{
  "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."
          }
        ]
      }
    }
  ]
}