arXiv:2504.10340cs.CLcs.AI2025-04被引 4

用时间标注的病历文本预测临床风险,提升医疗AI时序建模能力。

Forecasting Clinical Risk from Textual Time Series: Structuring Narratives for Temporal AI in Healthcare

  • 基于大模型标注时间序列病历,构建时序输入用于预测。
  • 编码器模型在事件预测和时间排序上表现更优,尤其长程预测。
  • 强调时间顺序重要性,适合医疗时序分析与早期预警场景。

临床病例报告中包含患者随时间演变的轨迹,但传统机器学习方法多依赖结构化数据,未能充分挖掘其信息。本文提出从文本时间序列中进行临床风险预测的新任务,通过大语言模型辅助的标注流程提取带时间戳的临床发现作为主要输入。我们系统评估了多种模型,包括微调的解码器类大模型与编码器类Transformer,在事件发生预测、时间排序及生存分析任务上的表现。实验表明,编码器模型在短/长周期事件预测中均取得更高F1值与更好的时间一致性;而微调的掩码方法能提升排序性能。相比之下,指令微调的解码器模型在生存分析中表现更佳,尤其在早期预后场景。敏感性分析进一步证明,时间顺序比文本顺序更重要,强调构建时间有序语料对时序医疗任务的价值,为大模型在医疗时序应用中的发展提供新思路。

原文摘要 · Abstract (English)

Clinical case reports encode temporal patient trajectories that are often underexploited by traditional machine learning methods relying on structured data. In this work, we introduce the forecasting problem from textual time series, where timestamped clinical findings -- extracted via an LLM-assisted annotation pipeline -- serve as the primary input for prediction. We systematically evaluate a diverse suite of models, including fine-tuned decoder-based large language models and encoder-based transformers, on tasks of event occurrence prediction, temporal ordering, and survival analysis. Our experiments reveal that encoder-based models consistently achieve higher F1 scores and superior temporal concordance for short- and long-horizon event forecasting, while fine-tuned masking approaches enhance ranking performance. In contrast, instruction-tuned decoder models demonstrate a relative advantage in survival analysis, especially in early prognosis settings. Our sensitivity analyses further demonstrate the importance of time ordering, which requires clinical time series construction, as compared to text ordering, the format of the text inputs that LLMs are classically trained on. This highlights the additional benefit that can be ascertained from time-ordered corpora, with implications for temporal tasks in the era of widespread LLM use.

医疗AI时序预测大模型病历分析

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