t2a_v2/output/structured/134_23050890/CRH_23050890_cim10.json

{
  "source_file": "CRH 23050890.pdf",
  "document_type": "crh",
  "sejour": {
    "sexe": "F"
  },
  "diagnostic_principal": {
    "texte": "Anémie",
    "cim10_suggestion": "D64.9",
    "cim10_confidence": "high",
    "cim10_final": "D64.9",
    "sources_rag": [],
    "preuves_cliniques": [],
    "est_cma": true,
    "niveau_severite": "non_evalue",
    "niveau_cma": 2,
    "source": "nuke3",
    "source_page": 1,
    "source_excerpt": "...le.\nElle bénéficiera d’une rééducation libérale, avec un traitement martial pour compenser un peu l’anémie postopératoire.\nElle bénéficiera d’une rééducation libérale, avec un traitement martial pour compen..."
  },
  "dp_selection": {
    "chosen_index": 0,
    "chosen_term": "Anémie",
    "chosen_code": "D64.9",
    "verdict": "REVIEW",
    "evidence": [
      "Scores proches : 3.0 vs 2.0"
    ],
    "reason": "Écart 1.0 < seuil 3.0, LLM indisponible",
    "candidates": [
      {
        "index": 0,
        "term": "Anémie",
        "code": "D64.9",
        "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
        }
      },
      {
        "index": 3,
        "term": "Épispadias",
        "code": "Q64.0",
        "source": "llm_das",
        "is_comorbidity_like": false,
        "is_symptom_like": false,
        "is_act_only": false,
        "section_strength": 1,
        "num_occurrences": 2,
        "score": 2.0,
        "score_details": {
          "section": 1,
          "confidence": 0,
          "occurrences": 1
        }
      },
      {
        "index": 4,
        "term": "Extrophie vésicale",
        "code": "Q64.1",
        "source": "llm_das",
        "is_comorbidity_like": false,
        "is_symptom_like": false,
        "is_act_only": false,
        "section_strength": 1,
        "num_occurrences": 2,
        "score": 2.0,
        "score_details": {
          "section": 1,
          "confidence": 0,
          "occurrences": 1
        }
      },
      {
        "index": 1,
        "term": "Dysplasie de hanche congénitale",
        "code": "Q65.8",
        "source": "llm_das",
        "is_comorbidity_like": false,
        "is_symptom_like": false,
        "is_act_only": false,
        "section_strength": 1,
        "num_occurrences": 1,
        "score": 1.0,
        "score_details": {
          "section": 1,
          "confidence": 0
        }
      },
      {
        "index": 2,
        "term": "Dysraphie antérieure",
        "code": "Q06.8",
        "source": "llm_das",
        "is_comorbidity_like": false,
        "is_symptom_like": false,
        "is_act_only": false,
        "section_strength": 1,
        "num_occurrences": 1,
        "score": 1.0,
        "score_details": {
          "section": 1,
          "confidence": 0
        }
      }
    ],
    "debug_scores": {
      "top1": 3.0,
      "top2": 2.0,
      "delta": 1.0
    }
  },
  "dp_crh_only": {
    "chosen_index": 0,
    "chosen_term": "Anémie",
    "chosen_code": "D64.9",
    "verdict": "REVIEW",
    "evidence": [
      "Scores proches : 3.0 vs 2.0"
    ],
    "reason": "Écart 1.0 < seuil 3.0, LLM indisponible",
    "candidates": [
      {
        "index": 0,
        "term": "Anémie",
        "code": "D64.9",
        "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
        }
      },
      {
        "index": 3,
        "term": "Épispadias",
        "code": "Q64.0",
        "source": "llm_das",
        "is_comorbidity_like": false,
        "is_symptom_like": false,
        "is_act_only": false,
        "section_strength": 1,
        "num_occurrences": 2,
        "score": 2.0,
        "score_details": {
          "section": 1,
          "confidence": 0,
          "occurrences": 1
        }
      },
      {
        "index": 4,
        "term": "Extrophie vésicale",
        "code": "Q64.1",
        "source": "llm_das",
        "is_comorbidity_like": false,
        "is_symptom_like": false,
        "is_act_only": false,
        "section_strength": 1,
        "num_occurrences": 2,
        "score": 2.0,
        "score_details": {
          "section": 1,
          "confidence": 0,
          "occurrences": 1
        }
      },
      {
        "index": 1,
        "term": "Dysplasie de hanche congénitale",
        "code": "Q65.8",
        "source": "llm_das",
        "is_comorbidity_like": false,
        "is_symptom_like": false,
        "is_act_only": false,
        "section_strength": 1,
        "num_occurrences": 1,
        "score": 1.0,
        "score_details": {
          "section": 1,
          "confidence": 0
        }
      },
      {
        "index": 2,
        "term": "Dysraphie antérieure",
        "code": "Q06.8",
        "source": "llm_das",
        "is_comorbidity_like": false,
        "is_symptom_like": false,
        "is_act_only": false,
        "section_strength": 1,
