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2026-03-05 00:37:34 +01:00
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{
"mode": "déterministe + LLM fallback + SynthesePMSI",
"total": 10,
"evaluable": 9,
"gold_none": 1,
"exact_match": 1,
"exact_match_pct": 11.1,
"family4": 1,
"family4_pct": 11.1,
"family3": 1,
"family3_pct": 11.1,
"coverage_dp": 8,
"coverage_dp_pct": 80.0,
"review_count": 3,
"review_pct": 30.0,
"confirmed_count": 7,
"comorbidity_fallback_count": 3,
"comorbidity_fallback_pct": 30.0,
"errors": [
{
"dir": "115_23066188",
"crh": "CRH_23066188",
"gold_code": "A87.0",
"gold_label": "Méningite à entérovirus",
"gold_conf": "high",
"new_code": "B95.1",
"new_label": "Méningite virale due à un entérovirus",
"new_source": "llm_oneshot (synthese)",
"verdict": "confirmed",
"winner_reason": "LLM fallback: B95.1 (high, synthese)",
"candidates": [
{
"code": "B95.1",
"label": "Méningite virale due à un entérovirus",
"section": "llm_oneshot (synthese)",
"score": 3,
"details": {
"llm_confidence": 3
}
}
],
"is_f4": false,
"is_f3": false
},
{
"dir": "123_23071970",
"crh": "CRH_23071970",
"gold_code": "R06.0",
"gold_label": "Dyspnée",
"gold_conf": "high",
"new_code": "J90",
"new_label": "Pneumothorax spontané primaire",
"new_source": "llm_oneshot (conclusion)",
"verdict": "confirmed",
"winner_reason": "LLM fallback: J90 (high, conclusion)",
"candidates": [
{
"code": "J90",
"label": "Pneumothorax spontané primaire",
"section": "llm_oneshot (conclusion)",
"score": 3,
"details": {
"llm_confidence": 3
}
}
],
"is_f4": false,
"is_f3": false
},
{
"dir": "126_23075530",
"crh": "CRH_23075530",
"gold_code": "E03.9",
"gold_label": "Hypopthyroïdie",
"gold_conf": "high",
"new_code": "(aucun)",
"new_label": "(aucun)",
"new_source": "",
"verdict": "review",
"winner_reason": "code invalide L48.9",
"candidates": [],
"is_f4": false,
"is_f3": false
},
{
"dir": "127_23048705",
"crh": "CRH_23048705",
"gold_code": "M17.9",
"gold_label": "Gonarthrose",
"gold_conf": "high",
"new_code": "K80",
"new_label": "Cholélithiase avec cholécystite aiguë",
"new_source": "llm_oneshot (actes)",
"verdict": "review",
"winner_reason": "LLM fallback: K80 — section faible (actes)",
"candidates": [
{
"code": "K80",
"label": "Cholélithiase avec cholécystite aiguë",
"section": "llm_oneshot (actes)",
"score": 3,
"details": {
"llm_confidence": 3
}
}
],
"is_f4": false,
"is_f3": false
},
{
"dir": "128_23076141",
"crh": "CRH_23076141",
"gold_code": "E11",
"gold_label": "Diabète de type 2",
"gold_conf": "high",
"new_code": "R17",
"new_label": "Ictère",
"new_source": "motif_hospitalisation",
"verdict": "confirmed",
"winner_reason": "score 3 vs 0 (delta 3)",
"candidates": [
{
"code": "R17",
"label": "Ictère",
"section": "motif_hospitalisation",
"score": 3,
"details": {
"section": 3,
"proof_excerpt": 2,
"r_code_dp": -2
}
},
{
"code": "K83.0",
"label": "Angiocholite",
"section": "conclusion",
"score": 0,
"details": {
"section": 2,
"proof_excerpt": 2,
"negation": -4
}
}
],
"is_f4": false,
"is_f3": false
},
{
"dir": "130_23077240",
"crh": "CRH_23077240",
"gold_code": "J90",
"gold_label": "Epanchement pleural",
"gold_conf": "high",
"new_code": "I50.9",
"new_label": "Insuffisance cardiaque, non précisée",
"new_source": "llm_oneshot (motif_hospitalisation)",
"verdict": "confirmed",
