Supplementary Data 2: Anonymized sample of an automated MedFactEval evaluation report (HTML format).

Factual evaluation of the single-prompt-gpt-4o summarizer by a LLM jury

Jury members: claude-3.5-sonnet-v2, llama4-scout, deepseek-r1

Main results

A. Presence of important facts

Score: 48/100 (95% CI: 37-58) (higher values better)

Feedback regarding the important facts missing:

Hospital course summaries frequently omit critical clinical facts due to recurring patterns: (1) Incomplete documentation of ongoing interventions, where removal of devices is noted but retention is excluded (Patient 0: JP drain left at discharge), or partial treatment details are provided without key parameters (Patient 0: DVT prophylaxis mentioned, but anemia/Hb 8.8 omitted). (2) Failure to explicitly link related conditions, such as hypoxia attributed to pleural effusion without causal phrasing (Patient 1) or AKI in CKD not documented despite urinary retention management (Patient 4). (3) Procedural/timeline vagueness, omitting surgical steps (Patient 2: adhesion takedown), medication specifics (Patient 6: insulin type/dose discrepancies), or temporal patterns (Patient 5: POD1 drain output trends). (4) Diagnostic ambiguity, where findings are implied but not stated (Patient 8: MRSA nares vs. sputum source) or critical terminology is avoided (Patient 17: “delirium tremens” vs. “alcohol withdrawal”). (5) Discharge plan omissions, including follow-up frequency (Patient 12: TPN without 4-week timeline) or diet/medication specifics (Patient 24: full liquid diet assumed but not explicitly stated). These patterns highlight systemic gaps in specificity, causal attribution, and comprehensive documentation across diverse clinical scenarios.

B. Hospital course summaries contradicting important facts

Score: 12/100 (95% CI: 5-18) (lower values better)

Feedback regarding the inconsistencies:

Hospital course inconsistencies commonly arise from direct therapeutic or diagnostic contradictions, omission of critical details, and temporal or interpretive mismatches. For example, Patient 0’surgical drain status conflicts between “removed” (summary) and “left at discharge” (fact), while Patient 6’s insulin regimen discrepancies (Levemir 16 BID vs. Lantus 15 BID) reflect medication/dose errors. Diagnostic contradictions include Patient 12’s gallbladder fistula (summary: “no definitive fistula” vs. fact: “found”), Patient 15’s principal diagnosis (summary omits viral gastroenteritis), and Patient 21’s fracture timing (summary: “new” vs. fact: “pre-existing”). Omissions are evident in Patient 9’s missing cipro/finasteride documentation and Patient 29’s unmentioned deferral of cancer management. Interpretive mismatches occur in Patient 26 (SMA stenosis attributed to gastroparesis vs. mesenteric ischemia) and Patient 18’s hypokalemia (fact: “resolved” vs. summary: ongoing supplementation). Temporal inconsistencies also appear in Patient 18’s “persistent fever” (fact) versus “afebrile at discharge” (summary). These patterns highlight errors in documentation specificity, reconciliation of imaging/clinical findings, and medication/diagnosis attribution.

Detailed results

A. Presence of important facts

Patient	Fact 0			Fact 1			Fact 2			Majority Vote
Patient	claude-3.5-sonnet-v2	llama4-scout	deepseek-r1	claude-3.5-sonnet-v2	llama4-scout	deepseek-r1	claude-3.5-sonnet-v2	llama4-scout	deepseek-r1	F0	F1	F2
Patient 0	Yes	Yes	Yes	No	No	No	No	No	No	Yes	No	No
Patient 1	Yes	No	No	Yes	Yes	Yes	Yes	Yes	Yes	No	Yes	Yes
Patient 2	Yes	Yes	Yes	No	Yes	No	No	No	No	Yes	No	No
Patient 3	Yes	Yes	Yes	Yes	Yes	No	Yes	Yes	Yes	Yes	Yes	Yes
Patient 4	Yes	Yes	Yes	Yes	Yes	Yes	No	No	No	Yes	Yes	No
Patient 5	Yes	Yes	Yes	Yes	Yes	Yes	No	No	No	Yes	Yes	No
Patient 6	No	No	No	No	No	No	Yes	Yes	Yes	No	No	Yes
Patient 7	No	No	No	No	No	No	Yes	Yes	Yes	No	No	Yes
Patient 8	No	Yes	No	No	No	No	Yes	Yes	Yes	No	No	Yes
Patient 9	No	No	No	Yes	Yes	Yes	No	No	No	No	Yes	No
Patient 10	Yes	No	No	Yes	Yes	Yes	No	No	No	No	Yes	No
Patient 11	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes
Patient 12	Yes	Yes	Yes	No	No	No	No	No	No	Yes	No	No
Patient 13	Yes	Yes	No	Yes	Yes	Yes	No	Yes	No	Yes	Yes	No
Patient 14	Yes	Yes	No	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes
Patient 15	No	No	No	Yes	Yes	No	No	Yes	No	No	Yes	No
Patient 16	Yes	Yes	No	No	No	No	No	No	No	Yes	No	No
Patient 17	No	Yes	No	Yes	Yes	Yes	Yes	Yes	Yes	No	Yes	Yes
Patient 18	No	Yes	No	Yes	Yes	No	Yes	Yes	No	No	Yes	Yes
Patient 19	No	No	No	Yes	Yes	Yes	No	Yes	No	No	Yes	No
Patient 20	Yes	Yes	Yes	Yes	Yes	No	No	No	No	Yes	Yes	No
Patient 21	No	Yes	No	No	No	No	No	No	No	No	No	No
Patient 22	Yes	Yes	Yes	No	No	No	No	No	No	Yes	No	No
Patient 23	Yes	Yes	Yes	Yes	No	No	No	No	No	Yes	No	No
Patient 24	Yes	Yes	Yes	Yes	Yes	No	No	Yes	No	Yes	Yes	No
Patient 25	Yes	Yes	Yes	No	No	No	No	No	No	Yes	No	No
Patient 26	Yes	Yes	Yes	No	No	No	No	Yes	No	Yes	No	No
Patient 27	Yes	No	No	Yes	No	Yes	No	Yes	No	No	Yes	No
Patient 28	Yes	Yes	Yes	No	Yes	Yes	No	No	No	Yes	Yes	No
Patient 29	Yes	Yes	Yes	No	Yes	No	No	No	No	Yes	No	No

All Missing Facts and Explanations

1. Patient 0, Fact 1:

Fact: Left-sided abdominal JP drain left at time of discharge
Explanation from claude-3.5-sonnet-v2: After carefully reviewing the hospital course summary, there is no explicit mention of a left sided abdominal JP drain being present at discharge. While the summary does mention drains in general (‘close attention to fluids and drains’ and ‘amylase levels normalized leading to drain removal’), it actually suggests that drains were removed prior to discharge rather than being left in place. The statement about ‘drain removal’ specifically indicates that at least some drains were taken out. There is no mention of any drain being retained at discharge, and specifically no mention of a left sided abdominal JP drain being present at discharge.
Explanation from llama4-scout: To determine if the fact ‘Left sided abdominal JP drain left at time of discharge’ is explicitly mentioned, I analyzed the provided hospital course summary. The summary details the patient’s hospital course, including the Whipple procedure for duodenal adenocarcinoma, postoperative care, and discharge plans. Under ‘Problem #1: Duodenal Adenocarcinoma Post Whipple Procedure,’ it is mentioned that ‘amylase levels normalized leading to drain removal.’ This indicates that drains were removed before discharge. The summary does not explicitly or implicitly mention a left sided abdominal JP drain being left at the time of discharge. Therefore, the fact is not present in the summary.
Explanation from deepseek-r1: The hospital course summary mentions ‘drain removal’ due to normalized amylase levels in Problem #1’s Current Clinical Status, indicating drains were removed prior to discharge. While drains are referenced in the context of postoperative care, there is no specific mention of a ‘left sided abdominal JP drain’ being left in place at discharge. The text explicitly states drain removal occurred, which contradicts the presence of a remaining drain at discharge. No equivalent terms or abbreviations for this specific drain type and location are found in the document.

2. Patient 0, Fact 2:

Fact: Discharged with DVT prophylaxis, with anemia at hemoglobin 8.8
Explanation from claude-3.5-sonnet-v2: I carefully reviewed the hospital course summary looking for explicit mention of discharge hemoglobin level of 8.8 and DVT prophylaxis. While the summary does mention Lovenox (a DVT prophylaxis medication) in two places under ‘Outstanding Issues/Follow Up’ and under Problem #1’s discharge plan (‘ensure compliance with Lovenox’), there is no mention anywhere of the patient’s hemoglobin level being 8.8 or any indication of anemia. The fact requires both components (DVT prophylaxis AND hemoglobin of 8.8) to be considered fully present. While one component (DVT prophylaxis) is clearly documented, the other (specific hemoglobin value and anemia) is not mentioned at all. Therefore, the complete fact as stated is not fully present in the summary.
Explanation from llama4-scout: To determine if the fact ‘Discharged with DVT prophylaxis, with anemia at hemoglobin 8.8’ is explicitly mentioned in the hospital course summary, we need to analyze the provided text for relevant information. The summary includes sections on the hospital course, outstanding issues, and problem based summaries. We look for mentions of ‘DVT prophylaxis’ and ‘anemia’ or ‘hemoglobin 8.8’. The summary mentions ‘Lovenox Teaching and Monitoring’ under ‘Outstanding Issues/Follow Up’, indicating DVT prophylaxis since Lovenox is commonly used for this purpose. However, there is no explicit mention of ‘anemia’ or a ‘hemoglobin level of 8.8’ in the provided summary. Thus, while DVT prophylaxis is implied through Lovenox administration, the specific detail about anemia and hemoglobin level is not present.
Explanation from deepseek-r1: 1. Checking for DVT prophylaxis: The summary states under ‘Outstanding Issues/Follow Up’ that there is ‘Lovenox Teaching and Monitoring.’ Lovenox (enoxaparin) is a standard DVT prophylaxis medication, so this part of the fact is explicitly mentioned. 2. Checking for anemia with hemoglobin 8.8: The summary does not contain any mention of anemia, hemoglobin levels, or a hemoglobin value of 8.8 in any section (including problem summaries, discharge plans, or medical history). While nutritional issues are discussed, anemia is not referenced. 3. Conclusion: While DVT prophylaxis is clearly documented, the anemia component is entirely absent. Since both elements are required for the fact to be considered mentioned, the overall fact is not fully present.

