arXiv:2605.15168cs.CLcs.AI2026-05

用文本和表格联合建模,让临床时间线更准更全。

Text Knows What, Tables Know When: Clinical Timeline Reconstruction via Retrieval-Augmented Multimodal Alignment

论文配图:Text Knows What, Tables Know When: Clinical Timeline Reconstruction via Retrieval-Augmented Multimodal Alignment
图 1 · 摘自论文原文
  • 先从病历文本提取关键事件建骨架,再用表格数据校准时间点。
  • 在i2m4基准上,时间精度提升15.3%,事件匹配率不下降。
  • 适合做重症预测、病程分析的医疗AI研究者参考。

精准重建临床时间线对建模患者轨迹和预测复杂疾病(如脓毒症)风险至关重要。非结构化临床文本语义丰富但时间模糊,而结构化电子病历(EHR)虽有精确时间锚点,却遗漏大量临床事件。本文提出一种检索增强的多模态对齐框架,将时间线重建建模为图结构的多步过程:首先从文本中提取核心事件构建初始时间骨架,再将非核心事件相对定位到该骨架,并利用检索到的表格行作为外部时间证据进行校准。在涵盖MIMIC-III和MIMIC-IV的i2m4基准上,基于指令微调的大语言模型验证了该方法在绝对时间精度(AULTC)上的持续提升,且在几乎所有评估模型中均优于纯文本方法,同时保持事件匹配率不变。进一步分析显示,34.8%的文本事件在表格记录中完全缺失,表明多模态对齐可生成比单一来源更准确、更丰富的患者轨迹重建。

原文摘要 · Abstract (English)

Reconstructing precise clinical timelines is essential for modeling patient trajectories and forecasting risk in complex, heterogeneous conditions like sepsis. While unstructured clinical narratives offer semantically rich and contextually complete descriptions of a patient's course, they often lack temporal precision and contain ambiguous event timing. Conversely, structured electronic health record (EHR) data provides precise temporal anchors but misses a substantial portion of clinically meaningful events. We introduce a retrieval-augmented multimodal alignment framework that bridges this gap to improve the temporal precision of absolute clinical timelines extracted from text. Our approach formulates timeline reconstruction as a graph-based multistep process: it first extracts central anchor events from narratives to build an initial temporal scaffold, places non-central events relative to this backbone, and then calibrates the timeline using retrieved structured EHR rows as external temporal evidence. Evaluated using instruction-tuned large language models on the i2m4 benchmark spanning MIMIC-III and MIMIC-IV, our multimodal pipeline consistently improves absolute timestamp accuracy (AULTC) and improves temporal concordance across nearly all evaluated models over unimodal text-only reconstruction, without compromising event match rates. Furthermore, our empirical gap analysis reveals that 34.8% of text-derived events are entirely absent from tabular records, demonstrating that aligning these modalities can produce a more temporally faithful and clinically informative reconstruction of patient trajectories than either source alone.

临床时间线多模态对齐医疗AIEHR

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