Freezing the Physiological Encoder: Explanation Stability Under Bounded Updates of an ICU Model

The paper introduces a bounded updating framework for ICU prediction models that freezes the physiological encoder while allowing updates only to the treatment pathway and fusion head. Experiments on 84,792 MIMIC-IV ICU stays across four temporal shifts show that selective adaptation yields more stable explanations—higher rank correlation, better top‑5 feature agreement, and improved retrieval stability—compared to full model adaptation. Predictive performance varies by outcome, but the results demonstrate that explanation stability is governed by the structural boundaries of allowed adaptation rather than merely by freezing components.

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