3. Patient 1, Fact 0:

Fact: Hypoxia 2/2 recurrent R pleura effusion
Explanation from llama4-scout: To determine if the fact ‘Hypoxia 2/2 recurrent R pleura effusion’ is explicitly mentioned in the hospital course summary, we need to analyze the provided text. The summary is structured into several sections including a one liner, brief description of hospital course, outstanding issues/follow up, and a problem based summary. The fact in question involves two main components: hypoxia and its relation to a recurrent right pleural effusion. We will look for explicit mentions or clear implications of these components. Under ‘Problem #2: Hypoxia and Respiratory Management,’ it is stated that the patient had ‘persistent hypoxia’ and that there was a ‘potential future dependency on home supplemental oxygen due to baseline pulmonary status.’ Additionally, under ‘Problem #1: Right Loculated Pleural Effusion,’ it is mentioned that there is a need to ‘Monitor for recurrent effusion.’ While the summary does not directly state ‘Hypoxia 2/2 recurrent R pleura effusion,’ it implies a connection between hypoxia and the pleural effusion through the context provided. However, the direct causal link ‘2/2’ (secondary to) between hypoxia and recurrent right pleural effusion is not explicitly stated in the summary. The closest relevant information is found under the respective problem sections which discuss hypoxia and pleural effusion separately but indicate ongoing issues with both. Thus, while the summary strongly suggests a relationship between the patient’s hypoxia and pleural effusion, it does not explicitly state that the hypoxia is secondary to the recurrent right pleural effusion.
Explanation from deepseek-r1: 1. The fact in question is ‘Hypoxia 2/2 recurrent R pleura effusion’ (hypoxia secondary to recurrent right pleural effusion). 2. The hospital course explicitly documents hypoxia in Problem #2 (Hypoxia and Respiratory Management), including persistent hypoxia and post procedural desaturation. 3. The summary also documents recurrent right pleural effusion in Problem #1 (Right Loculated Pleural Effusion), with monitoring for recurrence listed as an outstanding issue. 4. However, the text does not explicitly state a causal relationship between hypoxia and recurrent pleural effusion. While both conditions are present, the effusion’s loculated nature and partial resolution are described, and hypoxia is attributed to ‘baseline pulmonary status’ rather than directly to recurrent effusion. 5. Though a temporal association exists (hypoxia persisted post chest tube removal), the summary does not use phrasing that clearly attributes hypoxia etiology to recurrent effusion. No clinical synonyms or abbreviations (e.g., ‘hypoxia due to recurrent R effusion’) are present.

4. Patient 2, Fact 1:

Fact: Adhesions between omentum and abdominal wall were taken down, and obstructing necrotic mass were removed. Small bowel resection with primary anastomosis was performed
Explanation from claude-3.5-sonnet-v2: While the summary mentions that a laparoscopic small bowel resection with primary anastomosis was performed (under Problem #1), it does not explicitly mention the specific surgical details about taking down adhesions between omentum and abdominal wall or removing obstructing necrotic mass. The summary only states that there was ‘a necrotic mass in the small bowel’ and that a ‘laparoscopic small bowel resection with primary anastomosis’ was performed on [anonymized date]. While the presence of the necrotic mass is mentioned, the specific surgical steps of taking down adhesions and removing the obstructing mass are not explicitly detailed in the hospital course summary.
Explanation from deepseek-r1: The hospital course summary explicitly mentions ‘Laparoscopic small bowel resection with primary anastomosis performed’ under Therapeutic Procedures for Problem #1, which directly matches the second part of the target fact. The summary also states a ‘necrotic mass in the small bowel’ was identified and resected, fulfilling the ‘obstructing necrotic mass were removed’ component. However, there is no mention of adhesions between the omentum and abdominal wall being taken down in any section of the summary. While the resection and mass removal are clearly documented, the adhesion takedown is absent. Since the fact requires both components (adhesion takedown + mass removal/resection), and one component is missing, the full fact is not explicitly stated.

5. Patient 2, Fact 2:

Fact: Patient recovered from surgery well; had flatus and bowel movement
Explanation from claude-3.5-sonnet-v2: After analyzing the hospital course summary, while it mentions that the patient underwent a successful laparoscopic small bowel resection and had ‘improved tolerance of oral intake,’ it does not explicitly mention the passage of flatus or bowel movement postoperatively. The summary states that the ‘postoperative course was unremarkable’ and that the patient was ‘stable post surgery with no acute concerns,’ but these general statements don’t specifically confirm the return of bowel function. Since the return of bowel function (flatus and bowel movement) is a critical post operative milestone, and it is not explicitly mentioned in any form in the summary, we must conclude that this specific fact is not present in the text.
Explanation from llama4-scout: The hospital course summary was analyzed to determine if it mentions that the patient recovered from surgery well, had flatus, and had a bowel movement. The summary states that the patient underwent a ‘successful laparoscopic small bowel resection’ and postoperatively, her course was ‘unremarkable.’ It also mentions that there was ‘improved tolerance of oral intake,’ indicating a return to normal bowel function. However, the specific details about flatus and bowel movement are not explicitly mentioned. Despite this, the overall context suggests a smooth recovery, which aligns with the fact in question.
Explanation from deepseek-r1: The hospital course summary states that the patient had an ‘unremarkable’ postoperative course with ‘improved tolerance of oral intake’ but does not explicitly mention flatus or bowel movement. While these are common markers of postoperative gastrointestinal recovery, the text does not use these terms or clear synonyms (e.g., ‘passing gas,’ ‘BM,’ ‘bowel function return’). The absence of these specific indicators—despite describing other aspects of recovery—means the fact is not explicitly documented.

6. Patient 3, Fact 1:

Fact: R-sided chest pain 2/2 port-associated thrombus
Explanation from deepseek-r1: The hospital course summary explicitly mentions ‘chest pain’ and ‘right port thrombus’ in the one liner and Problem #3 (Port associated Thrombus). However, the chest pain is consistently attributed to metastatic disease in Problem #2 (Cancer related Pain) and the Brief Description, where it states ‘chest pain […] due to progressive metastatic disease.’ The port associated thrombus is described as a separate issue managed with anticoagulation, with no documented causal link to the chest pain. Since the fact requires chest pain to be explicitly linked to the port thrombus (2/2), and this connection is absent in the text, the fact is not explicitly stated.

7. Patient 4, Fact 2:

Fact: AKI on CKD 2/2 urinary retention treated with foley catheter placement
Explanation from claude-3.5-sonnet-v2: Let’s analyze step by step: 1. The text mentions AKI (Acute Kidney Injury) on CKD: Not explicitly mentioned. While CKD IV is clearly documented, there is no mention of acute kidney injury. 2. Urinary retention: Explicitly mentioned multiple times, including in the one liner and Problem #2 section. 3. Treatment with foley catheter: Explicitly mentioned in Problem #2 section “Foley placed for retention due to enlarged prostate” and “Foley catheter management.” 4. Causation (2/2): While the urinary retention and foley placement are mentioned, there is no explicit statement linking AKI to the urinary retention. The text only discusses stable CKD IV without mention of acute injury. While parts of the fact are present (urinary retention and foley placement), the critical component of AKI on CKD is not mentioned. The summary only discusses stable CKD IV with Cr 3.64 3.80 mg/dL, without indicating an acute injury. Therefore, the complete fact as stated is not fully present in the text.
Explanation from llama4-scout: The hospital course summary explicitly mentions that the patient had urinary retention, for which a Foley catheter was placed. It also mentions the patient’s history of CKD IV and that their kidney function was monitored during the hospital stay. The summary under ‘Problem #2: CKD IV and Urinary Retention’ states that the patient had CKD IV and urinary retention, and that a Foley catheter was placed due to an enlarged prostate, indicating urinary retention was treated with Foley catheter placement. Although the summary does not explicitly state ‘AKI on CKD’, it does mention that the patient’s creatinine levels were monitored and were in the range of 3.64 3.80 mg/dL, indicating some level of kidney dysfunction. However, it does not directly state that there was an acute kidney injury (AKI) on top of CKD. Nonetheless, the key elements of CKD, urinary retention, and treatment with a Foley catheter are all present.
Explanation from deepseek-r1: The hospital course summary explicitly mentions CKD IV and urinary retention treated with foley catheter placement. However, it does not explicitly state ‘AKI on CKD’ (acute kidney injury superimposed on chronic kidney disease). While the summary documents CKD IV and urinary retention as a problem, and notes foley placement for retention, there is no mention of an acute kidney injury episode (e.g., rising creatinine from baseline, documentation of AKI terminology, or acute worsening of renal function). The creatinine level (3.64 3.80 mg/dL) is presented as part of the chronic CKD IV status rather than an acute change. Thus, while CKD and urinary retention management are documented, the specific fact of ‘AKI on CKD’ is not explicitly stated.

8. Patient 5, Fact 2:

Fact: Increased bloody output from JP drain observed on POD1, gradually improved
Explanation from claude-3.5-sonnet-v2: After reviewing the hospital course summary, there is no explicit mention of increased bloody output from the JP drain on POD1 that gradually improved. While the summary does discuss JP drain output in several places (including mentions in the Brief Description, Outstanding Issues, and Problem Based Summary sections), it does not specifically state that there was increased bloody output on POD1 or describe a gradual improvement pattern. The only specific detail about the drain output is in the Problem Based Summary section, which notes a ‘reduction in JP drain output’ on POD3, but this does not indicate whether there was increased bloody output on POD1. The summary mentions ‘some complications with JP drain output’ but does not specify the nature or timing of these complications.
Explanation from llama4-scout: The hospital course summary mentions that the patient ‘experienced some complications with JP drain output’ post operatively, and there are instructions to ‘monitor JP drain output’ and ‘recognizing abnormal output volumes or characteristics’ upon discharge. On POD3, there was a ‘reduction in JP drain output.’ While the summary does not explicitly state ‘increased bloody output from JP drain observed on POD1,’ it implies that there was an issue with JP drain output that later reduced. However, the specific detail about ‘increased bloody output on POD1’ is not directly mentioned. The closest information is the mention of complications with JP drain output and its later reduction.
Explanation from deepseek-r1: The hospital course summary mentions ‘complications with JP drain output’ post operatively and specifically notes ‘a reduction in JP drain output’ by post operative day three (POD3). However, it does not explicitly state that increased bloody output was observed on POD1 or describe a gradual improvement starting from POD1. While the reduction by POD3 implies improvement over time, the specific timing (POD1) and characterization of the output as ‘bloody’ are not mentioned. The summary lacks direct references to POD1 drain characteristics or a clear timeline of output changes starting from that day.

9. Patient 6, Fact 0:

Fact: Adrenal crisis in a patient with primary adrenal insufficiency secondary to autoimmune ployglandular syndrome likely due to intolerance of PO prednisone.
Explanation from claude-3.5-sonnet-v2: Let’s analyze the text step by step: 1. The one liner confirms the patient has Autoimmune Polyglandular Syndrome Type 2 and primary adrenal insufficiency 2. The summary explicitly states the patient was admitted for adrenal crisis presenting with hypotension 3. However, while the text mentions the adrenal crisis and its treatment with IV hydrocortisone, it does not explicitly state that the crisis was due to PO prednisone intolerance 4. The summary mentions transitioning from IV to oral hydrocortisone (not prednisone), but doesn’t discuss any previous medication intolerance 5. While malabsorption workup is mentioned as pending, there’s no explicit connection made between medication intolerance and the adrenal crisis 6. Therefore, while the adrenal crisis in a patient with APS and primary adrenal insufficiency is clearly documented, the specific detail about it being due to PO prednisone intolerance is not explicitly mentioned
Explanation from llama4-scout: The hospital course summary explicitly mentions that the patient was admitted with an adrenal crisis, and it is implied that this occurred in the context of primary adrenal insufficiency secondary to Autoimmune Polyglandular Syndrome Type 2. The summary does not directly state that the adrenal crisis was due to intolerance of PO prednisone. However, it does mention the patient’s condition and treatment, including the transition from IV hydrocortisone to oral hydrocortisone, indicating a management plan for adrenal insufficiency. The fact that the patient was on IV hydrocortisone and was being transitioned to oral hydrocortisone suggests that there was an issue with their adrenal crisis management, potentially related to their oral medication regimen. While ‘prednisone’ is not mentioned, ‘hydrocortisone’ is a steroid used for adrenal insufficiency, and issues with oral administration could imply intolerance or inadequate dosing. Thus, the summary implies a potential issue with the patient’s oral steroid regimen, aligning with the notion of intolerance to PO prednisone or another oral steroid.
Explanation from deepseek-r1: The hospital course summary explicitly mentions adrenal crisis in the context of primary adrenal insufficiency secondary to Autoimmune Polyglandular Syndrome Type 2 (stated in the one liner and Problem #1). However, there is no mention of prednisone use, intolerance to oral prednisone, or any reference to prednisone in the therapeutic regimen. The treatment described uses hydrocortisone (IV and oral), not prednisone. While the first three components of the fact (adrenal crisis, primary adrenal insufficiency, autoimmune polyglandular syndrome) are clearly present, the attribution to ‘intolerance of PO prednisone’ is absent. The summary does not discuss prednisone at all, nor does it suggest a medication related cause for the crisis.

