Chief Complaints and ICD Codes

Mixed methods assessment of the influence of demographics on medical advice of ChatGPT

OBJECTIVES

To evaluate demographic biases in diagnostic accuracy and health advice between generative artificial intelligence (AI) (ChatGPT GPT-4) and traditional symptom checkers like WebMD.

MATERIALS AND METHODS

Combination symptom and demographic vignettes were developed for 27 most common symptom complaints. Standardized prompts, written from a patient perspective, with varying demographic permutations of age, sex, and race/ethnicity were entered into ChatGPT (GPT-4) between July and August 2023. In total, 3 runs of 540 ChatGPT prompts were compared to the corresponding WebMD Symptom Checker output using a mixed-methods approach. In addition to diagnostic correctness, the associated text generated by ChatGPT was analyzed for readability (using Flesch-Kincaid Grade Level) and qualitative aspects like disclaimers and demographic tailoring.

RESULTS

ChatGPT matched WebMD in 91% of diagnoses, with a 24% top diagnosis match rate. Diagnostic accuracy was not significantly different across demographic groups, including age, race/ethnicity, and sex. ChatGPT's urgent care recommendations and demographic tailoring were presented significantly more to 75-year-olds versus 25-year-olds (P < .01) but were not statistically different among race/ethnicity and sex groups. The GPT text was suitable for college students, with no significant demographic variability.

DISCUSSION

The use of non-health-tailored generative AI, like ChatGPT, for simple symptom-checking functions provides comparable diagnostic accuracy to commercially available symptom checkers and does not demonstrate significant demographic bias in this setting. The text accompanying differential diagnoses, however, suggests demographic tailoring that could potentially introduce bias.

CONCLUSION

These results highlight the need for continued rigorous evaluation of AI-driven medical platforms, focusing on demographic biases to ensure equitable care.

Sepsis prediction, early detection, and identification using clinical text for machine learning: a systematic review

OBJECTIVE

To determine the effects of using unstructured clinical text in machine learning (ML) for prediction, early detection, and identification of sepsis.

MATERIALS AND METHODS

PubMed, Scopus, ACM DL, dblp, and IEEE Xplore databases were searched. Articles utilizing clinical text for ML or natural language processing (NLP) to detect, identify, recognize, diagnose, or predict the onset, development, progress, or prognosis of systemic inflammatory response syndrome, sepsis, severe sepsis, or septic shock were included. Sepsis definition, dataset, types of data, ML models, NLP techniques, and evaluation metrics were extracted.

RESULTS

The clinical text used in models include narrative notes written by nurses, physicians, and specialists in varying situations. This is often combined with common structured data such as demographics, vital signs, laboratory data, and medications. Area under the receiver operating characteristic curve (AUC) comparison of ML methods showed that utilizing both text and structured data predicts sepsis earlier and more accurately than structured data alone. No meta-analysis was performed because of incomparable measurements among the 9 included studies.

DISCUSSION

Studies focused on sepsis identification or early detection before onset; no studies used patient histories beyond the current episode of care to predict sepsis. Sepsis definition affects reporting methods, outcomes, and results. Many methods rely on continuous vital sign measurements in intensive care, making them not easily transferable to general ward units.

CONCLUSIONS

Approaches were heterogeneous, but studies showed that utilizing both unstructured text and structured data in ML can improve identification and early detection of sepsis.

Cloud-based intelligent self-diagnosis and department recommendation service using Chinese medical BERT

With the rapid development of hospital informatization and Internet medical service in recent years, most hospitals have launched online hospital appointment registration systems to remove patient queues and improve the efficiency of medical services. However, most of the patients lack professional medical knowledge and have no idea of how to choose department when registering. To instruct the patients to seek medical care and register effectively, we proposed CIDRS, an intelligent self-diagnosis and department recommendation framework based on Chinese medical Bidirectional Encoder Representations from Transformers (BERT) in the cloud computing environment. We also established a Chinese BERT model (CHMBERT) trained on a large-scale Chinese medical text corpus. This model was used to optimize self-diagnosis and department recommendation tasks. To solve the limited computing power of terminals, we deployed the proposed framework in a cloud computing environment based on container and micro-service technologies. Real-world medical datasets from hospitals were used in the experiments, and results showed that the proposed model was superior to the traditional deep learning models and other pre-trained language models in terms of performance.