arXiv:2503.22092cs.CL2025-03

用大模型集体投票预测病历中隐含的诊断,提升医疗数据关联性。

Leveraging LLMs for Predicting Unknown Diagnoses from Clinical Notes

  • 通过多种大模型配置投票,提升诊断预测准确率。
  • 集成方法达75%准确率,优于单一模型的66%。
  • 适合医疗文本分析与电子病历智能挖掘的研究者。

电子健康记录(EHR)常缺乏药物与诊断间的明确关联,导致临床决策和研究困难。即使存在关联,诊断列表也可能不完整,尤其在患者初诊时。出院小结通常包含更全面的信息,借助大语言模型(LLMs)可帮助推断准确诊断。本研究探究LLMs是否能从临床笔记中预测隐含诊断并将其与药物关联。我们构建了一个包含240个专家标注的药物-诊断对的新数据集,基于20份MIMIC-IV病历。使用GPT-3.5 Turbo,测试18种提示配置,涵盖短/长摘要长度,共生成8568个测试案例。结果表明,多数投票策略达到75%准确率,优于最佳单配置的66%。无单一超参数设置占优,但结合确定性、平衡性与探索性策略可提升性能。较短摘要通常带来更高准确率。结论:多样化配置的集成投票法显著提升EHR中诊断预测效果,为药物与诊断关联提供有效路径。

原文摘要 · Abstract (English)

Electronic Health Records (EHRs) often lack explicit links between medications and diagnoses, making clinical decision-making and research more difficult. Even when links exist, diagnosis lists may be incomplete, especially during early patient visits. Discharge summaries tend to provide more complete information, which can help infer accurate diagnoses, especially with the help of large language models (LLMs). This study investigates whether LLMs can predict implicitly mentioned diagnoses from clinical notes and link them to corresponding medications. We address two research questions: (1) Does majority voting across diverse LLM configurations outperform the best single configuration in diagnosis prediction? (2) How sensitive is majority voting accuracy to LLM hyperparameters such as temperature, top-p, and summary length? To evaluate, we created a new dataset of 240 expert-annotated medication-diagnosis pairs from 20 MIMIC-IV notes. Using GPT-3.5 Turbo, we ran 18 prompting configurations across short and long summary lengths, generating 8568 test cases. Results show that majority voting achieved 75 percent accuracy, outperforming the best single configuration at 66 percent. No single hyperparameter setting dominated, but combining deterministic, balanced, and exploratory strategies improved performance. Shorter summaries generally led to higher accuracy.In conclusion, ensemble-style majority voting with diverse LLM configurations improves diagnosis prediction in EHRs and offers a promising method to link medications and diagnoses in clinical texts.

大模型医疗文本诊断预测集成学习

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