Prompt engineering enables open-source large language models to match proprietary models in diagnostic accuracy for...

This study aimed to test whether open-source large language models (LLMs) can match the diagnostic accuracy of proprietary models in annotating trauma radiology reports written in a low-resource language across 3 clinical findings.

This retrospective study included 2939 radiology reports of trauma radiographs collected from 3 Danish emergency hospital centers. The data were split, with 600 cases for prompt engineering and 2339 for model evaluation. Eight LLMs, GPT-4o, GPT-4o-mini, Ministral-8b, Qwen3-8b, DeepseekR1-8b, and 3 Llama3 variants were prompted to annotate the reports for fractures, effusions, and luxations. The reference standard was human annotations. The diagnostic performance was assessed using accuracy, sensitivity, specificity, positive predictive value, and negative predictive value.

Prompt engineering improved the Match score for Llama3-8b from 77.8% (95% CI: 74.4%-81.1%) to 94.3% (95% CI: 92.5%-96.2%). GPT-4o achieved the highest overall diagnostic accuracy at 97.9% (95%; CI: 97.3%-98.5%), followed by Qwen3-8b (97.8%; 95% CI: 97.4%-98.1%), Llama3.1-405b (97.1%; 95% CI: 96.4%-97.8%), GPT-4o-mini (96.9%; 95% CI: 96.2%-97.6%), Ministral-8b (96.9%; 95% CI 96.4%-97.2%) and Llama3-8b (96.9%; 95% CI: 95.9%-97.3%). Across the 3 specific findings, all models performed best for fractures, whereas effusion and luxation were more prone to errors. Of the error types, semantic confusion was the most frequent, with 53.2%-59.4% of misclassifications.

Small, open-source LLMs can accurately annotate trauma radiology reports written in a low-resource language when supported by effective prompt engineering, achieving accuracy levels that rival proprietary competitors. They offer a viable, privacy-conscious alternative for clinical use.