10. Patient 6, Fact 1:

Fact: Type 1 diabetes, insulin changed to lantus 15units twice a day.
Explanation from claude-3.5-sonnet-v2: Analyzing the summary step by step: 1. Type 1 diabetes is explicitly mentioned multiple times in the summary, including in the one liner and Problem #2. 2. Regarding insulin changes: The summary mentions the patient was converted from insulin gtt (drip) to subcutaneous insulin The discharge plan specifically states ‘Use Levemir 16 UNITS BID’ (not Lantus 15 units) 3. While insulin changes are mentioned, the specific change to Lantus 15 units twice daily is not mentioned anywhere in the text. Instead, a different insulin (Levemir) at a different dose (16 units) is prescribed. 4. The fact we’re looking for requires both Type 1 diabetes AND a specific insulin change to Lantus 15 units twice daily. While the diabetes part is present, the specific insulin change mentioned is different.
Explanation from llama4-scout: The hospital course summary mentions that the patient has Type 1 Diabetes Mellitus and that she was converted from insulin gtt (intravenous insulin) to a subcutaneous insulin regimen. The discharge plan for Type 1 Diabetes Mellitus states that the patient will be using ‘Levemir 16 UNITS BID and Insulin 1:7 TID AC’. Although the summary does not explicitly mention ‘Lantus’, Levemir is another long acting insulin, similar to Lantus. However, the exact medication mentioned is Levemir, not Lantus. The dosage is also different (16 units BID vs 15 units twice a day). Therefore, the specific fact ‘insulin changed to Lantus 15units twice a day’ is not explicitly mentioned in the summary.
Explanation from deepseek-r1: The hospital course summary under Problem #2: Type 1 Diabetes Mellitus states the discharge plan includes ‘Levemir 16 UNITS BID and Insulin 1:7 TID AC.’ Levemir (insulin detemir) is a different basal insulin from Lantus (insulin glargine), and the specified dose is 16 units BID rather than 15 units BID. While the summary confirms a change in insulin regimen, it does not explicitly mention Lantus or the 15 unit dose. The phrasing ‘converted subcutaneous from insulin gtt’ also lacks specificity about the exact regimen change. No synonyms, abbreviations, or equivalent phrasing matching ‘Lantus 15units twice a day’ are present.

11. Patient 7, Fact 0:

Fact: Left renal cell carcinoma status-post neoadjuvant chemotherapy and now post-op left nephrectomy, IVC thrombectomy.
Explanation from claude-3.5-sonnet-v2: The hospital course summary mentions the key elements of left renal cell carcinoma and IVC thrombectomy, but does not explicitly mention neoadjuvant chemotherapy. Breaking down the analysis: 1. Left renal cell carcinoma is confirmed in multiple places: One liner mentions ‘renal mass identified as renal cell carcinoma’ Problem #1 specifically lists ‘Renal Cell Carcinoma with IVC Tumor Thrombus’ 2. Left nephrectomy is confirmed: ‘Left radical nephrectomy’ is mentioned multiple times 3. IVC thrombectomy is confirmed: ‘IVC tumor thrombectomy’ is explicitly mentioned in the brief description 4. However, there is no mention of neoadjuvant chemotherapy anywhere in the summary: The surgical history section doesn’t mention it The problem based summary doesn’t reference any pre surgical chemotherapy No chemotherapy history is noted in the relevant medical history Since neoadjuvant chemotherapy is a key component of the fact we’re looking for and it’s not mentioned, we must mark this as 0.
Explanation from llama4-scout: The hospital course summary provides a detailed account of the patient’s admission and treatment for renal cell carcinoma with IVC tumor thrombus. The ‘One Liner’ section introduces the patient with a renal mass identified as renal cell carcinoma with IVC tumor thrombus. The ‘Brief Description of Hospital Course’ section mentions that the patient underwent a left radical nephrectomy and IVC tumor thrombectomy. The ‘Problem Based Summary’ under ‘Problem #1: Renal Cell Carcinoma with IVC Tumor Thrombus’ further elaborates on the diagnosis, treatment, and current status of the renal cell carcinoma. It confirms the diagnosis through imaging, the therapeutic procedures performed (left radical nephrectomy and IVC thrombectomy), and the patient’s stable postoperative recovery. Although the summary does not explicitly mention ‘neoadjuvant chemotherapy,’ it comprehensively covers the diagnosis, surgical treatment, and postoperative status of the left renal cell carcinoma and IVC thrombectomy.
Explanation from deepseek-r1: 1. The summary explicitly states ‘left radical nephrectomy and IVC thrombectomy’ under Therapeutic Procedures Performed (Problem #1), confirming the surgical components of the fact. 2. The diagnosis of ‘renal cell carcinoma with IVC tumor thrombus’ is clearly documented in the One Liner and Problem #1. 3. However, there is no mention of neoadjuvant chemotherapy in any section of the hospital course summary, including diagnostic investigations, therapeutic procedures, or medical history. 4. While the surgical components and diagnosis are present, the absence of any reference to preoperative chemotherapy (neoadjuvant therapy) means the full fact as stated is not explicitly mentioned.

12. Patient 7, Fact 1:

Fact: Hypersensitivity (?) reaction to ipi/nivo, switched to cabozantinib second-line
Explanation from claude-3.5-sonnet-v2: After carefully reviewing the hospital course summary, there is no explicit mention of: 1) Any treatment with ipi/nivo (ipilimumab/nivolumab), 2) A hypersensitivity reaction to these medications, or 3) A switch to cabozantinib as second line therapy. The summary only mentions the patient’s renal cell carcinoma diagnosis and surgical management via nephrectomy. While there is mention of follow up with oncology ([Dr. anonymized name]), there are no details about systemic therapy choices or changes. The only treatments discussed are related to the surgery and post operative care.
Explanation from llama4-scout: The hospital course summary is analyzed to determine if it mentions a hypersensitivity reaction to ipi/nivo and a switch to cabozantinib as a second line treatment. Upon reviewing the summary, there is no mention of ‘ipi/nivo’ (likely referring to ipilimumab/nivolumab, a combination immunotherapy) or ‘cabozantinib’ (a tyrosine kinase inhibitor used in renal cell carcinoma treatment). The summary focuses on the patient’s surgical resection for renal cell carcinoma and postoperative care, without discussing prior systemic treatments or changes in treatment regimens. Therefore, the specific fact regarding a hypersensitivity reaction to ipi/nivo and switching to cabozantinib is not explicitly mentioned.
Explanation from deepseek-r1: 1. Reviewed the entire hospital course summary for mentions of immunotherapy (ipi/nivo) or cabozantinib. 2. Scanned ‘Therapeutic Procedures Performed’ and ‘Discharge Plan’ sections across all problem summaries only surgical interventions and apixaban/CPAP/diabetes management are documented. 3. Checked ‘Relevant Medical History’ and ‘Outstanding Issues’ no references to prior immunotherapy use or adverse reactions. 4. Oncology follow up is mentioned but without specifying treatment agents. 5. No documentation of hypersensitivity reactions, treatment changes due to adverse events, or second line therapies like cabozantinib in any section. The summary focuses on surgical recovery and chronic condition management without addressing systemic cancer treatments.

13. Patient 8, Fact 0:

Fact: Down’s syndrome, neurogenic bladder, admitted for pneumonia, treated with CAP regimen and vancomycin due to positive sputum culture for MRSA
Explanation from claude-3.5-sonnet-v2: Let’s analyze each component of the fact: 1. Down’s syndrome: Explicitly mentioned in both the one liner and relevant medical history 2. Neurogenic bladder: Explicitly mentioned in the one liner and detailed in Problem #2 3. Admitted for pneumonia: Clearly stated in the one liner and Brief Description as ‘admitted for community acquired pneumonia’ 4. Treatment with CAP regimen and vancomycin: The summary states that the patient received ‘IV antibiotics, including ceftriaxone, azithromycin, and vancomycin’ 5. Positive sputum culture for MRSA: While the summary mentions ‘sputum culture with rare staph aureus’ and ‘MRSA nares positivity’, it doesn’t explicitly state that the sputum culture was positive for MRSA specifically. The vancomycin addition was due to MRSA nares positivity, not a positive sputum culture for MRSA. All components are present except for the specific mention of MRSA in the sputum culture, which is a key part of the fact we’re looking for. Therefore, while most elements are present, we cannot say the entire fact as stated is explicitly mentioned.
Explanation from deepseek-r1: 1. Down’s syndrome and neurogenic bladder are explicitly listed in the ‘One Liner’ and ‘Relevant Medical History’ sections. 2. Admission for pneumonia is clearly stated in the ‘One Liner’ and Problem #1 (Community Acquired Pneumonia). 3. CAP regimen is addressed with ceftriaxone + azithromycin (standard CAP coverage), and vancomycin is documented as part of the therapy. 4. However, vancomycin was added due to ‘MRSA nares positivity’ (nasal swab), not a positive sputum culture for MRSA. The sputum culture only showed ‘rare staph aureus’ without MRSA specification. 5. The critical distinction: The fact requires vancomycin use to be linked to MRSA in sputum, but the summary explicitly ties it to nasal MRSA colonization. No sputum MRSA result is documented.

14. Patient 8, Fact 1:

Fact: Potential aspiration event prior to discharge, 1/4 bottles positive for GPC, speciation not complete by time of discharge
Explanation from claude-3.5-sonnet-v2: After carefully reviewing the hospital course summary, I do not find any explicit mention of: 1) an aspiration event prior to discharge, 2) blood cultures showing 1/4 bottles positive for GPC (Gram positive cocci), or 3) pending speciation results. The summary discusses the patient’s pneumonia treatment course, including antibiotic therapy with ceftriaxone, azithromycin, and vancomycin, and mentions a sputum culture with rare staph aureus. However, there is no mention of blood cultures, their results, or any aspiration events. The only cultures explicitly mentioned are sputum and urine cultures. While the patient has a history of dysphagia and G tube placement, which puts them at risk for aspiration, no actual aspiration event is documented in this summary.
Explanation from llama4-scout: The task requires determining whether the fact ‘Potential aspiration event prior to discharge, 1/4 bottles positive for GPC, speciation not complete by time of discharge’ is explicitly mentioned in the provided hospital course summary. To accomplish this, I analyzed the summary section by section. The ‘One Liner’ section provides a brief overview of the patient’s condition and history but does not mention the specific fact. The ‘Brief Description of Hospital Course’ discusses the patient’s admission for community acquired pneumonia and improvement during hospitalization but does not reference any aspiration event or GPC positivity. The ‘Outstanding Issues/Follow Up’ section lists several follow up tasks but does not include the specific fact. The ‘Problem Based Summary’ section details the patient’s issues, including community acquired pneumonia, neurogenic bladder and bowel, and nutrition/dysphagia. While it discusses sputum culture results showing rare Staph aureus, it does not mention GPC or an aspiration event. The ‘Relevant Medical History’ and ‘Relevant Surgical History’ sections provide background information but also do not contain the fact in question. Since there is no explicit mention of a potential aspiration event, GPC positivity, or speciation status in the summary, the fact is not present.
Explanation from deepseek-r1: The analysis proceeds as follows: 1) The fact specifies three elements: potential aspiration event prior to discharge, 1/4 bottles positive for GPC, and incomplete speciation at discharge. 2) The summary documents dysphagia and tube feeding (a chronic risk factor for aspiration) but does not describe any acute aspiration event near discharge. 3) Sputum culture identified rare Staph aureus (a GPC), but there is no mention of ‘1/4 bottles’ or multiple culture bottles. 4) Speciation for Staph aureus was completed (identified by name), contradicting the ‘speciation not complete’ element. While GPCs are present via Staph aureus identification, the specific phrasing and context of the fact (multiple culture bottles, incomplete speciation) are absent. The summary does not explicitly state the three components together as described in the fact.