        "num_occurrences": 1,
        "score": 1.0,
        "score_details": {
          "section": 1,
          "confidence": 0
        }
      }
    ],
    "debug_scores": {
      "top1": 3.0,
      "top2": 2.0,
      "delta": 1.0
    }
  },
  "dp_final": {
    "chosen_index": 0,
    "chosen_term": "Anémie",
    "chosen_code": "D64.9",
    "verdict": "REVIEW",
    "evidence": [
      "Scores proches : 3.0 vs 2.0"
    ],
    "reason": "Écart 1.0 < seuil 3.0, LLM indisponible",
    "candidates": [
      {
        "index": 0,
        "term": "Anémie",
        "code": "D64.9",
        "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
        }
      },
      {
        "index": 3,
        "term": "Épispadias",
        "code": "Q64.0",
        "source": "llm_das",
        "is_comorbidity_like": false,
        "is_symptom_like": false,
        "is_act_only": false,
        "section_strength": 1,
        "num_occurrences": 2,
        "score": 2.0,
        "score_details": {
          "section": 1,
          "confidence": 0,
          "occurrences": 1
        }
      },
      {
        "index": 4,
        "term": "Extrophie vésicale",
        "code": "Q64.1",
        "source": "llm_das",
        "is_comorbidity_like": false,
        "is_symptom_like": false,
        "is_act_only": false,
        "section_strength": 1,
        "num_occurrences": 2,
        "score": 2.0,
        "score_details": {
          "section": 1,
          "confidence": 0,
          "occurrences": 1
        }
      },
      {
        "index": 1,
        "term": "Dysplasie de hanche congénitale",
        "code": "Q65.8",
        "source": "llm_das",
        "is_comorbidity_like": false,
        "is_symptom_like": false,
        "is_act_only": false,
        "section_strength": 1,
        "num_occurrences": 1,
        "score": 1.0,
        "score_details": {
          "section": 1,
          "confidence": 0
        }
      },
      {
        "index": 2,
        "term": "Dysraphie antérieure",
        "code": "Q06.8",
        "source": "llm_das",
        "is_comorbidity_like": false,
        "is_symptom_like": false,
        "is_act_only": false,
        "section_strength": 1,
        "num_occurrences": 1,
        "score": 1.0,
        "score_details": {
          "section": 1,
          "confidence": 0
        }
      }
    ],
    "debug_scores": {
      "top1": 3.0,
      "top2": 2.0,
      "delta": 1.0
    }
  },
  "quality_flags": {
    "rag_status": "error",
    "crh_only_mode": true
  },
  "diagnostics_associes": [
    {
      "texte": "Dysplasie de hanche congénitale",
      "cim10_suggestion": "Q65.8",
      "cim10_confidence": "medium",
      "cim10_final": "Q65.8",
      "justification": "Diagnostic congénital explicitement mentionné comme indication chirurgicale. La dysplasie de hanche a mobilisé des ressources supplémentaires (technique chirurgicale spécifique, matériel adapté) et justifie l'intervention réalisée.",
      "sources_rag": [],
      "preuves_cliniques": [],
      "niveau_severite": "non_evalue",
      "niveau_cma": 1,
      "source": "llm_das",
      "source_page": 1,
      "source_excerpt": "...TE SUR HANCHE DYSPLASIQUE.\nHistoire de la maladie :\nPatiente âgée de 52 ans.\nPatiente victime d’une dysplasie de hanche congénitale associée à une dysraphie antérieure et un épispadias et à une\nextrophie vésicale.\nEn ce qui concern..."
    },
    {
      "texte": "Dysraphie antérieure",
      "cim10_suggestion": "Q06.8",
      "cim10_confidence": "medium",
      "cim10_final": "Q06.8",
      "justification": "Malformation congénitale associée explicitement mentionnée dans le contexte clinique du patient, faisant partie de son tableau clinique global.",
      "sources_rag": [],
      "preuves_cliniques": [],
      "est_cma": true,
      "niveau_severite": "non_evalue",
      "niveau_cma": 2,
      "source": "llm_das",
      "source_page": 1,
      "source_excerpt": "...ie :\nPatiente âgée de 52 ans.\nPatiente victime d’une dysplasie de hanche congénitale associée à une dysraphie antérieure et un épispadias et à une\nextrophie vésicale.\nEn ce qui concerne la hanche, il s’agit d’une dysplas..."
    },
    {
      "texte": "Épispadias",
      "cim10_suggestion": "Q64.0",
      "cim10_confidence": "low",
      "cim10_final": "Q64.0",
      "justification": "Malformation congénitale urogénitale explicitement mentionnée dans le contexte clinique du patient.",
      "sources_rag": [],
      "preuves_cliniques": [],
      "niveau_severite": "non_evalue",
      "niveau_cma": 1,
      "source": "llm_das",
      "source_page": 1,
      "source_excerpt": "...s.\nPatiente victime d’une dysplasie de hanche congénitale associée à une dysraphie antérieure et un épispadias et à une\nextrophie vésicale.\nEn ce qui concerne la hanche, il s’agit d’une dysplasie tout à fait ha..."
