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t2a_v2/output/structured/154_23096269/CRH_23096269_cim10.json
dom 13fe9fa666 chore: mise à jour output pipeline (anonymized + structured) 
Résultats de re-traitement pipeline v2 sur 261 dossiers.

Co-Authored-By: Claude Opus 4.6 <noreply@anthropic.com>
2026-03-07 23:14:42 +01:00

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{
"source_file": "CRH 23096269.pdf",
"document_type": "crh",
"sejour": {
"sexe": "F",
"age": 65,
"date_entree": "30/05/2023",
"date_sortie": "02/06/2023",
"duree_sejour": 3
},
"diagnostic_principal": {
"texte": "Diabète de type 2",
"cim10_suggestion": "E11.9",
"cim10_confidence": "high",
"cim10_final": "E11.9",
"sources_rag": [],
"preuves_cliniques": [],
"est_cma": true,
"niveau_severite": "non_evalue",
"niveau_cma": 2,
"source": "nuke3",
"source_page": 2,
"source_excerpt": "...E (avant chirurgie genou) à la clinique de St Jean de Luz\nSecrétariat :\n05.59.44.37.33 Conclusion : Diabète de type 2 avec HbA1c en amélioration à 7.8% mais problématique d'hypoglycémies à répétition.\nENDOCRINOLOGIE S..."
},
"dp_selection": {
"chosen_index": 1,
"chosen_term": "Diabète de type 2",
"chosen_code": "E11.9",
"verdict": "CONFIRMED",
"evidence": [
"Score 4.0 — source: regex (section forte)",
"Motif hospitalisation: «Dr Elisa MAURY\nDr Laurence RITZ-QUILLACQ\nD D r r M M a a r th io ie n u G A S U C Z H I WIND - MT Dr Foucaud\nSecrétariat :\n05.59.44.37.42 Motif d’hospitalisation\nMAL. INFECTIEUSES Tentative de sevrage en rapides dans le cadre d'un diabète d»",
"Delta +3.0 vs Trouble anxio-dépressif (F41.9)"
],
"reason": "Écart score 3.0 >= seuil 3.0",
"candidates": [
{
"index": 1,
"term": "Diabète de type 2",
"code": "E11.9",
"source": "regex",
"is_comorbidity_like": true,
"is_symptom_like": false,
"is_act_only": false,
"section_strength": 3,
"num_occurrences": 1,
"score": 4.0,
"score_details": {
"section": 3,
"confidence": 0,
"motif_align": 2,
"diag_section_bonus": 2,
"comorbidity_malus": -3
}
},
{
"index": 3,
"term": "Trouble anxio-dépressif",
"code": "F41.9",
"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": 0,
"term": "Hypertension artérielle",
"code": "I10",
"source": "regex",
"is_comorbidity_like": true,
"is_symptom_like": false,
"is_act_only": false,
"section_strength": 3,
"num_occurrences": 1,
"score": 0.0,
"score_details": {
"section": 3,
"confidence": 0,
"comorbidity_malus": -3
}
},
{
"index": 2,
"term": "Obésité (IMC 41.49)",
"code": "E66.0",
"source": "regex",
"is_comorbidity_like": true,
"is_symptom_like": false,
"is_act_only": false,
"section_strength": 3,
"num_occurrences": 1,
"score": 0.0,
"score_details": {
"section": 3,
"confidence": 0,
"comorbidity_malus": -3
}
}
],
"debug_scores": {
"top1": 4.0,
"top2": 1.0,
"delta": 3.0
}
},
"dp_crh_only": {
"chosen_index": 1,
"chosen_term": "Diabète de type 2",
"chosen_code": "E11.9",
"verdict": "CONFIRMED",
"evidence": [
"Score 4.0 — source: regex (section forte)",
"Motif hospitalisation: «Dr Elisa MAURY\nDr Laurence RITZ-QUILLACQ\nD D r r M M a a r th io ie n u G A S U C Z H I WIND - MT Dr Foucaud\nSecrétariat :\n05.59.44.37.42 Motif d’hospitalisation\nMAL. INFECTIEUSES Tentative de sevrage en rapides dans le cadre d'un diabète d»",
"Delta +3.0 vs Trouble anxio-dépressif (F41.9)"
],
"reason": "Écart score 3.0 >= seuil 3.0",
"candidates": [
{
"index": 1,
"term": "Diabète de type 2",
"code": "E11.9",
"source": "regex",
"is_comorbidity_like": true,
"is_symptom_like": false,
"is_act_only": false,
"section_strength": 3,
"num_occurrences": 1,
"score": 4.0,
"score_details": {
"section": 3,
"confidence": 0,
"motif_align": 2,
"diag_section_bonus": 2,
"comorbidity_malus": -3
}
},
{
"index": 3,
"term": "Trouble anxio-dépressif",
"code": "F41.9",
