{
  "source_file": "CRH 23071970.pdf",
  "document_type": "crh",
  "sejour": {
    "sexe": "M",
    "age": 23,
    "date_entree": "11/04/2023",
    "date_sortie": "17/04/2023",
    "duree_sejour": 6
  },
  "diagnostic_principal": {
    "texte": "Pneumopathie",
    "cim10_suggestion": "J18.9",
    "cim10_confidence": "low",
    "cim10_final": "J18.9",
    "cim10_decision": {
      "action": "PROMOTE_DP",
      "final_code": "J18.9",
      "reason": "DAS promu en DP (score (2, 1, 4))",
      "needs_info": [],
      "applied_rules": [
        "RULE-DAS-TO-DP"
      ]
    },
    "sources_rag": [],
    "preuves_cliniques": [],
    "source": "regex",
    "source_page": 1,
    "source_excerpt": "...nce d'un\nTel: 05.59.44.38.53 infiltrat en verre dépoli du lobe inférieur gauche compatible avec une pneumopathie interstitielle bien que non spécifique\nExplorations Endoscopies Pas d'épaississement, d'épanchement..."
  },
  "dp_selection": {
    "chosen_index": 0,
    "chosen_term": "Pneumopathie",
    "chosen_code": "J18.9",
    "verdict": "CONFIRMED",
    "evidence": [
      "Score 3.0 — source: regex (section forte)"
    ],
    "reason": "Candidat unique",
    "candidates": [
      {
        "index": 0,
        "term": "Pneumopathie",
        "code": "J18.9",
        "source": "regex",
        "is_comorbidity_like": false,
        "is_symptom_like": false,
        "is_act_only": false,
        "section_strength": 3,
        "num_occurrences": 1,
        "score": 3.0,
        "score_details": {
          "section": 3,
          "confidence": 0
        }
      }
    ],
    "debug_scores": {
      "top1": 3.0
    }
  },
  "dp_crh_only": {
    "chosen_index": 0,
    "chosen_term": "Pneumopathie",
    "chosen_code": "J18.9",
    "verdict": "CONFIRMED",
    "evidence": [
      "Score 3.0 — source: regex (section forte)"
    ],
    "reason": "Candidat unique",
    "candidates": [
      {
        "index": 0,
        "term": "Pneumopathie",
        "code": "J18.9",
        "source": "regex",
        "is_comorbidity_like": false,
        "is_symptom_like": false,
        "is_act_only": false,
        "section_strength": 3,
        "num_occurrences": 1,
        "score": 3.0,
        "score_details": {
          "section": 3,
          "confidence": 0
        }
      }
    ],
    "debug_scores": {
      "top1": 3.0
    }
  },
  "dp_final": {
    "chosen_index": 0,
    "chosen_term": "Pneumopathie",
    "chosen_code": "J18.9",
    "verdict": "CONFIRMED",
    "evidence": [
      "Score 3.0 — source: regex (section forte)"
    ],
    "reason": "Candidat unique",
    "candidates": [
      {
        "index": 0,
        "term": "Pneumopathie",
        "code": "J18.9",
        "source": "regex",
        "is_comorbidity_like": false,
        "is_symptom_like": false,
        "is_act_only": false,
        "section_strength": 3,
        "num_occurrences": 1,
        "score": 3.0,
        "score_details": {
          "section": 3,
          "confidence": 0
        }
      }
    ],
    "debug_scores": {
      "top1": 3.0
    }
  },
  "quality_flags": {
    "rag_status": "error",
    "crh_only_mode": true
  },
  "diagnostics_associes": [],
  "actes_ccam": [
    {
      "texte": "TDM abdominal",
      "code_ccam_suggestion": "ZCQK002",
      "sources_rag": [],
      "validite": "valide",
      "alertes": []
    }
  ],
  "antecedents": [],
  "traitements_sortie": [],
  "biologie_cle": [
    {
      "test": "CRP",
      "valeur": "49",
      "valeur_num": 49.0,
      "anomalie": true,
      "quality": "ok",
      "source_page": 2,
      "source_excerpt": "...r\nmédical de fédération Hb14.3, leuco 12.5, plaquettes 257, Na 137, K 3.8, Cl 100, RA 26, créat 84, CRP 49\nChef de Pôle\nDr Emmanuel ELLIE Antalgie\nNeurologue\nrepos\neellie@ch-cotebasque.fr\nCadre de Pôle\nR..."
    },
    {
      "test": "Sodium",
      "valeur": "137",
      "valeur_num": 137.0,
      "anomalie": false,
      "quality": "ok"
    },
    {
      "test": "Potassium",
      "valeur": "3.8",
      "valeur_num": 3.8,
      "anomalie": false,
      "quality": "ok"
    },
    {
      "test": "Chlore",
      "valeur": "100",
      "valeur_num": 100.0,
      "quality": "ok"
    },
    {
      "test": "Plaquettes",
      "valeur": "257",
      "valeur_num": 257.0,
      "anomalie": false,
      "quality": "ok",
      "source_page": 2,
      "source_excerpt": "...logie\nfédération\nTP 87%\nDr Thomas Grellety, coordonnateur\nmédical de fédération Hb14.3, leuco 12.5, plaquettes 257, Na 137, K 3.8, Cl 100, RA 26, créat 84, CRP 49\nChef de Pôle\nDr Emmanuel ELLIE Antalgie\nNeurolo..."
