Large Language Model Capabilities in Perioperative Risk Prediction and Prognostication

We investigate whether general-domain large language models such as GPT-4 Turbo can perform risk stratification and predict post-operative outcome measures using a description of the procedure and a patient's clinical notes derived from the electronic health record. We examine predictive performance on 8 different tasks: prediction of ASA Physical Status Classification, hospital admission, ICU admission, unplanned admission, hospital mortality, PACU Phase 1 duration, hospital duration, and ICU duration. Few-shot and chain-of-thought prompting improves predictive performance for several of the tasks. We achieve F1 scores of 0.50 for ASA Physical Status Classification, 0.81 for ICU admission, and 0.86 for hospital mortality. Performance on duration prediction tasks were universally poor across all prompt strategies. Current generation large language models can assist clinicians in perioperative risk stratification on classification tasks and produce high-quality natural language summaries and explanations.

MedAlign: A Clinician-Generated Dataset for Instruction Following with Electronic Medical Records

The ability of large language models (LLMs) to follow natural language instructions with human-level fluency suggests many opportunities in healthcare to reduce administrative burden and improve quality of care. However, evaluating LLMs on realistic text generation tasks for healthcare remains challenging. Existing question answering datasets for electronic health record (EHR) data fail to capture the complexity of information needs and documentation burdens experienced by clinicians. To address these challenges, we introduce MedAlign, a benchmark dataset of 983 natural language instructions for EHR data. MedAlign is curated by 15 clinicians (7 specialities), includes clinician-written reference responses for 303 instructions, and provides 276 longitudinal EHRs for grounding instruction-response pairs. We used MedAlign to evaluate 6 general domain LLMs, having clinicians rank the accuracy and quality of each LLM response. We found high error rates, ranging from 35% (GPT-4) to 68% (MPT-7B-Instruct), and an 8.3% drop in accuracy moving from 32k to 2k context lengths for GPT-4. Finally, we report correlations between clinician rankings and automated natural language generation metrics as a way to rank LLMs without human review. We make MedAlign available under a research data use agreement to enable LLM evaluations on tasks aligned with clinician needs and preferences.

Feature-weighted elastic net: using "features of features" for better prediction

In some supervised learning settings, the practitioner might have additional information on the features used for prediction. We propose a new method which leverages this additional information for better prediction. The method, which we call the feature-weighted elastic net ("fwelnet"), uses these "features of features" to adapt the relative penalties on the feature coefficients in the elastic net penalty. In our simulations, fwelnet outperforms the lasso in terms of test mean squared error and usually gives an improvement in true positive rate or false positive rate for feature selection. We also apply this method to early prediction of preeclampsia, where fwelnet outperforms the lasso in terms of 10-fold cross-validated area under the curve (0.86 vs. 0.80). We also provide a connection between fwelnet and the group lasso and suggest how fwelnet might be used for multi-task learning.