"winner_reason": "LLM fallback: I50.9 (high, motif_hospitalisation)",
"candidates": [
{
"code": "I50.9",
"label": "Insuffisance cardiaque, non précisée",
"section": "llm_oneshot (motif_hospitalisation)",
"score": 3,
"details": {
"llm_confidence": 3
}
},
{
"code": "E66.0",
"label": "Obésité",
"section": "motif_hospitalisation",
"score": 2,
"details": {
"section": 3,
"proof_excerpt": 2,
"comorbidity_weak": -3
}
}
],
"is_f4": false,
"is_f3": false
},
{
"dir": "131_23079402",
"crh": "CRH_23079402",
"gold_code": "R06.0",
"gold_label": "Dyspnée",
"gold_conf": "high",
"new_code": "(aucun)",
"new_label": "(aucun)",
"new_source": "",
"verdict": "review",
"winner_reason": "code invalide N08.3",
"candidates": [],
"is_f4": false,
"is_f3": false
},
{
"dir": "132_23080179",
"crh": "CRH_23080179",
"gold_code": "R59.9",
"gold_label": "Adénopathie",
"gold_conf": "high",
"new_code": "C88.0",
"new_label": "Lymphome non hodgkinien diffus à grandes cellules",
"new_source": "llm_oneshot (conclusion)",
"verdict": "confirmed",
"winner_reason": "LLM fallback: C88.0 (high, conclusion)",
"candidates": [
{
"code": "C88.0",
"label": "Lymphome non hodgkinien diffus à grandes cellules",
"section": "llm_oneshot (conclusion)",
"score": 3,
"details": {
"llm_confidence": 3
}
}
],
"is_f4": false,
"is_f3": false
}
],
"syntheses_pmsi": [
{
"crh": "CRH_23056364",
"gold_code": "M45",
"new_code": "M45",
"synthese": {
"motif_admission": "",
"probleme_pris_en_charge": "Poussée de spondylarthrite axiale",
"diagnostic_retenu": "Spondylarthrite axiale",
"actes_ou_traitements_majeurs": [
"Infliximab 5mg/kg IV",
"Salazopyrine",
"Apranax"
],
"complications": [],
"terrain_comorbidites": [],
"preuves": [
{
"section": "conclusion",
"excerpt": "Poussée de spondylarthrite axiale en inefficacité partielle de Idacio."
},
{
"section": "conclusion",
"excerpt": "Dr[PERSONNE_2]_26] pour INFLIXIMAB 5mg/kg IV (J0 le 20/03), Hospitalisation de jour pour J15-J45 et toutes [MEDECIN] 6 semaines."
},
{
"section": "conclusion",
"excerpt": "Poursuite Salazopyrine et Apranax."
}
]
}
},
{
"crh": "CRH_23056749",
"gold_code": null,
"new_code": "F41.1",
"synthese": {
"motif_admission": "maintien à domicile difficile",
"probleme_pris_en_charge": "syndrome anxio-dépressif",
"diagnostic_retenu": "syndrome anxio-dépressif avec troubles cognitifs débutants",
"actes_ou_traitements_majeurs": [
"prescription d'alprazolam"
],
"complications": [],
"terrain_comorbidites": [],
"preuves": [
{
"section": "conclusion",
"excerpt": "dans un contexte de syndrome anxio depressif"
},
{
"section": "conclusion",
"excerpt": "avec tr cognitifs débutants en cours de bilan"
},
{
"section": "conclusion",
"excerpt": "Transfert en psychiatrie a URTXOA à Cam de prat"
},
{
"section": "MEDECIN",
"excerpt": "ALPRAZOLAM ARW 0,25MG CPR [30] COMPRIME(S) 1 COMPRIME (ORALE) matin mid"
}
]
}
},
{
"crh": "CRH_23066188",
"gold_code": "A87.0",
"new_code": "B95.1",
"synthese": {
"motif_admission": "Non renseigné",
"probleme_pris_en_charge": "méningite à Entérovirus",
"diagnostic_retenu": "méningite à Entérovirus",
"actes_ou_traitements_majeurs": [
"antalgie par paracétamol",
"Nubain",
"AINS"
],
"complications": [],
"terrain_comorbidites": [],
"preuves": [
{
"section": "[synthese] du séjour",
"excerpt": "méningite à Entérovirus d'évolution favorable après antalgie par paracétamol, Nubain et Dr[PERSONNE_17]] AINS."
