将可计算的结构化表型与大型语言模型进行比较,使用电子健康记录数据识别阿片类药物使用障碍
Melanie Molina1,2, Cynthia Fenton2, Kathy T LeSaint1
1Department of Emergency Medicine, University of California, San Francisco, California, USA.
medRxiv : the preprint server for health sciences
|December 25, 2025
概括
一个大型语言模型 (LLM) 显示了在急诊室识别阿片类药物使用障碍 (OUD) 的前景,在特异性方面表现优于传统方法,同时保持对OUD查的高灵敏度.
科学领域:
- 紧急医疗 紧急医疗
- 临床信息学 临床信息学
- 医疗保健中的人工智能
背景情况:
- 阿片类药物使用障碍 (OUD) 是一个重要的公共卫生问题,经常在急诊室 (ED) 遇到.
- 目前的识别方法,如结构化可计算的表型,可能无法捕获准确诊断所需的全部临床背景.
研究的目的:
- 为了比较结构化可计算的OUD表型与零射击大语言模型 (LLM) 的性能.
- 将这些方法与专家临床审查进行评估,作为ED中OUD识别的参考标准.
主要方法:
- 对202个成年ED遭遇的回顾性分析.
- 专家医生审查与协商一致的裁决确定了OUD状态的参考标准.
- 一个结构化的表型利用了ICD-10代码,药物,毒理学和关键词规则.
- 一个零射击的LLM (GPT-4.1) 根据连接的ED临床笔记对OUD进行了分类.
主要成果:
- 专家评审人员达到了实质性的共识 (κ=0.77),在28%的遭遇中确定了OUD.
- 结构化的表型表现出高灵敏度 (0.98),但特异性低 (0.54).
- 与表型 (p<0.001) 相比,零射击的LLM获得了高灵敏度 (0.93) 和显著改善的特异性 (0.90).
结论:
- 一个零射击的LLM提供了一个平衡的性能概况,在特异性方面表现出色,同时保持OUD检测的高灵敏度.
- 这表明LLM可以成为在ED环境中针对阿片类药物使用障碍的分层查策略的有价值工具.
- 基于LLM的方法可以提高在紧急护理中识别OUD的准确性和效率.
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