15. Patient 9, Fact 0:

Fact: Sepsis from urinary source with potential pyelonephritis, finishing a 7-day course of cipro on discharge. Started on finasteride in an attempt to prevent future UTIs.
Explanation from claude-3.5-sonnet-v2: Let’s analyze the text step by step: 1. The summary confirms sepsis/complicated UTI from urinary source with potential pyelonephritis (explicitly stated in Problem #1 and one liner) 2. However, there is no mention of: A 7 day course of cipro specifically (text mentions Zosyn instead) Starting finasteride Any preventive medications for future UTIs 3. While the text does mention treatment with antibiotics (Vancomycin and Zosyn), it’s different from the specific treatment mentioned in the fact 4. The discharge plan mentions continuing Zosyn, not cipro 5. Though there is a history of recurrent UTIs noted, there’s no mention of preventive measures being initiated Therefore, while some elements overlap (urinary source infection/pyelonephritis), the specific treatment details and preventive measures mentioned in the fact are not present in the summary.
Explanation from llama4-scout: The hospital course summary details a patient admitted for a complicated UTI potentially escalating into pyelonephritis. The patient was treated with antibiotics and showed improvement. However, upon reviewing the summary, there is no explicit mention of ‘sepsis from urinary source.’ Although the patient presented with fever, confusion, and weakness, and was diagnosed with a complicated UTI potentially escalating into pyelonephritis caused by Klebsiella pneumoniae, the term ‘sepsis’ is not used. Additionally, the summary does not mention the patient finishing a ‘7 day course of cipro on discharge’; instead, it states the patient was discharged on Zosyn with pending sensitivities. Lastly, there is no mention of starting finasteride to prevent future UTIs. Therefore, the specific fact provided is not explicitly mentioned in the summary.
Explanation from deepseek-r1: 1. Sepsis mention: The summary states ‘complicated UTI potentially escalating into pyelonephritis’ and mentions ‘sepsis resolution’ in follow up plans, but does not explicitly use the term ‘sepsis’ in the context of the admission diagnosis. 2. Urinary source with pyelonephritis: Explicitly stated in Problem #1 (‘complicated UTI with potential pyelonephritis’). 3. 7 day cipro course: The discharge plan specifies continuing Zosyn (piperacillin/tazobactam), not cipro. No mention of ciprofloxacin use. 4. Finasteride initiation: No reference to finasteride in any section of the summary. While pyelonephritis and UTI source are confirmed, two critical components (cipro completion and finasteride initiation) are absent from the text.

16. Patient 9, Fact 2:

Fact: Right upper extremity and left lower extremity swelling, DVT US negative, unclear etiology
Explanation from claude-3.5-sonnet-v2: After carefully reviewing the hospital course summary, there is no mention of right upper extremity or left lower extremity swelling, nor any DVT ultrasound studies. The summary covers the patient’s primary problems (complicated UTI, diabetes, and possible NPH) in detail, along with their diagnostic workup and management. While the summary includes various diagnostic tests and clinical findings, it does not mention any extremity swelling or DVT related investigations. The physical examination findings and diagnostic studies described focus on the UTI, diabetes management, and neurological symptoms. There is no explicit or implicit reference to extremity swelling or DVT ultrasound results.
Explanation from llama4-scout: The hospital course summary was thoroughly reviewed to determine if the fact ‘Right upper extremity and left lower extremity swelling, DVT US negative, unclear etiology’ is explicitly mentioned. The summary covers the patient’s admission for a complicated UTI, management of diabetes, and evaluation of possible normal pressure hydrocephalus. It details the patient’s diagnosis, treatment, and follow up plans for various conditions. However, upon careful examination, there is no mention of swelling in the right upper extremity or left lower extremity, nor is there any reference to a DVT ultrasound or its results. The summary focuses on the patient’s UTI, diabetic management, and potential neurological issues without addressing extremity swelling or DVT evaluations.
Explanation from deepseek-r1: The hospital course summary was analyzed section by section. The ‘One Liner’ and ‘Brief Description’ focus on UTI management and possible hydrocephalus. The ‘Outstanding Issues’ and problem based summaries (Problems #1 3) detail UTI treatment, diabetes management, and hydrocephalus evaluation. There is no mention of extremity swelling (right upper or left lower), DVT ultrasound results, or any discussion of unexplained edema in any part of the document. The surgical history mentions orchiectomy but no vascular studies. All documented assessments and follow ups relate to infections, diabetes, and neurological evaluation without reference to limb swelling or negative DVT imaging.

17. Patient 10, Fact 0:

Fact: The patient with polysubstance use disorder (alcohol, meth) was admitted to the hospital due to concerns for acute alcohol withdrawal and received inpatient treatment for alcohol use disorder as well as linkages to outpatient MAT treatment.
Explanation from llama4-scout: The task is to determine if the fact that ‘the patient with polysubstance use disorder (alcohol, meth) was admitted to the hospital due to concerns for acute alcohol withdrawal and received inpatient treatment for alcohol use disorder as well as linkages to outpatient MAT treatment’ is explicitly mentioned in the hospital course summary. The summary indicates the patient was admitted for alcohol withdrawal and received treatment for it. It mentions ‘polysubstance abuse disorder’ and positive urine toxicology for ethanol and methamphetamine, confirming polysubstance use. The summary also details inpatient treatment for alcohol withdrawal and follow up with addiction medicine, which implies treatment for alcohol use disorder. However, it does not explicitly mention ‘linkages to outpatient MAT treatment’. It does mention ‘outpatient follow up with addiction medicine’ and ‘consideration for residential treatment’, which are related to ongoing addiction treatment. Despite this, ‘MAT treatment’ specifically is not mentioned. Therefore, the fact is partially mentioned but not entirely, as it lacks the specific detail about ‘MAT treatment’.
Explanation from deepseek-r1: 1. The summary explicitly states the patient was admitted for alcohol withdrawal and has polysubstance abuse disorder (alcohol and meth) in the one liner and Problem #1. 2. Inpatient treatment for alcohol use disorder is evidenced by pharmacological management (lorazepam, thiamine), addiction consults, and discharge planning with naloxone/outpatient addiction follow up. 3. However, MAT (medication assisted treatment) linkages are not explicitly mentioned while addiction follow up is planned, there is no specific reference to MAT medications (e.g., naltrexone, acamprosate) or structured MAT programs. 4. The combination of ‘inpatient treatment for alcohol use disorder’ is clearly present, but MAT linkages (a distinct element in the target fact) are only implied through general addiction follow up rather than explicitly stated.

18. Patient 10, Fact 2:

Fact: The patient had alcohol ketosis on presentation
Explanation from claude-3.5-sonnet-v2: After carefully reviewing the hospital course summary, there is no explicit mention of alcohol ketosis on presentation. The summary details the patient’s admission for alcohol withdrawal and mentions several complications including liver injury, cirrhosis, and pancytopenia, but does not specifically mention ketosis. While the patient’s alcohol use and its complications are extensively documented, including elevated LFTs and positive urine toxicology for ethanol, there is no reference to ketosis or a metabolic derangement consistent with alcohol ketosis. The admission details focus on withdrawal symptoms and liver related issues rather than ketotic state.
Explanation from llama4-scout: The hospital course summary does not explicitly mention ‘alcohol ketosis’ on presentation. The summary discusses the patient’s admission for alcohol withdrawal, positive urine toxicology for ethanol, and various liver issues potentially related to alcohol use, such as elevated LFTs and cirrhotic morphology on ultrasound. However, ‘alcohol ketosis’ or ‘alcoholic ketoacidosis,’ which is the likely condition being referred to, is not directly mentioned in the provided text. The closest related information is the discussion of the patient’s alcohol dependence and withdrawal, but this does not directly equate to alcohol ketosis.
Explanation from deepseek-r1: The hospital course summary does not explicitly mention ‘alcohol ketosis’ or any direct synonyms (e.g., alcoholic ketoacidosis, ketonemia, ketonuria). While the patient has a history of alcohol dependence and was admitted for withdrawal, the documented findings (elevated LFTs, positive ethanol on toxicology, cirrhotic morphology) focus on liver injury and withdrawal management. No ketosis related labs (e.g., anion gap, serum/urine ketones) or treatments (e.g., dextrose for hypoglycemia) are noted. The absence of any reference to ketosis or its clinical indicators suggests this fact is not mentioned.

19. Patient 12, Fact 1:

Fact: He was started on empiric antibiotics but was found to have a normal WBC with normal lactate and abx were discontinued, he was not discharged on antibiotics
Explanation from claude-3.5-sonnet-v2: After carefully reviewing the hospital course summary, there is no explicit mention of: 1) The patient being started on empiric antibiotics, 2) Having a normal WBC count, 3) Having a normal lactate level, or 4) Antibiotics being discontinued. While the summary discusses various aspects of the patient’s care including TPN management, gallbladder fistula concerns, and electrolyte management, it does not contain any information about antibiotic administration or discontinuation. The laboratory values mentioned are primarily focused on BUN, glucose, and triglycerides, but do not include WBC or lactate values. Additionally, the discharge medications or plans do not mention anything about antibiotics or their discontinuation.
Explanation from llama4-scout: The hospital course summary does not explicitly mention that the patient was started on empiric antibiotics, had a normal WBC with normal lactate, and that antibiotics were discontinued. It also doesn’t state that the patient was not discharged on antibiotics. The summary focuses on the patient’s management with non surgical interventions, including TPN and close monitoring, and discusses the patient’s condition and discharge planning related to the gallbladder enteric fistula and other issues. There is no direct mention of antibiotic use or its discontinuation.
Explanation from deepseek-r1: The hospital course summary does not mention antibiotics at any point. Key components of the fact (empiric antibiotics initiation, normal WBC/lactate results, antibiotic discontinuation, or discharge without antibiotics) are absent. While infection related issues like gallbladder fistula and monitoring for infection signs are noted, there is no explicit reference to antibiotic use, lab values related to infection (WBC/lactate), or decisions to stop/discontinue antibiotics. The summary focuses on TPN, imaging, and non surgical management instead.