},
{
"section": "[synthese] du séjour",
"excerpt": "méningite à Entérovirus"
}
]
}
},
{
"crh": "CRH_23071970",
"gold_code": "R06.0",
"new_code": "J90",
"synthese": {
"motif_admission": "raison de l'entrée à l'hôpital (symptôme ou circonstance)",
"probleme_pris_en_charge": "pneumomédiastin et pneumothorax",
"diagnostic_retenu": "pneumomédiastin diffus et pneumothorax apical gauche, probablement spontané",
"actes_ou_traitements_majeurs": [
"TDM abdominal"
],
"complications": [],
"terrain_comorbidites": [],
"preuves": [
{
"section": "conclusion",
"excerpt": "Pneumomédiastin diffus et lame de pneumothorax apical gauche, probablement spontané."
},
{
"section": "MEDECIN",
"excerpt": "IPP [IPP_1] / N° Episode [EPISODE_1] (PNEUMOLOGIE PHTISIOLOGIE HC)"
}
]
}
},
{
"crh": "CRH_23075530",
"gold_code": "E03.9",
"new_code": null,
"synthese": {
"motif_admission": "Diabète déséquilibré",
"probleme_pris_en_charge": "Diabète déséquilibré",
"diagnostic_retenu": "Diabète de type 2",
"actes_ou_traitements_majeurs": [
"Prescription d'Atarax 25mg",
"Prescription de Brintellix 10mg",
"Prescription de Cetirizine Arw 10mg"
],
"complications": [],
"terrain_comorbidites": [
"Urticaire chronique"
],
"preuves": [
{
"section": "MOTIF D'HOSPITALISATION",
"excerpt": "Diabète déséquilibré"
},
{
"section": "conclusion",
"excerpt": "diabète de type 2 bien équilibré pendant l'hospitalisation, pas de modification de traitement"
},
{
"section": "EMAIL_5",
"excerpt": "urticaire chronique"
},
{
"section": "Pharmacie",
"excerpt": "ATARAX 25MG CPR [30] COMPRIME(S) 1 COMPRIME (ORALE) ttes les 6h [2h 8h 14h 20h]"
},
{
"section": "Pharmacie",
"excerpt": "BRINTELLIX 10MG CPR [28] CPR(s) 1 COMPRIME (ORALE) matin [8h]"
},
{
"section": "Pharmacie",
"excerpt": "CETIRIZINE ARW 10MG CPR [60] COMPRIME(S) 2"
}
]
}
},
{
"crh": "CRH_23048705",
"gold_code": "M17.9",
"new_code": "K80",
"synthese": {
"motif_admission": "",
"probleme_pris_en_charge": "Cholécystite aiguë",
"diagnostic_retenu": "Cholécystite aiguë ayant nécessité une cholécystectomie",
"actes_ou_traitements_majeurs": [
"Cholécystectomie"
],
"complications": [],
"terrain_comorbidites": [],
"preuves": [
{
"section": "ACTES RÉALISÉS",
"excerpt": "Cholécystectomie (HMFC004)"
}
]
}
},
{
"crh": "CRH_23076141",
"gold_code": "E11",
"new_code": "R17",
"synthese": {
"motif_admission": "Apparition d'un ictère chez une patiente suivie pour un adénocarnimoe de l'uncus",
"probleme_pris_en_charge": "Ictère cholestasique",
"diagnostic_retenu": "Ictère cholestasique dans un contexte d'adénocarcinome de l'uncus",
"actes_ou_traitements_majeurs": [
"Echographie abdominale"
],
"complications": [
"Insuffisance rénale aiguë"
],
"terrain_comorbidites": [
"Diabète de type 2",
"Arthrose",
"Tuberculose du genou",
"Spondylodiscite à staphylocoque",
"Hernie discale"
],
"preuves": [
{
"section": "SECTIONS CLINIQUES",
"excerpt": "Motif : Apparition d'un ictère chez une patiente suivie pour un adénocarnimoe de l'uncus"
},
{
"section": "conclusion",
"excerpt": "Ictère cholestasique dans un contexte d'adénocarcinome de l'uncus, sans angiocholite associée."
