354 lines
9.7 KiB
JSON
354 lines
9.7 KiB
JSON
{
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"source_file": "CRO 23098838.pdf",
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"document_type": "crh",
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"sejour": {
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"sexe": "M"
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},
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"diagnostic_principal": {
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"texte": "Suspicion de carcinome urothélial",
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"cim10_suggestion": "C67.9",
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"cim10_confidence": "low",
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"cim10_final": "C67.9",
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"sources_rag": [],
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"preuves_cliniques": [],
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"niveau_severite": "non_evalue",
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"niveau_cma": 1,
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"source": "nuke3"
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},
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"dp_selection": {
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"chosen_index": 3,
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"chosen_term": "Suspicion de carcinome urothélial",
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"chosen_code": "C67.9",
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"confidence": "medium",
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"verdict": "CONFIRMED",
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"evidence": [
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"Le contexte clinique suggère une lésion vésicale identifiée.",
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"Le code C67.9 (Lésion polypoïde de la vessie) est le plus précis et reflète la prise en charge initiale."
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],
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"reason": "La lésion polypoïde est le motif principal de la consultation et de l'investigation.",
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"candidates": [
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{
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"index": 1,
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"term": "Lésion polypoïde de la vessie",
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"code": "C67.9",
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"confidence": "high",
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"source": "llm_das",
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"is_comorbidity_like": false,
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"is_symptom_like": false,
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"is_act_only": false,
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"section_strength": 1,
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"num_occurrences": 3,
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"score": 6.0,
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"score_details": {
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"section": 1,
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"confidence": 3,
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"occurrences": 2
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}
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},
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{
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"index": 3,
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"term": "Suspicion de carcinome urothélial",
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"code": "C67.9",
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"confidence": "high",
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"source": "llm_das",
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"is_comorbidity_like": false,
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"is_symptom_like": false,
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"is_act_only": false,
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"section_strength": 1,
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"num_occurrences": 3,
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"score": 6.0,
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"score_details": {
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"section": 1,
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"confidence": 3,
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"occurrences": 2
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}
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},
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{
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"index": 2,
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"term": "Carcinome in situ de la vessie",
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"code": "C67.9",
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"confidence": "medium",
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"source": "llm_das",
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"is_comorbidity_like": false,
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"is_symptom_like": false,
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"is_act_only": false,
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"section_strength": 1,
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"num_occurrences": 3,
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"score": 4.0,
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"score_details": {
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"section": 1,
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"confidence": 1,
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"occurrences": 2
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}
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},
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{
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"index": 0,
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"term": "Gynécologique",
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"code": "D26.0",
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"confidence": "medium",
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"source": "edsnlp",
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"is_comorbidity_like": false,
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"is_symptom_like": false,
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"is_act_only": false,
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"section_strength": 2,
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"num_occurrences": 1,
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"score": 3.0,
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"score_details": {
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"section": 2,
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"confidence": 1
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}
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}
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],
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"debug_scores": {
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"top1": 6.0,
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"top2": 6.0,
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"delta": 0.0,
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"llm": true
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}
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},
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"dp_crh_only": {
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"chosen_index": 3,
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"chosen_term": "Suspicion de carcinome urothélial",
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"chosen_code": "C67.9",
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"confidence": "medium",
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"verdict": "CONFIRMED",
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"evidence": [
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"Le contexte clinique suggère une lésion vésicale identifiée.",
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"Le code C67.9 (Lésion polypoïde de la vessie) est le plus précis et reflète la prise en charge initiale."
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],
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"reason": "La lésion polypoïde est le motif principal de la consultation et de l'investigation.",
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"candidates": [
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{
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"index": 1,
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"term": "Lésion polypoïde de la vessie",
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"code": "C67.9",
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"confidence": "high",
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"source": "llm_das",
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"is_comorbidity_like": false,
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"is_symptom_like": false,
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"is_act_only": false,
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"section_strength": 1,
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"num_occurrences": 3,
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"score": 6.0,
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"score_details": {
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"section": 1,
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"confidence": 3,
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"occurrences": 2
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}
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},
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{
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"index": 3,
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"term": "Suspicion de carcinome urothélial",
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"code": "C67.9",
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"confidence": "high",
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"source": "llm_das",
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"is_comorbidity_like": false,
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"is_symptom_like": false,
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"is_act_only": false,
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"section_strength": 1,
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"num_occurrences": 3,
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"score": 6.0,
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"score_details": {
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"section": 1,
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"confidence": 3,
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"occurrences": 2
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}
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},
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{
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"index": 2,
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"term": "Carcinome in situ de la vessie",
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"code": "C67.9",
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"confidence": "medium",
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"source": "llm_das",
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"is_comorbidity_like": false,
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"is_symptom_like": false,
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"is_act_only": false,
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"section_strength": 1,
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"num_occurrences": 3,
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"score": 4.0,
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"score_details": {
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"section": 1,
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"confidence": 1,
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"occurrences": 2
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}
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},
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{
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"index": 0,
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"term": "Gynécologique",
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"code": "D26.0",
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"confidence": "medium",
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"source": "edsnlp",
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"is_comorbidity_like": false,
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"is_symptom_like": false,
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"is_act_only": false,
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"section_strength": 2,
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"num_occurrences": 1,
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"score": 3.0,
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"score_details": {
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"section": 2,
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"confidence": 1
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}
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}
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],
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"debug_scores": {
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"top1": 6.0,
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"top2": 6.0,
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"delta": 0.0,
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"llm": true
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}
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},
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"dp_final": {
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"chosen_index": 3,
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"chosen_term": "Suspicion de carcinome urothélial",
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"chosen_code": "C67.9",
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"confidence": "medium",
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"verdict": "CONFIRMED",
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"evidence": [
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"Le contexte clinique suggère une lésion vésicale identifiée.",
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"Le code C67.9 (Lésion polypoïde de la vessie) est le plus précis et reflète la prise en charge initiale."
