Improving Emergency Department Efficiency With Large Language Model-Guided Orthopaedic Triage for Proximal Humerus Fractures.

OBJECTIVES

To evaluate whether large language models can reduce consults for proximal humerus fractures that do not meet institutional consult criteria.

DESIGN

Retrospective review.

SETTING

Single-center Level 1 trauma center.

PATIENT SELECTION CRITERIA: Adults presenting to the emergency department (ED) with isolated proximal humerus fractures over a 2-year period were included. Exclusion criteria were polytrauma, concomitant orthopaedic injuries, pathologic fractures, lack of in-house ED imaging, and fractures missed in the ED.

OUTCOME MEASURES AND COMPARISONS: Generative Pretrained Transformer-4o (GPT-4o) and o4-mini were provided history of present illnesses, physical examinations, and X-ray reports and asked whether orthopaedics consultation was indicated based on institutional criteria (open fracture, tenting skin, neurovascular compromise, or humeral head dislocation). A gold standard was determined by 2 independent authors who retrospectively reviewed each case and reached consensus on consult necessity based on these criteria. Large language models alignment with this standard was compared with performance of real-world providers using generalized linear models. Consult wait time and work relative value unit (wRVU) savings were estimated using the cohort's average wait time and Current Procedural Terminology-based wRVUs for a 30-minute low-to-moderate complexity outpatient consult.

RESULTS

Three-hundred fifteen patients (99 males and 216 females) were included (average age: 65.1 years, range: 20-100 years). Alignment with consult criteria was 92.4% [95% confidence interval (CI) (88.9%, 94.8%)] for GPT-4o, 94.9% [95% CI (91.9%, 96.9%)] for o4-mini and 32.7% [95% CI (27.7%, 38.1%)] for ED providers. From a baseline of 240 consults, 327.3 wait hours, and 432 wRVUs, GPT-4o could have saved 179 consults, 295.3 wait hours, and 322.2 wRVUs over 2 years. o4-mini could have saved 183 consults, 302.0 wait hours, and 329.4 wRVUs.

CONCLUSIONS

Large language models accurately identified uncomplicated proximal humerus fractures, potentially conserving unnecessary ED orthopaedic consults.

LEVEL OF EVIDENCE: Prognostic, Level III. See Instructions for Authors for a complete description of levels of evidence.