},
{
"section": "Evolution",
"excerpt": "Du fait d’une insuffisance rénale aigue à l’arrivée, réalisation d’une échographie abdominale qui retrouve une dilatation des"
},
{
"section": "SECTIONS CLINIQUES",
"excerpt": "Antécédents : Hépato-gastro-entérologue - Diabète de type 2"
},
{
"section": "SECTIONS CLINIQUES",
"excerpt": "- Arthrose"
},
{
"section": "SECTIONS CLINIQUES",
"excerpt": "- Tuberculose du genou à 23 ans"
},
{
"section": "SECTIONS CLINIQUES",
"excerpt": "- Spondylodiscite à staphylocoque en 2003"
},
{
"section": "SECTIONS CLINIQUES",
"excerpt": "DESC Cancérologie - Hernie discale non opérée en L3/L4 et L5/S"
}
]
}
},
{
"crh": "CRH_23077240",
"gold_code": "J90",
"new_code": "I50.9",
"synthese": {
"motif_admission": "diabète et décompensation cardiaque",
"probleme_pris_en_charge": "décompensation cardiaque",
"diagnostic_retenu": "diabète",
"actes_ou_traitements_majeurs": [
"TDM abdominal"
],
"complications": [],
"terrain_comorbidites": [
"HTA",
"diabète type 2",
"dyslipidémie",
"histiocytose"
],
"preuves": [
{
"section": "motif_hospitalisation",
"excerpt": "Motif d'hospitalisation : diabète et décompensation cardiaque."
},
{
"section": "motif_hospitalisation",
"excerpt": "DT2 avec modification de traitement et CI metformine du fait d'une hypoxie chronique"
},
{
"section": "SECTIONS CLINIQUES",
"excerpt": "DESC Nutrition - Histiocytose diagnostiquée à 1 an avec traité par corticoïdes"
},
{
"section": "SECTIONS CLINIQUES",
"excerpt": "- HTA"
},
{
"section": "SECTIONS CLINIQUES",
"excerpt": "- Dysl"
}
]
}
},
{
"crh": "CRH_23079402",
"gold_code": "R06.0",
"new_code": null,
"synthese": {
"motif_admission": "",
"probleme_pris_en_charge": "néphropathie impure",
"diagnostic_retenu": "néphropathie impure avec HTA et hématurie microscopique",
"actes_ou_traitements_majeurs": [
"corticothérapie par PREDNISONE 60 mg par jour",
"protection gastrique par INEXIUM 20 mg",
"antihypertenseur par RAMIPRIL 2.5 mg",
"anticoagulation préventive par LOVENOX SC 0.4 mL/j"
],
"complications": [],
"terrain_comorbidites": [
"HTA"
],
"preuves": [
{
"section": "synthese",
"excerpt": "néphrotique impur avec HTA et hématurie microcospique."
},
{
"section": "Neuropsychologues",
"excerpt": "Corticothérapie par PREDNISONE 60 mg par jour sous couvert d'une protection gastrique par INEXIUM 20 mg."
},
{
"section": "Neuropsychologues",
"excerpt": "Mise en place d'antihypertenseur devant l'HTA par RAMIPRIL 2.5 mg ."
},
{
"section": "Assistantes Sociales",
"excerpt": "Anticoagulation préventive par LOVENOX SC 0.4 mL/j"
}
]
}
},
{
"crh": "CRH_23080179",
"gold_code": "R59.9",
"new_code": "C88.0",
"synthese": {
"motif_admission": "soulager au mieux [PERSONNE][PERSONNE_2]",
"probleme_pris_en_charge": "DLBCL en progression",
"diagnostic_retenu": "DLBCL en progression",
"actes_ou_traitements_majeurs": [
"traitement protocolaire VALYM",
"pose de PICC LINE"
],
"complications": [],
"terrain_comorbidites": [],
"preuves": [
{
"section": "conclusion",
"excerpt": "Initiation d'un traitement protocolaire VALYM pour un DLBCL en progression après 2 lignes de traitement."
},
{
"section": "PROCHAINS RDV",
"excerpt": "Pose de PICC LINE le 05/05/23."
}
]
}
}
]
}