, Zhandong Liu, Hyun-Hwan Jeong
arXiv Computation and Language
Sep 22

LLMs Anchor on Chief Complaint and Fail to Integrate Evidence in Sequential Clinical Triage

The study evaluates large language models (LLMs) on sequential emergency department triage, where acuity labels are predicted from progressively longer nurse‑patient conversations. Six LLMs were tested at five checkpoints on simulated and physician‑authored dialogues, showing a decline from moderate‑to‑substantial agreement on full records to only fair‑to‑moderate agreement at each checkpoint. The models consistently anchor on chief complaint exchanges and fail to integrate later evidence, yielding low agreement with clinicians (QWK 0.295 vs. 0.887‑0.929) and concentrating predictions on ESI‑2 and ESI‑3. whyItMatters":"The findings reveal that LLMs, despite strong offline performance, cannot reliably handle the sequential nature of real‑time triage, highlighting a critical gap for safe deployment in emergency settings."

By Dipankar Srirag, Haokai Zhao, Ashutosh Kumar, Eleanor Hopper, Michael Dalton, Quoc Dung Nguyen, Aditya Joshi, Salil S. Kanhere, Padmanesan Narasimhan
arXiv AI
Jun 30

LUMEN: Cost-Transparent Multi-Agent Pipeline for Automated Systematic Review and Meta-Analysis

arXiv:2606. 28362v1 Announce Type: cross Abstract: Systematic reviews and meta-analyses (SR/MA) remain the gold standard for evidence synthesis, yet completing one typically requires 67 weeks and substantial expert effort.

By Yen-Hsun Huang (Department of Education, Taipei Veterans General Hospital, Taipei, Taiwan), Yu-Shiou Lin (Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan)
arXiv Computation and Language
Sep 1

CARE: Privacy-Compliant Agentic Reasoning with Evidence Discordance

The paper introduces MIMIC-DOS, a dataset derived from MIMIC-IV that focuses on ICU cases where patient symptoms and medical signs are discordant. It presents CARE, a privacy‑compliant multi‑stage agentic reasoning framework that uses a proprietary LLM to generate structured categories and transitions, while a local LLM performs evidence acquisition and decision‑making. In retrospective evaluations on MIMIC‑DOS, CARE outperforms other LLMs and agentic workflows, demonstrating stronger handling of conflicting clinical evidence while preserving patient privacy.

By Haochen Liu, Weien Li, Rui Song, Zeyu Li, Chun Jason Xue, Xiao-Yang Liu, Sam Nallaperuma-Herzberg, Xue Liu, Ye Yuan
arXiv AI
Jul 10

A safety-oriented hypothetico-deductive framework for AI-assisted differential diagnosis

arXiv:2607. 08038v1 Announce Type: new Abstract: Diagnostic error is a major threat to patient safety, yet current large language model (LLM) systems often treat diagnosis as a one-shot prediction task, lacking safeguards against missed high-risk alternatives or rigorous verification of their reasoning.

By Fan Ma, Mauro Giuffr\`e, Donald Wright, Kent McCann, Mark Iscoe, Lingfei Qian, Mingyang Jiang, Chi Wing Ng, Na Hong, Huan He, Cathy Shyr, Qingyu Chen, Lee Schwamm, Lucila Ohno-Machado, Hua Xu
arXiv AI
2d ago

Counterfactual Auditing of Bias in Open-Source Large Language Models for Clinical Triage

The study evaluates counterfactual bias in ten open‑source large language models (LLMs) for pediatric Emergency Severity Index (ESI) prediction. By creating paired clinical vignettes that differ only in demographic or socioeconomic variables, the authors measure shifts in acuity assignment, finding that counterfactual sensitivity varies widely across model families and sizes. A fine‑tuned Qwen2.5‑7B model exhibited the lowest sensitivity, while larger or medical‑domain models sometimes showed greater shifts, highlighting the need for fairness assessment before clinical deployment.

By Manar Aljohani, Brandon Ho, Kenneth McKinley, Dennis Ren, Xuan Wang