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t2a_v2/output/structured/142_23093202/CRH_23093202_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 23093202.pdf",
"document_type": "crh",
"sejour": {
"sexe": "F",
"age": 86,
"date_entree": "12/05/2023",
"date_sortie": "16/05/2023",
"duree_sejour": 4
},
"diagnostic_principal": {
"texte": "Angiocholite",
"cim10_suggestion": "K83.0",
"cim10_confidence": "high",
"cim10_final": "K83.0",
"sources_rag": [],
"preuves_cliniques": [],
"est_cma": true,
"niveau_severite": "non_evalue",
"niveau_cma": 2,
"source": "nuke3",
"source_page": 1,
"source_excerpt": "...suivant:\nfaudemar@ch-cotebasque.fr\nPraticiens Hospitaliers\n- Patiente transférée de St Palais pour angiocholite aiguë lithiasique chez une patiente cholécystectomisée.\nDr M. BOUBE\nA. In. Hôpitaux Clermont Ferran..."
},
"dp_selection": {
"chosen_index": 0,
"chosen_term": "Angiocholite",
"chosen_code": "K83.0",
"verdict": "REVIEW",
"evidence": [
"Scores proches : 3.0 vs 1.0"
],
"reason": "Écart 2.0 < seuil 3.0, LLM indisponible",
"candidates": [
{
"index": 0,
"term": "Angiocholite",
"code": "K83.0",
"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": 1,
"term": "Rétrécissement aortique",
"code": "I35.0",
"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": 1.0,
"delta": 2.0
}
},
"dp_crh_only": {
"chosen_index": 0,
"chosen_term": "Angiocholite",
"chosen_code": "K83.0",
"verdict": "REVIEW",
"evidence": [
"Scores proches : 3.0 vs 1.0"
],
"reason": "Écart 2.0 < seuil 3.0, LLM indisponible",
"candidates": [
{
"index": 0,
"term": "Angiocholite",
"code": "K83.0",
"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": 1,
"term": "Rétrécissement aortique",
"code": "I35.0",
"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": 1.0,
"delta": 2.0
}
},
"dp_final": {
"chosen_index": 0,
"chosen_term": "Angiocholite",
"chosen_code": "K83.0",
"verdict": "REVIEW",
"evidence": [
"Scores proches : 3.0 vs 1.0"
],
"reason": "Écart 2.0 < seuil 3.0, LLM indisponible",
"candidates": [
{
"index": 0,
"term": "Angiocholite",
"code": "K83.0",
"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": 1,
"term": "Rétrécissement aortique",
"code": "I35.0",
"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": 1.0,
"delta": 2.0
}
},
"quality_flags": {
"rag_status": "error",
"crh_only_mode": true
},
"diagnostics_associes": [
{
"texte": "Rétrécissement aortique",
"cim10_suggestion": "I35.0",
"cim10_confidence": "medium",
"cim10_final": "I35.0",
"justification": "Souffle systolique modéré irradiant dans les carotides avec mention 'RA connu' (rétrécissement aortique). Antécédent cardiaque pertinent pour le séjour d'une patiente de 86 ans ayant nécessité une consultation d'anesthésie et une prise en charge médicale adaptée.",
"sources_rag": [],
"preuves_cliniques": [],
"niveau_severite": "non_evalue",
"niveau_cma": 1,
"source": "llm_das"
}
],
"actes_ccam": [
{
"texte": "TDM abdominal",
"code_ccam_suggestion": "ZCQK002",
"sources_rag": [],
"date": "12/05",
"validite": "valide",
"alertes": []
}
],
"antecedents": [],
"traitements_sortie": [],
"biologie_cle": [],
"biologie_discarded": [],
"imagerie": [],
"complications": [
{
"texte": "Fièvre",
"source_page": 1,
"source_excerpt": "...Lovenox préventif suspendu dimanche soir\nHépato-gastro-entérologue\nProctologue - Prélever Hémoc si fièvre\nExplorations Fonct. Digestives - Alimentation BYC\nmcboudier@ch-cotebasque.fr - Consultation d'anest..."
}
],
"alertes_codage": [
"QUALITE DEGRADEE : erreur RAG — codage sans référentiels",
"NUKE-3 REVIEW: DP ambigu — Écart 2.0 < seuil 3.0, LLM indisponible",
"CMA niveau 2 : 'Angiocholite' (K83.0) — sévérité non_evalue",
"QC: ⚠️ ALERTE MAJEURE: Aucune preuve clinique documentée pour les 2 codes principaux. Cela suggère un codage par 'habitude' ou 'hypothèse' sans fondement dans le dossier.",
"QC: ⚠️ DP K83.0 sans justification: Risque de codage abusif. Demander au clinicien la documentation précise (biologie, imagerie, diagnostic confirmé).",
"QC: ⚠️ Fièvre mentionnée comme complication mais NON codée (R50.9 ou spécifique). À clarifier: est-ce lié à l'angiocholite supposée ou autre?",
"QC: ⚠️ Durée courte (4 jours) + patient âgé (86 ans) + 1 complication: Vérifier la pertinence du DP et des DAS pour justifier la complexité du séjour.",
"QC: ⚠️ RECOMMANDATION: Demander au clinicien une documentation complète avec preuves biologiques/radiologiques avant validation définitive.",
"VETOS[PDF]: FAIL (score=40)",
"VETO-02 [MEDIUM] diagnostics_associes[0]: DAS I35.0 sans preuve exploitable",
"VETO-02 [HARD] actes_ccam[0]: Acte ZCQK002 sans preuve exploitable",
"VETO-03 [MEDIUM] diagnostic_principal: DP K83.0 basé sur du conditionnel"
],
"source_files": [],
"ghm_estimation": {
"cmd": "07",
"cmd_libelle": "Affections hépatobiliaires et pancréatiques",
"type_ghm": "K",
"severite": 1,
"ghm_approx": "07K??1",
"cma_count": 0,
"cms_count": 0,
"alertes": []
},
"controles_cpam": [],
"veto_report": {
"verdict": "FAIL",
"score_contestabilite": 40,
"issues": [
{
"veto": "VETO-02",
"severity": "MEDIUM",
"where": "diagnostics_associes[0]",
"message": "DAS I35.0 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": "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)"
},
{
"veto": "VETO-03",
"severity": "MEDIUM",
"where": "diagnostic_principal",
"message": "DP K83.0 basé sur du conditionnel",
"citation": "Guide Méthodologique MCO : Un diagnostic conditionnel (suspecté, à éliminer) ne doit pas être codé comme confirmé"
}
]
},
"completude": {
"checks": [],
"score_global": 100,
"verdict_global": "defendable",
"documents_presents": [
"crh"
],
"documents_manquants": []
},
"processing_time_s": 20.59,
"metrics": {
"das_total": 1,
"das_active": 1,
"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": []
}
}
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