20. Patient 12, Fact 2:

Fact: He was discharged on TPN with instructions to follow up in 4 weeks
Explanation from claude-3.5-sonnet-v2: After analyzing the hospital course summary, I found that while the discharge on TPN is explicitly mentioned multiple times (e.g., ‘Discharge with home TPN’ and ‘Home TPN arranged, with [anonymized institution] providing infusion supplies and support’), there is no explicit mention of a 4 week follow up instruction. The summary does mention follow up requirements with Primary Care and IR consultation, but does not specify a 4 week timeframe. The discharge planning sections mention various follow ups needed but none with the specific 4 week timing mentioned in the fact we’re looking for.
Explanation from llama4-scout: The hospital course summary provides detailed information about the patient’s admission, management, and discharge plans. To determine if the fact ‘He was discharged on TPN with instructions to follow up in 4 weeks’ is mentioned, we need to look for evidence of discharge on TPN and a follow up instruction in 4 weeks. The summary indicates that the patient was managed with TPN during the stay and that ‘Discharge with home TPN’ was part of the plan. It also mentions ‘Follow up with Primary Care for monitoring labs and treatment regimen adherence.’ However, it does not specify a follow up in exactly 4 weeks. Despite this, the presence of TPN at discharge is confirmed.
Explanation from deepseek-r1: The hospital course summary explicitly mentions discharge with TPN in multiple sections (e.g., ‘Discharge with home TPN’ in Problem #1 and ‘Home TPN arranged’ in Problem #3). However, the specific instruction to ‘follow up in 4 weeks’ is not found anywhere in the text. While follow up with Primary Care and home health is mentioned, no time frame of 4 weeks is specified. The absence of this temporal detail means the full fact as stated is not explicitly documented.

21. Patient 13, Fact 0:

Fact: Patient with breast cancer admitted for bilateral mastectomy with unremarkable post operative course and discharge home
Explanation from deepseek-r1: 1. The summary explicitly states the patient was admitted for ‘bilateral complete mastectomies and right axillary lymph node dissection,’ matching the bilateral mastectomy component of the fact. 2. The postoperative course is described as ‘largely uneventful’ with ‘no signs of infection or major complications,’ which is a direct clinical equivalent to ‘unremarkable postoperative course.’ 3. While the summary details discharge plans (e.g., wound care, follow ups) and mentions transitioning to oral medications, the phrase ‘discharge home’ is not explicitly stated anywhere in the text. The absence of this specific terminology (or a clear synonym like ‘discharged to home’) means this component of the fact is missing. 4. Despite strong evidence for the first two components, the lack of explicit documentation about discharge disposition (even if implied by context) requires a 0 for the full fact as defined.

22. Patient 13, Fact 2:

Fact: It does not appear her chronic medical conditions including DM2 were worsened perioperatively
Explanation from claude-3.5-sonnet-v2: After reviewing the hospital course summary, particularly the section on comorbid conditions (Problem #3), there is no explicit statement indicating that the patient’s chronic medical conditions, including DM2, were stable or not worsened perioperatively. In fact, the summary notes that blood glucose was elevated and required management with insulin sliding scale. The summary mentions ‘hyperglycemia being managed’ which could suggest some degree of perioperative glucose control challenges. Without an explicit statement about the stability or lack of worsening of her chronic conditions, and with evidence of at least some glucose management needs, we cannot definitively say this fact is present in the text.
Explanation from deepseek-r1: 1. The hospital course summary explicitly lists Type 2 Diabetes Mellitus (DM2) under ‘Relevant Medical History’ and ‘Problem #3: Comorbid Conditions’. 2. Under ‘Problem #3’, it states ‘hyperglycemia being managed’ and discharge instructions include ‘Continue moderate sliding scale insulin regimen’. 3. While the text documents management of DM2, there is no explicit statement about whether DM2 was or was not worsened perioperatively. The summary mentions elevated blood glucose but does not characterize this as a worsening of the chronic condition. 4. The absence of any phrasing indicating stability or lack of exacerbation of DM2 (e.g., ‘remained stable’, ‘no worsening’, or ‘well controlled’) means the specific fact about perioperative worsening is not addressed.

23. Patient 14, Fact 0:

Fact: Acute lower extremity weakness caused by nerve root compression from neurofibromas, with no evidence of spinal cord compression as shown on MRI.
Explanation from deepseek-r1: The summary explicitly states that lower extremity weakness was caused by nerve root compression from neurofibromas (Problem #1: ‘MRI confirmed extensive neurofibromas compressing multiple nerve roots’). However, there is no mention of spinal cord compression status on MRI. While nerve root compression is documented, the absence of spinal cord compression is not explicitly stated. The guidelines require explicit mention of all key components of the fact, and since spinal cord compression status is unaddressed, the full fact is not present.

24. Patient 15, Fact 0:

Fact: Principal diagnosis at discharge: viral gastroenteritis.
Explanation from claude-3.5-sonnet-v2: After carefully reviewing the hospital course summary, I do not find any explicit mention of viral gastroenteritis as the principal diagnosis at discharge. While the summary does discuss nausea and vomiting as symptoms (Problem #1), it attributes these symptoms to a different clinical picture specifically as contributing factors to AKI. The summary suggests these symptoms were part of a presentation that included hypotension and led to pre renal injury and ATN. Nowhere in the document is there a clear statement that viral gastroenteritis was the principal or final diagnosis. In fact, the symptoms appear to be discussed more in the context of their impact on the patient’s kidney function and other comorbidities rather than as a primary viral illness.
Explanation from llama4-scout: To determine if the principal diagnosis at discharge was viral gastroenteritis, we need to examine the provided hospital course summary. The summary includes a one liner describing the patient’s background, a brief description of the hospital course, outstanding issues, and a problem based summary. The one liner and brief description indicate the patient was admitted with acute kidney injury (AKI) secondary to nausea and vomiting, along with hypotension. The problem based summary details the patient’s issues, including nausea/vomiting, AKI, hypotension, heart failure, and type 2 diabetes mellitus. Throughout the summary, the cause of nausea and vomiting is not explicitly attributed to viral gastroenteritis. The summary focuses on the management and resolution of the patient’s symptoms and conditions, primarily AKI and its related issues. There is no mention of viral gastroenteritis as a diagnosis or consideration in the patient’s hospital course or discharge summary. Therefore, the fact ‘principal diagnosis at discharge: viral gastroenteritis’ is not explicitly mentioned.
Explanation from deepseek-r1: The hospital course summary attributes the patient’s AKI to nausea and vomiting, which were managed with antiemetics and fluids. While nausea/vomiting is listed as a problem and the cause of AKI, the summary does not explicitly state ‘viral gastroenteritis’ as the underlying cause of these symptoms. The principal diagnosis mentioned in the one liner and throughout the summary is AKI due to nausea/vomiting, but no specific cause (e.g., viral, bacterial, or other) for the nausea/vomiting is provided. Since ‘viral gastroenteritis’ or an equivalent term (e.g., ‘viral enteritis,’ ‘infectious diarrhea’) is absent from all sections, the fact is not explicitly mentioned.

25. Patient 15, Fact 1:

Fact: The patient presented with acute kidney injury in the context of a renal transplant, with a serum creatinine level elevated to 3.9 mg/dL from a baseline of 1.4 mg/dL.
Explanation from deepseek-r1: The hospital course summary explicitly mentions the patient’s AKI in the context of a renal transplant (under ‘Relevant Medical History’ and Problem #2). The serum creatinine elevation to 3.9 mg/dL is clearly stated in Problem #2. However, the baseline creatinine value of 1.4 mg/dL is not explicitly mentioned anywhere in the text. While the summary refers to ‘deterioration from baseline,’ the specific baseline value (1.4 mg/dL) required by the fact is absent. All other components of the fact are present, but the absence of the numerical baseline creatinine value necessitates a score of 0.

26. Patient 15, Fact 2:

Fact: Immunosuppressant medications (tacrolimus, mycophenolate, and prednisone) were temporarily stopped when the patient initially came to the hospital.
Explanation from claude-3.5-sonnet-v2: The fact about immunosuppressant medications being temporarily stopped is partially mentioned in the summary. Specifically, under Problem #2 (Acute Kidney Injury), the text states they ‘held tacrolimus and mycophenolate pending renal team input.’ This covers two of the three medications mentioned (tacrolimus and mycophenolate), but there is no explicit mention of prednisone being stopped. Since the fact specifically asks about all three medications (tacrolimus, mycophenolate, AND prednisone), and prednisone’s status is not mentioned, we cannot confirm the complete fact as stated.
Explanation from deepseek-r1: The hospital course summary explicitly mentions under Problem #2 (Acute Kidney Injury) that tacrolimus and mycophenolate were held. However, prednisone is not mentioned in the context of being stopped. The fact requires confirmation that all three medications (tacrolimus, mycophenolate, and prednisone) were temporarily discontinued. Since prednisone is not referenced in the therapeutic interventions or medication adjustments, the full fact as stated is not explicitly documented. While two of the three medications are addressed, the absence of prednisone in this context means the complete fact is not present.

27. Patient 16, Fact 0:

Fact: Diffuse supratentorial brain metastases with extensive vasogenic edema in bilateral parietal and occipital lobes, right greater than left, were diagnosed on MRI.
Explanation from deepseek-r1: The hospital course summary explicitly mentions ‘diffuse supratentorial metastases with substantial vasogenic edema’ and specifies that ‘the largest lesions are in the bilateral parietal and occipital lobes’ via MRI. However, the summary does not include the detail ‘right greater than left’ regarding the laterality of the lesions. While all other components of the fact are clearly stated, the absence of this specific comparative laterality (right > left) means the fact as defined is not fully present. A busy physician would note the presence of bilateral involvement but would not find explicit documentation of right sided predominance.

28. Patient 16, Fact 1:

Fact: Currently on high dose dexamethasone and Bactrim for Pneumocystis jirovecii prophylaxis
Explanation from claude-3.5-sonnet-v2: After carefully reviewing the hospital course summary, I do not find any explicit mention of the patient being on high dose dexamethasone or Bactrim for PCP prophylaxis. While the summary does mention ‘steroids’ multiple times (e.g., ‘symptoms… were managed with steroids’ and ‘steroid therapy post surgical intervention’), it does not specifically state dexamethasone or its dosing. Similarly, there is no mention of Bactrim or PCP/Pneumocystis jirovecii prophylaxis anywhere in the text. The only medications explicitly mentioned are acetaminophen and levothyroxine. Even though steroid use is documented, the specific details about high dose dexamethasone and the prophylactic use of Bactrim are not present.
Explanation from llama4-scout: To determine if the fact ‘Currently on high dose dexamethasone and Bactrim for Pneumocystis jirovecii prophylaxis’ is mentioned in the hospital course summary, we need to look for any reference to ‘high dose dexamethasone’ and ‘Bactrim’ or ‘Pneumocystis jirovecii prophylaxis’. The summary mentions that the patient’s symptoms were managed with ‘steroids’ and that there are plans to ‘adjust steroid regimen per surgical outcomes’, indicating the use of steroids. However, it does not explicitly mention ‘high dose dexamethasone’ or ‘Bactrim’ or ‘Pneumocystis jirovecii prophylaxis’. The term ‘steroids’ is used, which could imply dexamethasone but is not specific. There is no mention of ‘Bactrim’ or its use for ‘Pneumocystis jirovecii prophylaxis’. Therefore, the specific fact is not explicitly mentioned in the summary.
Explanation from deepseek-r1: 1. Searched for ‘dexamethasone’ or ‘steroids’ in the summary. Found references to steroids being used for symptom management (headaches/edema) but no specific mention of ‘dexamethasone’ or ‘high dose’ steroids. 2. Looked for ‘Bactrim’ or ‘Pneumocystis prophylaxis’ in all sections. No references found in medication lists, therapeutic procedures, or discharge plans. 3. While steroids are mentioned generically, the specific drug name (dexamethasone) and dose (high dose) are absent. Prophylaxis for Pneumocystis jirovecii is not addressed at all. 4. The combination of both required elements (dexamethasone at high dose + Bactrim prophylaxis) is not explicitly stated in any form.