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],
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"reason": "La lésion polypoïde est le motif principal de la consultation et de l'investigation.",
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"candidates": [
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{
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"index": 1,
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"term": "Lésion polypoïde de la vessie",
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"code": "C67.9",
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"confidence": "high",
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"source": "llm_das",
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"is_comorbidity_like": false,
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"is_symptom_like": false,
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"is_act_only": false,
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"section_strength": 1,
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"num_occurrences": 3,
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"score": 6.0,
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"score_details": {
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"section": 1,
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"confidence": 3,
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"occurrences": 2
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}
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},
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{
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"index": 3,
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"term": "Suspicion de carcinome urothélial",
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"code": "C67.9",
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"confidence": "high",
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"source": "llm_das",
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"is_comorbidity_like": false,
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"is_symptom_like": false,
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"is_act_only": false,
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"section_strength": 1,
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"num_occurrences": 3,
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"score": 6.0,
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"score_details": {
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"section": 1,
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"confidence": 3,
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"occurrences": 2
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}
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},
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{
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"index": 2,
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"term": "Carcinome in situ de la vessie",
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"code": "C67.9",
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"confidence": "medium",
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"source": "llm_das",
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"is_comorbidity_like": false,
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"is_symptom_like": false,
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"is_act_only": false,
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"section_strength": 1,
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"num_occurrences": 3,
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"score": 4.0,
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"score_details": {
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"section": 1,
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"confidence": 1,
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"occurrences": 2
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}
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},
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{
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"index": 0,
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"term": "Gynécologique",
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"code": "D26.0",
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"confidence": "medium",
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"source": "edsnlp",
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"is_comorbidity_like": false,
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"is_symptom_like": false,
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"is_act_only": false,
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"section_strength": 2,
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"num_occurrences": 1,
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"score": 3.0,
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"score_details": {
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"section": 2,
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"confidence": 1
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}
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}
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],
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"debug_scores": {
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"top1": 6.0,
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"top2": 6.0,
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"delta": 0.0,
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"llm": true
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}
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},
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"quality_flags": {
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"crh_only_mode": true
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},
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"diagnostics_associes": [],
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"actes_ccam": [],
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"antecedents": [],
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"traitements_sortie": [],
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"biologie_cle": [],
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"biologie_discarded": [],
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"imagerie": [],
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"complications": [],
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"alertes_codage": [
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"QC: DP C67.9 confiance medium→low — Le code C67.9 (Suspicion de carcinome urothélial) est inapproprié sans confirmation diagnostique. La justification 'Preuves: aucune' indique clairement qu'il s'agit d'une suspicion et non d'un diagnostic confirmé. Un code plus approprié serait X99.9 (État suspecté d'une tumeur maligne, non confirmé), qui reflète l'état actuel de la suspicion. Il est crucial de ne coder que ce qui est diagnostiqué, et non les suspicions.",
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"QC: Le codage actuel semble basé sur une suspicion diagnostique. Il est impératif de revoir le dossier clinique pour confirmer ou infirmer le diagnostic et ajuster le codage en conséquence. L'utilisation de codes de suspicion doit être limitée et justifiée.",
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"VETOS[PDF]: FAIL (score=70)",
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"VETO-02 [HARD] diagnostic_principal: DP C67.9 sans preuve exploitable"
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],
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"source_files": [],
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"ghm_estimation": {
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"cmd": "17",
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"cmd_libelle": "Tumeurs malignes",
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"type_ghm": "M",
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"severite": 1,
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"ghm_approx": "17M??1",
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"cma_count": 0,
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"cms_count": 0,
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"alertes": []
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},
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"controles_cpam": [],
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"veto_report": {
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"verdict": "FAIL",
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"score_contestabilite": 70,
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"issues": [
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{
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"veto": "VETO-02",
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"severity": "HARD",
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"where": "diagnostic_principal",
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"message": "DP C67.9 sans preuve exploitable"
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}
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]
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},
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"processing_time_s": 53.53,
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"metrics": {
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"das_total": 0,
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"das_active": 0,
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"das_excluded": 0,
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"das_removed": 0,
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"das_ruled_out": 0,
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"das_no_code": 0,
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"actes_total": 0,
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"actes_with_code": 0,
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"dp_has_code": true
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},
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"rules_runtime": {
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"router_version": 1,
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"mode": "strict",
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"enabled_packs": [
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"decisions_core",
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"vetos_core"
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],
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"always_on_rules": [],
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"triggers_fired": []
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}
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} |