    }
  ],
  "biologie_discarded": [],
  "imagerie": [
    {
      "type": "TDM abdominal",
      "conclusion": "des\n[EMAIL_8]\nsibilants bilatéraux.\nDr [MEDECIN_6]\nIl n'y a pas de syndrome d'ingestion évoquant une rupture œsophagienne\nPneumologue\nDESC Cancérologie\n[EMAIL_7] La radio de thorax et le scanner confirme un pneumomédiastin.\nIl n'y a pas de lésion autre retrouvée.\nDr [MEDECIN_7] [PERSONNE_4]\nPneumologue Conduite à tenir :\nMédecin du Sport Pour le pneumomédiastin :\n[EMAIL_6] Oxygène, au repos, traitement antibiotique par céphalosporines de troisième génération.\nDr [MEDECIN_8] Antalgiques\nPneumolog"
    }
  ],
  "complications": [
    {
      "texte": "Fièvre",
      "source_page": 1,
      "source_excerpt": "...la maladie\nclethrosne@ch-cotebasque.fr\nToux et rhinorrhée claire depuis une semaine sans notion de fièvre\nDr Laurence MASSE\nCe jour vers 18h douleur basi thoracique transfixiante avec blockpnée associée\nPn..."
    }
  ],
  "alertes_codage": [
    "QUALITE DEGRADEE : erreur RAG — codage sans référentiels",
    "CMA niveau 2 : 'Pneumopathie' (J18.9) — sévérité non_evalue",
    "QC: ⚠️ DOSSIER INCOMPLET : Texte tronqué (TDM abdominal, radio thorax, scanner) — impossible de valider la pathologie respiratoire avec certitude",
    "QC: ⚠️ ABSENCE DE JUSTIFICATION : Aucune preuve clinique documentée pour J18.9 (pas de diagnostic médecin explicite, pas de description radiologique complète)",
    "QC: ⚠️ DIAGNOSTIC DIFFÉRENTIEL NON ÉCARTÉ : Les 'sibilants bilatéraux' suggèrent plutôt une BRONCHITE (J20.9) qu'une pneumopathie (J18.9)",
    "QC: ⚠️ COMPLICATION FIÈVRE : Codée comme 'complication' mais non codifiée en diagnostic. À clarifier : fièvre secondaire à la pneumopathie (non codée séparément) ou diagnostic indépendant ?",
    "QC: ⚠️ CONTEXTE CLINIQUE FLOU : Patient jeune (23 ans), durée 6 jours, CRP modérée — profil compatible avec infection virale ou bronchite plutôt que pneumonie bactérienne",
    "QC: ⚠️ MANQUE DE DIAGNOSTIC PRINCIPAL : Aucun diagnostic principal (DP) clairement identifié",
    "RULE-DAS-TO-DP: DP absent → DAS J18.9 (Pneumopathie) promu en DP",
    "DECISIONS[PDF]: 1 ligne(s)",
    "DECISION: diagnostic_principal J18.9 promu en DP (RULE-DAS-TO-DP)",
    "VETOS[PDF]: FAIL (score=70)",
    "VETO-02 [HARD] actes_ccam[0]: Acte ZCQK002 sans preuve exploitable"
  ],
  "source_files": [],
  "ghm_estimation": {
    "cmd": "04",
    "cmd_libelle": "Affections de l'appareil respiratoire",
    "type_ghm": "K",
    "severite": 1,
    "ghm_approx": "04K??1",
    "cma_count": 0,
    "cms_count": 0,
    "alertes": []
  },
  "controles_cpam": [],
  "veto_report": {
    "verdict": "FAIL",
    "score_contestabilite": 70,
    "issues": [
      {
        "veto": "VETO-02",
        "severity": "HARD",
        "where": "actes_ccam[0]",
        "message": "Acte ZCQK002 sans preuve exploitable",
        "citation": "Principe de preuve : tout diagnostic/acte doit être étayé par une trace dans le dossier médical (Guide Méthodologique MCO)"
      }
    ]
  },
  "completude": {
    "checks": [
      {
        "code": "J18.9",
        "libelle": "Pneumopathie",
        "type_diag": "DP",
        "items": [
          {
            "categorie": "imagerie",
            "element": "Radio/Scanner thoracique",
            "statut": "absent",
            "importance": "obligatoire",
            "impact_cpam": "Imagerie thoracique indispensable pour confirmer une pneumopathie"
          },
          {
            "categorie": "biologie",
            "element": "CRP",
            "statut": "present",
            "valeur": "49",
            "importance": "recommande",
            "impact_cpam": "CRP recommandée pour documenter le syndrome inflammatoire"
          }
        ],
        "score": 30,
        "verdict": "indefendable",
        "resume": "0/1 obligatoires, 1/1 recommandés"
      }
    ],
    "score_global": 30,
    "verdict_global": "indefendable",
    "documents_presents": [
      "crh"
    ],
    "documents_manquants": []
  },
  "processing_time_s": 16.76,
  "metrics": {
    "das_total": 0,
    "das_active": 0,
    "das_excluded": 0,
    "das_removed": 0,
    "das_ruled_out": 0,
    "das_no_code": 0,
    "actes_total": 1,
    "actes_with_code": 1,
    "dp_has_code": true
  },
  "rules_runtime": {
    "router_version": 1,
    "mode": "strict",
    "enabled_packs": [
      "decisions_core",
      "vetos_core"
    ],
    "always_on_rules": [],
    "triggers_fired": []
  }
}