Screening for Missed Opportunities for Diagnosis in the ED Using eTriggers and Large Language Models

Among 2 emergency department electronic trigger cohorts used for quality review, how did commercial large language models (LLMs) perform for identifying missed opportunities for diagnosis (MODs)?In this diagnostic study of 288 encounters, LLMs showed broadly similar discrimination for MODs but differing operating thresholds when asked to make binary adjudications, which were reflected in different physician-model concordances.These findings suggest that LLM-based screening for MODs should be evaluated within the target clinical context and that physician-like concordance and adjudicated screening performance are distinct model properties.

Corresponding Author: Adrian D. Haimovich, MD, PhD, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215 (adrian.haimovich@yale.edu).

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