29. Patient 16, Fact 2:

Fact: Metastatic breast cancer has progressed, requiring discontinuation of palbociclib
Explanation from claude-3.5-sonnet-v2: After carefully reviewing the hospital course summary, I do not find an explicit mention of palbociclib or its discontinuation. While the summary does indicate disease progression (evidenced by new brain metastases) and mentions ‘exploration of alternative systemic therapeutic options due to disease progression’ in the Outstanding Issues section, it does not specifically state that palbociclib was discontinued. The only references to treatment changes are general statements about exploring ‘alternative systemic therapeutic options’ and ‘alternative cancer treatment regimens.’ Without explicit mention of palbociclib discontinuation, I cannot mark this fact as present in the text.
Explanation from llama4-scout: The hospital course summary indicates that the patient has metastatic breast cancer with new brain metastases, suggesting disease progression. The ‘Outstanding Issues/Follow Up’ section mentions ‘Exploration of alternative systemic therapeutic options due to disease progression,’ which implies that the current treatment is not effective and needs to be changed. Additionally, the ‘Relevant Medical History’ section lists the patient’s history of treatments for metastatic breast cancer, including previous hormone therapy, suggesting that palbociclib (a hormone therapy drug) could have been part of the treatment regimen. However, the summary does not explicitly mention palbociclib or its discontinuation. The closest relevant information is the mention of ‘alternative systemic therapeutic options due to disease progression,’ which implies a change in treatment due to progression but does not directly state that palbociclib was discontinued.
Explanation from deepseek-r1: 1. The hospital summary explicitly states ‘Exploration of alternative systemic therapeutic options due to disease progression’ under Outstanding Issues, confirming cancer progression. 2. While this implies a treatment change, there is no mention of palbociclib (or any specific medication) being discontinued in any section. 3. The follow up with Medical Oncology to ‘assess alternative cancer treatment regimens’ suggests therapy modification but does not specify which drug(s) are being changed. 4. The required fact combines both progression and palbociclib discontinuation while progression is documented, the specific drug discontinuation is not explicitly stated.

30. Patient 17, Fact 0:

Fact: Delirium tremens requiring intravenous benzodiazepines and phenobarbital for symptom control
Explanation from claude-3.5-sonnet-v2: While the summary describes acute alcohol withdrawal with hallucinations and tremors requiring treatment with phenobarbital and ativan, it does not explicitly mention delirium tremens (DT). The treatment approach described (phenobarbital and ativan) is consistent with DT management, but the summary only mentions ‘acute alcohol withdrawal with associated hallucinations and tremors.’ Without explicit mention of delirium tremens, and following the conservative principle of only marking as present what is explicitly stated, this must be marked as not present. The key elements are there (withdrawal, hallucinations, tremors, IV benzos and phenobarbital) but the specific diagnosis of delirium tremens is not explicitly stated.
Explanation from deepseek-r1: The hospital course summary explicitly mentions treatment with phenobarbital IV) and ativan (a benzodiazepine) for alcohol withdrawal with hallucinations and tremors. However, the term ‘delirium tremens’ is never used in the document. The diagnosis is consistently labeled as ‘alcohol withdrawal with perceptual disturbance,’ which may represent a less severe form of withdrawal. While the treatment described aligns with delirium tremens management, the absence of explicit documentation of the term itself or unambiguous synonyms (e.g., ‘severe alcohol withdrawal with autonomic instability’) means the specific fact as phrased is not clearly stated.

31. Patient 18, Fact 0:

Fact: Persistent fever with suspected pulmonary infection despite negative infectious workups
Explanation from claude-3.5-sonnet-v2: Step 1: Searched for mentions of fever Found that patient was admitted for non neutropenic fever. Step 2: Looked for pulmonary infection suspicion Found that broad spectrum antibiotics were given, suggesting infection suspicion. Step 3: Checked for negative workups Found multiple mentions of negative infectious workups: Blood cultures: NGTD (no growth to date) CXR and CT Abdomen showed no infectious focus Step 4: Checked for persistence of fever The summary indicates patient became ‘afebrile 24 hours prior to discharge,’ suggesting the fever resolved rather than persisted. While there was fever with suspected infection and negative workups initially, the fever did not persist, which is a key component of the fact we’re looking for. Therefore, this specific fact is not fully present in the summary.
Explanation from deepseek-r1: The hospital course summary states the patient had non neutropenic fever and received empiric antibiotics despite negative infectious workups (blood cultures: NGTD; CXR/CT: no infectious focus). However, the suspected cause for fever was explicitly attributed to ‘increased tumor burden’ rather than a pulmonary infection. While pulmonary imaging (CXR) was performed and showed no infection, there is no mention of clinical suspicion for a pulmonary infection as the source. The antibiotics were likely initiated for broad coverage rather than targeted pulmonary concern. Thus, while persistent fever and negative workups are present, the specific suspicion of a pulmonary infection is not stated.

32. Patient 18, Fact 1:

Fact: Diffuse Large B-Cell Lymphoma recently complicated by progression to CNS lymphoma
Explanation from deepseek-r1: The hospital course summary mentions ‘high grade B cell lymphoma with CNS progression’ in the Brief Description and ‘History of CNS lymphoma’ in the Relevant Medical History. However, the specific term ‘Diffuse Large B Cell Lymphoma’ (DLBCL) is not explicitly stated. While high grade B cell lymphoma is a category that includes DLBCL, the summary does not confirm this subtype. The [anonymized genetic information] noted in the medical history is associated with high grade lymphomas but does not definitively equate to DLBCL. Since the fact requires explicit mention of DLBCL (or a clear synonym), which is absent, the fact is not fully stated as phrased.

33. Patient 18, Fact 2:

Fact: Acute kidney injury with hypokalemia resolved during admission
Explanation from deepseek-r1: The hospital course summary explicitly mentions ‘acute kidney injury (AKI)’ as resolved with fluid resuscitation (Problem #3). Hypokalemia is documented as a separate issue (Problem #4) with low potassium levels (3.3 3.4) treated via oral supplementation and described as ‘responsive to treatment.’ However, the summary confirms resolution of AKI but does not explicitly state that hypokalemia itself was fully resolved during admission. While both conditions are addressed, the phrase ‘acute kidney injury with hypokalemia resolved’ (as a combined statement) is not present, and hypokalemia’s resolution is implied but not definitively declared. Thus, the specific fact as phrased is not explicitly mentioned.

34. Patient 19, Fact 0:

Fact: Hydronephrosis is complicated by urinary tract infections (ESBL E. coli, Klebsiella, and Enterococcus faecalis).
Explanation from claude-3.5-sonnet-v2: After carefully reviewing the hospital course summary, the specific fact about hydronephrosis being complicated by UTIs with ESBL E. coli, Klebsiella, and Enterococcus faecalis is not fully present. While the summary does mention: 1. UTIs and specifically E. faecalis in cultures 2. A history of ESBL producing organisms (implied by the initial choice of ertapenem) 3. A filling defect in the left renal pole However, the summary does not explicitly mention: 1. Hydronephrosis 2. Klebsiella infection 3. Current ESBL E. coli infection While there are elements of urinary tract infections and some of the specified organisms, the complete fact as stated, particularly the presence of hydronephrosis and its relationship to these specific infections, is not explicitly mentioned in the text.
Explanation from llama4-scout: The hospital course summary details the patient’s admission for a urinary tract infection associated with a cystostomy catheter. It mentions that the patient has a history of recurrent UTIs and type 2 diabetes mellitus, and that E. faecalis was identified in urine cultures. The summary also references past ESBL producing organisms. The CT imaging showed a filling defect in the left renal pole, which could be indicative of hydronephrosis or another issue, although ‘hydronephrosis’ is not directly stated. The presence of UTIs with ESBL E. coli (implied by ‘past ESBL producing organisms’), Klebsiella (not directly mentioned but possible given the context of recurrent UTIs and ESBL organisms), and Enterococcus faecalis is documented. Thus, while ‘hydronephrosis’ is not explicitly mentioned, the clinical context suggests its possibility. The fact that urinary tract infections are complicated by ESBL E. coli and Enterococcus faecalis is explicitly mentioned or strongly implied.
Explanation from deepseek-r1: 1. The hospital course summary mentions recurrent UTIs with E. faecalis and past ESBL producing organisms (though not specifically E. coli or Klebsiella in this admission). 2. Hydronephrosis is not explicitly mentioned in any part of the document. The CT finding describes a ‘filling defect in the left renal pole’ but does not use the term hydronephrosis or describe urinary obstruction. 3. While neurogenic bladder and suprapubic catheter (known risk factors for hydronephrosis) are documented, the summary does not state that hydronephrosis exists or that it is complicated by infections with the specified organisms. 4. The pathogens listed in the target fact (ESBL E. coli, Klebsiella, Enterococcus) are only partially matched E. faecalis is present, but ESBL organisms are only referenced historically, and Klebsiella is not mentioned in this admission’s culture results.

35. Patient 19, Fact 2:

Fact: Chronic opioid use and opioid-related constipation.
Explanation from claude-3.5-sonnet-v2: The hospital course summary explicitly mentions chronic opioid use in multiple places. Specifically: 1. Under ‘Outstanding Issues/Follow Up’ there is a note for ‘Chronic pain management and addiction medicine referral’ 2. Under ‘Problem #3: Chronic Pain and Opioid Use’, the summary states ‘chronic opioid dependency acknowledged’ and discusses ongoing pain management with oral hydromorphone 3. The discharge plan includes coordination with addiction medicine and establishing outpatient chronic pain management However, while opioid use is clearly documented, opioid related constipation is not explicitly mentioned anywhere in the summary. There is no discussion of bowel movements, constipation, or GI side effects from opioid use.
Explanation from deepseek-r1: 1. The summary explicitly mentions ‘chronic opioid use’ in Problem #3 (Chronic Pain and Opioid Use), stating ‘chronic opioid dependency acknowledged’ and ‘oral hydromorphone for pain management.’ 2. No mention of opioid related constipation is found in any section. While constipation is a common opioid side effect, the text does not reference bowel complications, constipation, or gastrointestinal issues related to opioids in the hospital course, discharge plans, or problem lists. 3. The combination of chronic opioid use AND opioid related constipation as a single fact is not explicitly stated. Only the opioid use component is documented.

36. Patient 20, Fact 1:

Fact: worsening thrombocytopenia, s/p prednisone taper initiation
Explanation from deepseek-r1: 1. The summary mentions ‘progressive thrombocytopenia’ in the one liner, which is a direct synonym for ‘worsening thrombocytopenia’. 2. Under Problem #2: Thrombocytopenia, it states ‘Prednisone initially 40 mg, increased to 100 mg daily’ and ‘Continue prednisone 100 mg daily’ in the discharge plan. However, there is no mention of a prednisone taper being initiated (taper implies dose reduction, while the documentation shows dose escalation followed by maintenance). 3. While corticosteroid treatment and dose changes are documented, the specific concept of a ‘prednisone taper initiation’ (a planned dose reduction strategy) is not explicitly stated in any section.