"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": 0,
"term": "Hypertension artérielle",
"code": "I10",
"source": "regex",
"is_comorbidity_like": true,
"is_symptom_like": false,
"is_act_only": false,
"section_strength": 3,
"num_occurrences": 1,
"score": 0.0,
"score_details": {
"section": 3,
"confidence": 0,
"comorbidity_malus": -3
}
},
{
"index": 2,
"term": "Obésité (IMC 41.49)",
"code": "E66.0",
"source": "regex",
"is_comorbidity_like": true,
"is_symptom_like": false,
"is_act_only": false,
"section_strength": 3,
"num_occurrences": 1,
"score": 0.0,
"score_details": {
"section": 3,
"confidence": 0,
"comorbidity_malus": -3
}
}
],
"debug_scores": {
"top1": 4.0,
"top2": 1.0,
"delta": 3.0
}
},
"dp_final": {
"chosen_index": 1,
"chosen_term": "Diabète de type 2",
"chosen_code": "E11.9",
"verdict": "CONFIRMED",
"evidence": [
"Score 4.0 — source: regex (section forte)",
"Motif hospitalisation: «Dr Elisa MAURY\nDr Laurence RITZ-QUILLACQ\nD D r r M M a a r th io ie n u G A S U C Z H I WIND - MT Dr Foucaud\nSecrétariat :\n05.59.44.37.42 Motif d’hospitalisation\nMAL. INFECTIEUSES Tentative de sevrage en rapides dans le cadre d'un diabète d»",
"Delta +3.0 vs Trouble anxio-dépressif (F41.9)"
],
"reason": "Écart score 3.0 >= seuil 3.0",
"candidates": [
{
"index": 1,
"term": "Diabète de type 2",
"code": "E11.9",
"source": "regex",
"is_comorbidity_like": true,
"is_symptom_like": false,
"is_act_only": false,
"section_strength": 3,
"num_occurrences": 1,
"score": 4.0,
"score_details": {
"section": 3,
"confidence": 0,
"motif_align": 2,
"diag_section_bonus": 2,
"comorbidity_malus": -3
}
},
{
"index": 3,
"term": "Trouble anxio-dépressif",
"code": "F41.9",
"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": 0,
"term": "Hypertension artérielle",
"code": "I10",
"source": "regex",
"is_comorbidity_like": true,
"is_symptom_like": false,
"is_act_only": false,
"section_strength": 3,
"num_occurrences": 1,
"score": 0.0,
"score_details": {
"section": 3,
"confidence": 0,
"comorbidity_malus": -3
}
},
{
"index": 2,
"term": "Obésité (IMC 41.49)",
"code": "E66.0",
"source": "regex",
"is_comorbidity_like": true,
"is_symptom_like": false,
"is_act_only": false,
"section_strength": 3,
"num_occurrences": 1,
"score": 0.0,
"score_details": {
"section": 3,
"confidence": 0,
"comorbidity_malus": -3
}
}
],
"debug_scores": {
"top1": 4.0,
"top2": 1.0,
"delta": 3.0
}
},
"quality_flags": {
"rag_status": "error",
"crh_only_mode": true
},
"diagnostics_associes": [
{
"texte": "Hypertension artérielle",
"cim10_suggestion": "I10",
"cim10_confidence": "high",
"cim10_final": "I10",
"sources_rag": [],
"preuves_cliniques": [],
"niveau_severite": "non_evalue",
"niveau_cma": 1,
"source": "regex"
},
{
"texte": "Obésité (IMC 41.49)",
"cim10_suggestion": "E66.0",
"cim10_confidence": "high",
"cim10_final": "E66.0",
"sources_rag": [],
"preuves_cliniques": [],
"niveau_severite": "non_evalue",
"niveau_cma": 1,
"source": "regex"
},
{
"texte": "Trouble anxio-dépressif",
"cim10_suggestion": "F41.9",
"cim10_confidence": "low",
"cim10_final": "F41.9",
"justification": "Mention explicite dans le texte : 'Proposition de suivi psychologique avec coordonnées remises pour possible sd anxio dépressif'. Diagnostic identifié pendant le séjour ayant mobilisé des ressources (orientation vers suivi psychologique).",
"sources_rag": [],
"preuves_cliniques": [],
"niveau_severite": "non_evalue",
"niveau_cma": 1,
"source": "llm_das"
}
],
"actes_ccam": [],
"antecedents": [
{
"texte": "/Maladie en cours",
"source_page": 1,
"source_excerpt": "...e en rapides dans le cadre d'un diabète de type 2\nDr Marc Olivier VAREIL\nChef de Service Antécédents/Maladie en cours\nDr Sophie FARBOS\nDr Heidi WILLE Diabète\nDr Laure ALLEMAN HTA\nDr Margaux BOUET\nSecrétariat :\nTraitem..."
