t2a_v2/output/structured/148_23018396/BACTERIO_23018396_cim10.json

{
  "source_file": "BACTERIO 23018396.pdf",
  "document_type": "crh",
  "sejour": {},
  "diagnostic_principal": {
    "texte": "Infection de la hanche à Staphylococcus epidermidis",
    "cim10_suggestion": "M00.9",
    "cim10_confidence": "medium",
    "cim10_final": "M00.9",
    "cim10_decision": {
      "action": "PROMOTE_DP",
      "final_code": "M00.9",
      "reason": "DAS promu en DP (score (2, 2, 4))",
      "needs_info": [],
      "applied_rules": [
        "RULE-DAS-TO-DP"
      ]
    },
    "justification": "Culture positive de Staphylococcus epidermidis sur prélèvement de pus profond au niveau de la hanche avec antibiothérapie en cours (daptomycine). Infection articulaire/osseuse documentée ayant mobilisé des ressources (prélèvement, culture, antibiothérapie).",
    "sources_rag": [],
    "preuves_cliniques": [],
    "source": "llm_das"
  },
  "dp_selection": {
    "chosen_index": 0,
    "chosen_term": "Infection de la hanche à Staphylococcus epidermidis",
    "chosen_code": "M00.9",
    "verdict": "CONFIRMED",
    "evidence": [
      "Score 1.0 — source: llm_das"
    ],
    "reason": "Candidat unique",
    "candidates": [
      {
        "index": 0,
        "term": "Infection de la hanche à Staphylococcus epidermidis",
        "code": "M00.9",
        "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
        }
      }
    ],
    "debug_scores": {
      "top1": 1.0
    }
  },
  "dp_crh_only": {
    "chosen_index": 0,
    "chosen_term": "Infection de la hanche à Staphylococcus epidermidis",
    "chosen_code": "M00.9",
    "verdict": "CONFIRMED",
    "evidence": [
      "Score 1.0 — source: llm_das"
    ],
    "reason": "Candidat unique",
    "candidates": [
      {
        "index": 0,
        "term": "Infection de la hanche à Staphylococcus epidermidis",
        "code": "M00.9",
        "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
        }
      }
    ],
    "debug_scores": {
      "top1": 1.0
    }
  },
  "dp_final": {
    "chosen_index": 0,
    "chosen_term": "Infection de la hanche à Staphylococcus epidermidis",
    "chosen_code": "M00.9",
    "verdict": "CONFIRMED",
    "evidence": [
      "Score 1.0 — source: llm_das"
    ],
    "reason": "Candidat unique",
    "candidates": [
      {
        "index": 0,
        "term": "Infection de la hanche à Staphylococcus epidermidis",
        "code": "M00.9",
        "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
        }
      }
    ],
    "debug_scores": {
      "top1": 1.0
    }
  },
  "quality_flags": {
    "rag_status": "error",
    "crh_only_mode": true
  },
  "diagnostics_associes": [],
  "actes_ccam": [],
  "antecedents": [],
  "traitements_sortie": [],
  "biologie_cle": [],
  "biologie_discarded": [],
  "imagerie": [],
  "complications": [],
  "alertes_codage": [
    "QUALITE DEGRADEE : erreur RAG — codage sans référentiels",
    "QC: ⚠️ PREUVE MANQUANTE : Le champ 'Preuves' indique 'aucune' alors que la justification cite une 'culture positive' - incohérence majeure. Les résultats de culture doivent être présents dans le dossier clinique.",
    "QC: ⚠️ DOSSIER INCOMPLET : 'Non précisé' en en-tête - impossible de valider sans accès au dossier clinique complet.",
    "QC: ⚠️ JUSTIFICATION INCOMPLÈTE : Le texte s'arrête brutalement ('Infe') - à compléter.",
    "QC: ⚠️ CODE INSUFFISAMMENT SPÉCIFIQUE : M00.9 ne code ni l'agent (Staphylococcus) ni la localisation (hanche). Utiliser la sous-catégorie M00.0- avec le 5e caractère pour la localisation.",
    "QC: ⚠️ ABSENCE DE CODE SECONDAIRE : Considérer si un code pour l'antibiothérapie (daptomycine) ou les complications est nécessaire selon le contexte clinique.",
    "RULE-DAS-TO-DP: DP absent → DAS M00.9 (Infection de la hanche à Staphylococcus epidermidis) promu en DP",
    "DECISIONS[PDF]: 1 ligne(s)",
    "DECISION: diagnostic_principal M00.9 promu en DP (RULE-DAS-TO-DP)",
    "VETOS[PDF]: NEED_INFO (score=85)",
    "VETO-02 [MEDIUM] diagnostics_associes[0]: DAS M00.9 sans preuve exploitable"
  ],
  "source_files": [],
  "ghm_estimation": {
    "cmd": "08",
    "cmd_libelle": "Affections du système ostéo-articulaire",
    "type_ghm": "M",
    "severite": 1,
    "ghm_approx": "08M??1",
    "cma_count": 0,
    "cms_count": 0,
    "alertes": []
  },
  "controles_cpam": [],
  "veto_report": {
    "verdict": "NEED_INFO",
    "score_contestabilite": 85,
    "issues": [
      {
        "veto": "VETO-02",
        "severity": "MEDIUM",
        "where": "diagnostics_associes[0]",
        "message": "DAS M00.9 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": [],
    "score_global": 100,
    "verdict_global": "defendable",
    "documents_presents": [
      "crh"
    ],
    "documents_manquants": []
  },
  "processing_time_s": 9.65,
  "metrics": {
    "das_total": 0,
    "das_active": 0,
    "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": []
  }
}