37. Patient 20, Fact 2:

Fact: Ordered twice weekly CBCs after discharge
Explanation from claude-3.5-sonnet-v2: After carefully reviewing the hospital course summary, particularly focusing on the discharge plans and follow up sections, there is no explicit mention of ordering twice weekly CBCs after discharge. While the summary does mention follow up CBC monitoring in several places (e.g., ‘follow up CBC and differential’ under Problem #2’s discharge plan), it does not specify the frequency as twice weekly. The closest reference is under ‘Problem #2: Thrombocytopenia’ where it mentions to ‘Continue prednisone 100 mg daily, follow up CBC and differential,’ but this does not specify twice weekly monitoring. The frequency of CBC monitoring is not explicitly stated anywhere in the document.
Explanation from llama4-scout: To determine if the fact ‘Ordered twice weekly CBCs after discharge’ is explicitly mentioned, I analyzed the provided hospital course summary. The summary is divided into several sections, including a one liner, brief description of hospital course, outstanding issues/follow up, problem based summary, relevant medical history, relevant surgical history, and additional requirements. I looked for any mention of CBC frequency post discharge. In the ‘Problem Based Summary’ under ‘Problem #2: Thrombocytopenia,’ the ‘Discharge Plan and Goals’ section states ‘follow up CBC and differential.’ Although it does not specify ‘twice weekly,’ it implies that CBC monitoring is required post discharge. However, the exact frequency is not mentioned. The ‘Outstanding/Pending Issues’ section for Thrombocytopenia mentions ‘Monitor for platelet response to corticosteroid therapy,’ which suggests ongoing monitoring but again does not specify the frequency. Since the exact phrase ‘twice weekly CBCs after discharge’ or an equivalent is not found, I conclude that the fact is not explicitly mentioned.
Explanation from deepseek-r1: The hospital course summary mentions under Problem #2 (Thrombocytopenia) discharge plan: ‘follow up CBC and differential’ and ‘Evaluate need for additional treatment based on CBC results.’ However, there is no explicit mention of the frequency (twice weekly) for these CBCs. While monitoring CBCs is clearly part of the follow up plan, the specific instruction for twice weekly frequency is absent from all sections of the summary, including discharge plans, outstanding issues, and additional requirements.

38. Patient 21, Fact 0:

Fact: recurrent falls of unknown etiology despite extensive workup inpatient
Explanation from claude-3.5-sonnet-v2: The summary mentions recurrent falls multiple times, but does not explicitly state that they are of unknown etiology despite extensive workup. While the summary shows that diagnostic investigations were performed (including telemetry showing runs of nonsustained SVT, and imaging confirming T6 compression fracture), it does not indicate that the underlying cause remained unknown or that the workup was extensive yet inconclusive. In fact, some potential contributing factors are identified (gait instability, cardiac issues). The hospital course describes evaluations for recurrent falls but does not specify that the etiology remained unclear despite thorough investigation. Therefore, while recurrent falls are clearly documented, the specific element of ‘unknown etiology despite extensive workup’ is not explicitly mentioned.
Explanation from deepseek-r1: The hospital course summary explicitly states ‘recurrent falls’ as a reason for admission and details evaluations including imaging, telemetry, and consultations. However, there is no explicit mention that the etiology remains unknown despite an inpatient workup. The summary notes findings (T6 fracture, NSVT) and interventions (PT, medication adjustments) but does not state that the cause of falls was undetermined after evaluation. While workup’ occurred, the specific fact of ‘unknown etiology despite extensive workup’ is not articulated in the text.

39. Patient 21, Fact 1:

Fact: T6 wedge compression fracture that likely happened before most recent fall
Explanation from claude-3.5-sonnet-v2: After reviewing the hospital course summary, there is no explicit mention that the T6 wedge compression fracture likely occurred before the most recent fall. The summary mentions the T6 compression fracture multiple times, particularly in Problem #1 and Problem #2 sections, but only describes it as being discovered after the current fall admission. In Problem #2, it’s specifically referred to as a ‘new T6 compression deformity,’ which actually suggests this is a recent injury rather than a pre existing condition. The temporal relationship suggesting the fracture predated the most recent fall is not stated anywhere in the text. While there is discussion of ‘recurrent falls,’ this doesn’t establish when the T6 fracture occurred in relation to these falls.
Explanation from llama4-scout: The hospital course summary mentions a T6 compression fracture multiple times, but it does not explicitly state that the fracture likely happened before the most recent fall. The ‘One Liner’ and ‘Brief Description of Hospital Course’ sections indicate that the T6 compression fracture occurred as a result of the fall. The ‘Problem Based Summary’ under ‘Problem #2: T6 Wedge Compression Fracture’ describes it as a ‘new T6 compression deformity,’ suggesting it was associated with the recent fall. There is no explicit mention that the fracture occurred before the most recent fall.
Explanation from deepseek-r1: The hospital course summary explicitly states that [Mrs. anonymized name] was admitted ‘following a fall resulting in a T6 compression fracture’ and describes the fracture as a ‘new T6 compression deformity’ in the problem based summary. These phrases directly attribute the fracture to the recent fall that prompted admission. While the summary documents recurrent falls as a broader issue, there is no mention of the T6 fracture being pre existing or occurring prior to the most recent fall. The absence of any qualifiers (e.g., ‘chronic,’ ‘old,’ or ‘prior’) or comparative imaging findings to suggest an older fracture supports the conclusion that the fact is not explicitly stated.

40. Patient 21, Fact 2:

Fact: Increased to metoprolol succinate 50 mg daily
Explanation from claude-3.5-sonnet-v2: After carefully reviewing the hospital course summary, I do not find an explicit mention of increasing metoprolol succinate to 50 mg daily. While the summary does mention metoprolol in the Heart Failure section (‘Adjusted metoprolol dosage’), it does not specify the exact change to 50 mg daily. The document only indicates that there was some adjustment to the metoprolol dosage without providing the specific details of the dose change. Therefore, while medication adjustment occurred, the specific fact we’re looking for (increase to metoprolol succinate 50 mg daily) is not explicitly stated.
Explanation from llama4-scout: The hospital course summary was analyzed to determine if the fact ‘Increased to metoprolol succinate 50 mg daily’ is explicitly mentioned. Under Problem #3: Heart Failure with Reduced Ejection Fraction (HFrEF), it is stated that ‘Adjusted metoprolol dosage’ was performed as part of the therapeutic procedures. However, the specific dosage or the fact that it was increased to 50 mg daily is not mentioned. Therefore, the exact fact is not explicitly stated in the summary.
Explanation from deepseek-r1: The hospital course summary under Problem #3 (HFrEF) states: ‘Adjusted metoprolol dosage; continued Lasix.’ While this confirms a dosage adjustment was made, the summary does not explicitly specify the exact new regimen of ‘metoprolol succinate 50 mg daily.’ The phrase ‘adjusted’ could imply either an increase or decrease, and no numerical dose or frequency is provided. There is no mention of ‘50 mg daily’ or equivalent phrasing elsewhere in the document. The absence of these specific details means the fact is not explicitly stated, though a dosage change is acknowledged.

41. Patient 22, Fact 1:

Fact: should continue and re-eval further continuation of augmentin therapy prior to the 14 day completion
Explanation from claude-3.5-sonnet-v2: After reviewing the hospital course summary in detail, there is no explicit mention of Augmentin therapy or its planned 14 day duration. While the summary does mention antibiotic therapy (specifically Zosyn for cholangitis) and includes statements about ‘continuation of empiric antibiotic therapy until infection resolves’ in the Outstanding Issues section, it does not specifically discuss Augmentin or any plans to re evaluate its continuation prior to a 14 day completion. The antibiotic discussions in the text are more general and focus on different antimicrobial therapy (Zosyn).
Explanation from llama4-scout: The hospital course summary does not explicitly mention ‘Augmentin therapy’ or the decision to continue or re evaluate it prior to the 14 day completion. The summary does mention ‘Continuation of empiric antibiotic therapy until infection resolves’ under ‘Outstanding Issues/Follow Up’, but it specifies that the patient was treated with intravenous Zosyn, not Augmentin. There is no clear indication or mention of Augmentin in the provided summary.
Explanation from deepseek-r1: The hospital course summary explicitly mentions treatment with intravenous Zosyn (piperacillin/tazobactam) for cholangitis and states ‘Continuation of empiric antibiotic therapy until infection resolves’ in the discharge plan. However, there is no mention of Augmentin (amoxicillin/clavulanate) therapy in any section of the summary. The instruction to ‘re eval further continuation of augmentin therapy prior to the 14 day completion’ is absent, as the antibiotic regimen described involves Zosyn rather than Augmentin. No equivalent phrasing or clinical synonyms for Augmentin therapy or a 14 day re evaluation are present.

42. Patient 22, Fact 2:

Fact: patient should follow up with Advanced Practice Provider (Nurse Practitioner/ Physician Assistant) in 1 week and [anonymized name], MD in in 2 weeks
Explanation from claude-3.5-sonnet-v2: After reviewing the hospital course summary thoroughly, including the One Liner, Brief Description, Outstanding Issues/Follow Up section, and Problem Based Summary, there is no explicit mention of follow up appointments with either an Advanced Practice Provider in 1 week or with [Dr. anonymized name], MD in 2 weeks. While the summary does mention several follow up requirements (including outpatient SLP, Nutrition Cancer Center, oncology follow up, and hepatic surgeons), it does not specify these particular providers or these specific timeframes. The closest mentions are general follow up recommendations without specific timing or provider details.
Explanation from llama4-scout: The hospital course summary provides detailed information about the patient’s hospital stay, diagnosis, treatment, and follow up plans. To determine if the specific fact about follow up appointments is mentioned, we need to look for any reference to scheduling follow ups with an Advanced Practice Provider (Nurse Practitioner/Physician Assistant) and [Dr. anonymized name], MD. The ‘Outstanding Issues/Follow Up’ section lists several follow up plans, including outpatient oncology follow up and other care continuations, but does not explicitly mention a follow up with an Advanced Practice Provider or [Dr. anonymized name], MD within the specified timeframe (1 week and 2 weeks respectively). The discharge plan and goals for various problems are discussed, but none directly state the required follow up appointments.
Explanation from deepseek-r1: The hospital course summary’s ‘Outstanding Issues/Follow Up’ section and problem based discharge plans mention follow ups with oncology, SLP, nutrition services, hepatic surgeons, IR, and endocrine specialists. However, there is no explicit reference to a follow up with an Advanced Practice Provider (Nurse Practitioner/Physician Assistant) in 1 week or with ‘[anonymized name], MD’ in 2 weeks. The name ‘[anonymized name]’ does not appear in the text, and the term ‘Advanced Practice Provider’ (or its synonyms/abbreviations) is absent. While follow ups are broadly recommended, the specific providers and timeframes in the fact are not stated.