},
{
"texte": "Traitement à l’entrée",
"source_page": 1,
"source_excerpt": "...n cours\nDr Sophie FARBOS\nDr Heidi WILLE Diabète\nDr Laure ALLEMAN HTA\nDr Margaux BOUET\nSecrétariat :\nTraitement à l’entrée\n05.59.44.37.32\nmetformine 850x2 Novorapid 28-28-36 Toujeo 70U le soir Vesicare questran Hyzaar 100/..."
},
{
"texte": "metformine 850x2 Novorapid 28-28-36 Toujeo 70U le soir Vesicare questran Hyzaar 100/25 Pravastatine 20",
"source_page": 1,
"source_excerpt": "...LE Diabète\nDr Laure ALLEMAN HTA\nDr Margaux BOUET\nSecrétariat :\nTraitement à l’entrée\n05.59.44.37.32\nmetformine 850x2 Novorapid 28-28-36 Toujeo 70U le soir Vesicare questran Hyzaar 100/25 Pravastatine 20\nNEPHROLOGIE\nDr Adeline LACRAZ\nMode de vie/Habitus\nChef de Service\nDr Pauline D'HALLUIN habite avec..."
}
],
"traitements_sortie": [],
"biologie_cle": [
{
"test": "GGT",
"valeur": "58",
"valeur_num": 58.0,
"anomalie": false,
"quality": "ok",
"source_page": 1,
"source_excerpt": "...ferme\nMetformine 850 bien tolérée\nBiologie à l'entrée :\nHbA1c 7.8%\nCRP nég\ntransaminases normales, GGT 58 U/L\nLDL 0.61 g/l, HDL 0.42 g/L, TG 1.45 g/L\nHb 12.6 g/dL, ferritine 44 ug/l\nTSH normale\nEvolutio..."
},
{
"test": "Hémoglobine",
"valeur": "12.6",
"valeur_num": 12.6,
"anomalie": false,
"quality": "ok",
"source_page": 2,
"source_excerpt": "...e le service avec:\nChef de Service\nDr Sophie FARBOS - Laboratoire :\nDr Heidi WILLE\nDr Laure ALLEMAN Hémoglobine glycosylée HbA1C ( dosage )\nDr Margaux BOUET - Matériel :\nSecrétariat : Bandelettes Cétonémie 1xjou..."
},
{
"test": "HbA1c",
"valeur": "13",
"valeur_num": 13.0,
"anomalie": true,
"quality": "ok",
"source_page": 1,
"source_excerpt": "...nue du service depuis 2007 initialement Dr Ritz puis Dr GSCHWIND puis Dr Maury\nRHUMATOLOGIE En 2018 HbA1c = 13% poids 82Kg sous ADO + Xultophy : hospitalisation de semaine pour rajout d'insuline rapide le..."
},
{
"test": "HbA1c",
"valeur": "7.8",
"valeur_num": 7.8,
"anomalie": true,
"quality": "ok",
"source_page": 1,
"source_excerpt": "...nue du service depuis 2007 initialement Dr Ritz puis Dr GSCHWIND puis Dr Maury\nRHUMATOLOGIE En 2018 HbA1c = 13% poids 82Kg sous ADO + Xultophy : hospitalisation de semaine pour rajout d'insuline rapide le..."