    },
    {
      "texte": "Extrophie vésicale",
      "cim10_suggestion": "Q64.1",
      "cim10_confidence": "low",
      "cim10_final": "Q64.1",
      "justification": "Malformation congénitale urogénitale majeure explicitement mentionnée dans le contexte clinique du patient.",
      "sources_rag": [],
      "preuves_cliniques": [],
      "niveau_severite": "non_evalue",
      "niveau_cma": 1,
      "source": "llm_das",
      "source_page": 1,
      "source_excerpt": "...d’une dysplasie de hanche congénitale associée à une dysraphie antérieure et un épispadias et à une\nextrophie vésicale.\nEn ce qui concerne la hanche, il s’agit d’une dysplasie tout à fait habituelle, j’ai plus l’opérer..."
    }
  ],
  "actes_ccam": [],
  "antecedents": [],
  "traitements_sortie": [],
  "biologie_cle": [],
  "biologie_discarded": [],
  "imagerie": [],
  "complications": [],
  "alertes_codage": [
    "QUALITE DEGRADEE : erreur RAG — codage sans référentiels",
    "NUKE-3 REVIEW: DP ambigu — Écart 1.0 < seuil 3.0, LLM indisponible",
    "2 CMA probables détectées — impact potentiel sur le niveau de sévérité GHM",
    "CMA niveau 2 : 'Anémie' (D64.9) — sévérité non_evalue",
    "CMA niveau 2 : 'Dysraphie antérieure' (Q06.8) — sévérité non_evalue",
    "QC: 🔴 CRITIQUE : Aucune preuve clinique documentée pour AUCUN code. Les justifications sont génériques sans référence au dossier réel.",
    "QC: 🔴 CRITIQUE : Conflit diagnostique majeur entre Q64.0 (épispadias) et Q64.1 (extrophie vésicale). Ces deux malformations graves coexistent exceptionnellement. Clarifier le diagnostic exact.",
    "QC: 🟠 GRAVE : D64.9 (anémie) codée sans justification clinique - risque de surcodage.",
    "QC: 🟠 GRAVE : Tous les codes Q (malformations congénitales) manquent de preuves documentées (examens, imagerie, compte-rendu opératoire).",
    "QC: 🟡 MOYEN : Codes Q65.8 et Q06.8 manquent de spécificité - utiliser codes plus précis si données disponibles.",
    "QC: 🟡 MOYEN : Absence de codes relatifs à la prise en charge chirurgicale (actes) - vérifier cohérence avec les interventions réalisées.",
    "QC: ⚠️ RECOMMANDATION : Demander au clinicien les preuves documentées (CR opératoire, imagerie, examen clinique) avant validation définitive."
  ],
  "source_files": [],
  "ghm_estimation": {
    "cmd": "16",
    "cmd_libelle": "Tumeurs bénignes, hémopathies",
    "type_ghm": "M",
    "severite": 2,
    "ghm_approx": "16M??2",
    "cma_count": 1,
    "cms_count": 0,
    "alertes": []
  },
  "controles_cpam": [],
  "veto_report": {
    "verdict": "PASS",
    "score_contestabilite": 100,
    "issues": []
  },
  "completude": {
    "checks": [
      {
        "code": "D64.9",
        "libelle": "Anémie",
        "type_diag": "DP",
        "items": [
          {
            "categorie": "biologie",
            "element": "Hémoglobine",
            "statut": "absent",
            "importance": "obligatoire",
            "impact_cpam": "Hémoglobine indispensable pour confirmer et qualifier une anémie"
          },
          {
            "categorie": "biologie",
            "element": "Ferritine",
            "statut": "absent",
            "importance": "recommande",
            "impact_cpam": "Permet de typer l'anémie (carentielle vs inflammatoire)"
          },
          {
            "categorie": "biologie",
            "element": "VGM",
            "statut": "absent",
            "importance": "recommande",
            "impact_cpam": "Oriente l'étiologie (microcytaire/macrocytaire)"
          }
        ],
        "score": 0,
        "verdict": "indefendable",
        "resume": "0/1 obligatoires, 0/2 recommandés"
      }
    ],
    "score_global": 0,
    "verdict_global": "indefendable",
    "documents_presents": [
      "crh"
    ],
    "documents_manquants": []
  },
  "processing_time_s": 15.18,
  "metrics": {
    "das_total": 4,
    "das_active": 4,
    "das_excluded": 0,
    "das_removed": 0,
    "das_ruled_out": 0,
    "das_no_code": 0,
    "actes_total": 0,
    "actes_with_code": 0,
    "dp_has_code": true
  },
  "rules_runtime": {
    "router_version": 1,
    "mode": "strict",
    "enabled_packs": [
      "decisions_core",
      "vetos_core"
    ],
    "always_on_rules": [],
    "triggers_fired": []
  }
}