}
],
"biologie_discarded": [],
"imagerie": [],
"complications": [],
"alertes_codage": [
"QUALITE DEGRADEE : erreur RAG — codage sans référentiels",
"CMA niveau 2 : 'Diabète de type 2' (E11.9) — sévérité non_evalue",
"QC: ⚠️ ALERTE CRITIQUE : F41.9 codé sur suspicion uniquement - non conforme aux règles de codage PMSI (diagnostic établi requis)",
"QC: ⚠️ Deux valeurs HbA1c contradictoires (13% vs 7.8%) - clarifier la chronologie et la validité",
"QC: ⚠️ Absence totale de justifications documentées pour E11.9, I10, E66.0 dans le dossier fourni - vérifier la complétude du dossier clinique",
"QC: ⚠️ Absence de valeurs tensionnelles pour justifier I10 - recommander documentation",
"QC: ⚠️ Absence de diagnostic principal clairement énoncé - le DP (E11.9) semble par défaut plutôt que justifié par le motif d'admission",
"QC: ℹ️ Vérifier le motif d'admission réel (3 jours) - aucun événement aigu documenté",
"VETOS[PDF]: NEED_INFO (score=55)",
"VETO-02 [MEDIUM] diagnostics_associes[0]: DAS I10 sans preuve exploitable",
"VETO-02 [MEDIUM] diagnostics_associes[1]: DAS E66.0 sans preuve exploitable",
"VETO-02 [MEDIUM] diagnostics_associes[2]: DAS F41.9 sans preuve exploitable"
],
"source_files": [],
"ghm_estimation": {
"cmd": "10",
"cmd_libelle": "Maladies endocriniennes",
"type_ghm": "M",
"severite": 1,
"ghm_approx": "10M??1",
"cma_count": 0,
"cms_count": 0,
"alertes": []
},
"controles_cpam": [],
"veto_report": {
"verdict": "NEED_INFO",
"score_contestabilite": 55,
"issues": [
{
"veto": "VETO-02",
"severity": "MEDIUM",
"where": "diagnostics_associes[0]",
"message": "DAS I10 sans preuve exploitable",
"citation": "Principe de preuve : tout diagnostic/acte doit être étayé par une trace dans le dossier médical (Guide Méthodologique MCO)"
},
{
"veto": "VETO-02",
"severity": "MEDIUM",
"where": "diagnostics_associes[1]",
"message": "DAS E66.0 sans preuve exploitable",
"citation": "Principe de preuve : tout diagnostic/acte doit être étayé par une trace dans le dossier médical (Guide Méthodologique MCO)"
},
{
"veto": "VETO-02",
"severity": "MEDIUM",
"where": "diagnostics_associes[2]",
"message": "DAS F41.9 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": "E11.9",
"libelle": "Diabète de type 2",
"type_diag": "DP",
"items": [
{
"categorie": "biologie",
"element": "HbA1c",
"statut": "present",
"valeur": "12.6",
"importance": "recommande",
"impact_cpam": "HbA1c attendue pour documenter l'équilibre glycémique"
},
{
"categorie": "biologie",
"element": "Glycémie",
"statut": "absent",
"importance": "recommande",
"impact_cpam": "Glycémie de base pour confirmer le diagnostic"
}
],
"score": 85,
"verdict": "defendable",
"resume": "1/2 recommandés"
},
{
"code": "E66.0",
"libelle": "Obésité (IMC 41.49)",
"type_diag": "DAS",
"items": [
{
"categorie": "clinique",
"element": "IMC",
"statut": "absent",
"importance": "obligatoire",
"impact_cpam": "IMC ≥ 30 indispensable pour coder une obésité"
},
{
"categorie": "clinique",
"element": "Poids",
"statut": "absent",
"importance": "obligatoire",
"impact_cpam": "Poids nécessaire pour calculer l'IMC"
}
],
"score": 30,
"verdict": "indefendable",
"resume": "0/2 obligatoires"
}
],
"score_global": 57,
"verdict_global": "indefendable",
"documents_presents": [
"crh"
],
"documents_manquants": []
},
"processing_time_s": 19.14,
"metrics": {
"das_total": 3,
"das_active": 3,
"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": []
}
}
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