43. Patient 23, Fact 1:

Fact: in setting of progressing CLL and mitral valvulopathy
Explanation from llama4-scout: The task is to determine if the fact ‘in setting of progressing CLL and mitral valvulopathy’ is explicitly mentioned in the provided hospital course summary. The summary is analyzed section by section to identify if this specific fact or its equivalent is mentioned. The ‘One Liner’ section introduces the patient with a history of CLL and heart failure. The ‘Problem Based Summary’ section details the patient’s issues, including CLL and heart failure exacerbation with mitral valve stenosis. While CLL is discussed, the term ‘progressing CLL’ is not directly stated; however, significant leukocytosis is noted. For mitral valvulopathy, the summary mentions ‘mitral valve stenosis’ with a mitral valve gradient of 25 on TTE, indicating its presence. The summary does not explicitly state ‘progressing CLL and mitral valvulopathy’ together, but it does discuss both conditions separately. The closest related information is found under ‘Problem #1: CLL’ and ‘Problem #2: Heart Failure Exacerbation and Mitral Valve Stenosis’. Although ‘mitral valvulopathy’ is not a direct synonym for ‘mitral valve stenosis’, it can be considered related as both pertain to mitral valve issues. The fact is not explicitly mentioned in the exact wording, but relevant information is present.
Explanation from deepseek-r1: 1. The hospital course summary explicitly mentions ‘Rai Stage II Chronic Lymphocytic Leukemia (CLL)’ under Problem #1, but does not describe the CLL as ‘progressing.’ The current clinical status states ‘disease is stable,’ which contradicts progression. 2. Mitral valvulopathy is addressed under Problem #2 as ‘Mitral Valve Stenosis’ (a specific type of valvulopathy) with details about valve gradient and management. However, the fact requires both ‘progressing CLL’ and ‘mitral valvulopathy’ to be mentioned together. While mitral valve pathology is documented, the absence of explicit or implicit evidence of CLL progression (e.g., rising WBC, treatment escalation for progression, or clinical deterioration) means the combined context is not stated. Thus, the specific fact is not fully present.

44. Patient 23, Fact 2:

Fact: Cardiology will help coordinate close follow up with the Heart Failure team to discuss transcatheter MVR iso likely new clinical trial drug [anonymized date]
Explanation from claude-3.5-sonnet-v2: After carefully reviewing the hospital course summary, I do not find any explicit mention of cardiology coordinating follow up with the Heart Failure team specifically to discuss transcatheter MVR or a new clinical trial drug for [anonymized date]. While the summary does mention cardiology follow up in several places (e.g., ‘Follow up with cardiology for heart valve assessment and management’ and ‘Ongoing cardiology follow up for comprehensive valve disease management’), it does not specify the particular details about transcatheter MVR or a clinical trial drug. The summary discusses the patient’s mitral valve issues and previous valve replacement, but does not mention future plans for transcatheter MVR or any clinical trials. This level of specific planning is not documented in the provided text.
Explanation from llama4-scout: The task is to determine if the fact ‘Cardiology will help coordinate close follow up with the Heart Failure team to discuss transcatheter MVR iso likely new clinical trial drug [anonymized date]’ is explicitly mentioned in the provided hospital course summary. Upon reviewing the summary, it is clear that while there are mentions of cardiology follow up and management of heart failure and valve disease, the specific details about ‘transcatheter MVR iso’ and ‘new clinical trial drug [anonymized date]’ are not present. The summary does mention ‘follow up with cardiology for heart valve assessment and management’ and ‘ongoing cardiology follow up for comprehensive valve disease management’, indicating that cardiology follow up is planned. However, it does not explicitly mention the specific fact regarding transcatheter MVR or a new clinical trial drug. Therefore, the fact is not explicitly mentioned in the summary.
Explanation from deepseek-r1: The hospital course summary mentions cardiology follow up for heart valve assessment and management, and comprehensive valve disease management. However, there is no explicit mention of coordination with the Heart Failure team, transcatheter MVR (mitral valve replacement), or a new clinical trial drug from [anonymized date]. While cardiology follow up is planned, the specific details about the Heart Failure team involvement, transcatheter intervention, or clinical trial drug are absent from the text. The summary does not contain equivalent phrases or abbreviations for these specific elements.

45. Patient 24, Fact 1:

Fact: this (and prior) small bowel obstruction managed nonoperatively
Explanation from deepseek-r1: 1. The hospital course summary explicitly states the current SBO was managed with ‘non operative management’ including NGT decompression and bowel rest. 2. The patient’s history of ‘multiple prior SBOs’ is documented, but there is no explicit mention of how those previous episodes were managed. 3. While the current non operative approach is clearly described, the summary does not contain any statement indicating prior SBOs were also managed nonoperatively (either directly or through equivalent phrasing). 4. The combination of this and prior SBOs being managed nonoperatively is not fully addressed, as prior management remains unspecified.

46. Patient 24, Fact 2:

Fact: discharged on full liquid diet and oral pain medications
Explanation from claude-3.5-sonnet-v2: I analyzed the hospital course summary step by step to determine if discharge on full liquid diet and oral pain medications was explicitly mentioned: 1. Regarding diet: The summary mentions ‘started on a full liquid diet’ under Problem #1 The discharge plan mentions ‘Gradually advance diet as tolerated’ However, it does not explicitly state the diet status at discharge 2. Regarding pain medications: While ‘pain control’ is mentioned as part of management There is no explicit mention of discharge pain medications The discharge plan does not specify medication regimen While both diet and pain management were part of the hospital course, the specific fact of being discharged on full liquid diet AND oral pain medications is not explicitly stated in the summary.
Explanation from deepseek-r1: Step 1: Search for ‘full liquid diet’ Found in Problem #1’s ‘Current Clinical Status’ section: ‘started on a full liquid diet.’ Step 2: Search for ‘oral pain medications’ The summary mentions ‘pain control’ in the Brief Description and Problem #1 management, but never specifies the route (oral) or discharge prescription of pain medications. While dietary modifications at discharge are documented, the discharge plan only mentions diet advancement without specifying pain medication administration method. The combination of both elements (full liquid diet AND oral pain medications) is required for the fact. Only one component is explicitly stated.

47. Patient 25, Fact 1:

Fact: Upper GI series showed no evidence for gastric outlet obstruction or significant obstruction along the duodenum. She was started on IV famotidine, later switching to PPI BID. Case was discussed with both general GI and advanced GI, who deferred EGD/ERCP and recommended empiric PPI for 8 weeks and outpatient evaluation for possible ERCP in the next few weeks.
Explanation from claude-3.5-sonnet-v2: After carefully reviewing the hospital course summary, the specific fact about the upper GI series, famotidine/PPI treatment, and GI consultation with recommendations for EGD/ERCP is not explicitly mentioned in the text. While the summary does mention GI follow up as an outstanding issue ‘for further evaluation of duodenitis and CBD narrowing,’ and includes references to gastrointestinal procedures in the patient’s surgical history, it does not contain the specific details about the upper GI series findings, medication changes from famotidine to PPI, or the GI consultants’ specific recommendations regarding EGD/ERCP. The only related information is a brief mention under ‘Outstanding Issues/Follow Up’ stating ‘GI follow up for further evaluation of duodenitis and CBD narrowing,’ but this does not include the specific details we’re looking for.
Explanation from llama4-scout: The task is to determine if the fact ‘Upper GI series showed no evidence for gastric outlet obstruction or significant obstruction along the duodenum. She was started on IV famotidine, later switching to PPI BID. Case was discussed with both general GI and advanced GI, who deferred EGD/ERCP and recommended empiric PPI for 8 weeks and outpatient evaluation for possible ERCP in the next few weeks.’ is explicitly mentioned in the provided hospital course summary. Upon reviewing the summary, there is no mention of the Upper GI series, the administration of IV famotidine, switching to PPI BID, or the discussion with GI specialists regarding EGD/ERCP and empiric PPI. The summary does mention ‘GI follow up for further evaluation of duodenitis and CBD narrowing’ under Outstanding Issues/Follow Up, which indicates some gastrointestinal evaluation but does not directly state the fact in question. Therefore, the specific details about the Upper GI series and subsequent management are not present in the summary.
Explanation from deepseek-r1: The hospital course summary does not explicitly mention the upper GI series results, initiation of IV famotidine/PPI, or discussions deferring EGD/ERCP. While GI follow up for ‘duodenitis and CBD narrowing’ is noted, there is no reference to the specific imaging findings (no obstruction), medication transitions (famotidine → PPI BID), or advanced GI recommendations (empiric PPI for 8 weeks, outpatient ERCP planning). These elements are critical to the fact in question and are absent across all sections of the summary, including diagnostic investigations, therapeutic interventions, and discharge plans.

48. Patient 25, Fact 2:

Fact: AKI on admission treated with fluids which resolved
Explanation from claude-3.5-sonnet-v2: After carefully reviewing the hospital course summary, there is no explicit mention of AKI (Acute Kidney Injury) on admission or its treatment with fluids and resolution. While there is a brief mention in the Outstanding Issues/Follow Up section to ‘Monitor kidney function and hydrate adequately,’ this is a forward looking instruction rather than a description of past AKI treatment. The summary covers multiple problems in detail (pancreatic cancer, ascites, portal vein thrombosis, and malnutrition) but does not include any discussion of kidney injury at admission or its treatment course. Even reviewing the Brief Description of Hospital Course and all problem based summaries, there is no indication of admission AKI or its management with fluids.
Explanation from llama4-scout: The hospital course summary does not explicitly mention ‘AKI on admission treated with fluids which resolved.’ To determine this, I reviewed the provided summary, focusing on sections that might discuss kidney function or fluid management. The ‘Brief Description of Hospital Course’ and ‘Problem Based Summary’ sections were examined for any mention of acute kidney injury (AKI), fluid treatment, or related conditions. While the summary does mention ‘Monitor kidney function and hydrate adequately’ under ‘Outstanding Issues/Follow Up,’ this does not directly indicate that AKI was present on admission or treated with fluids. There is no explicit mention of AKI or its treatment in the provided text.
Explanation from deepseek-r1: The hospital course summary was analyzed systematically. The ‘AKI on admission treated with fluids which resolved’ fact was evaluated by checking all sections (One Liner, Brief Description, Outstanding Issues, Problem Based Summaries). While ‘monitor kidney function and hydrate adequately’ is listed under Outstanding Issues, there is no explicit mention of AKI (acute kidney injury) being present on admission, nor any documentation of fluid administration specifically for AKI resolution. The text references hydration as a precaution but does not link it to a resolved AKI episode. No abbreviations (e.g., AKI) or clinical synonyms for acute kidney injury appear in the summary. The absence of AKI is further confirmed by its omission from all problem based summaries and therapeutic interventions.

49. Patient 26, Fact 1:

Fact: Metoprolol dosage increased to 75 mg twice daily for improved rate control; Apixaban dosage increased to 5 mg twice daily for anticoagulation.
Explanation from claude-3.5-sonnet-v2: After carefully reviewing the hospital course summary, the specific fact about metoprolol being increased to 75mg twice daily and apixaban being increased to 5mg twice daily is not explicitly mentioned. While the summary does mention rate control medications (including metoprolol) being used and adjusted (‘rate control with diltiazem and metoprolol’ and ‘rate improved with medication adjustments’), it does not specify the exact dosage changes. Similarly, there is no mention of apixaban or its dosage adjustment anywhere in the text. The closest related information is in Problem #2 regarding atrial fibrillation/flutter management, but it only mentions rate control medications without specific dosing details.
Explanation from llama4-scout: The hospital course summary was analyzed to determine if the specific fact ‘Metoprolol dosage increased to 75 mg twice daily for improved rate control; Apixaban dosage increased to 5 mg twice daily for anticoagulation’ was explicitly mentioned. The summary details the patient’s treatment for paroxysmal atrial fibrillation/flutter, including rate control with diltiazem and metoprolol, but does not specify the dosage of metoprolol or any adjustments made to it. Additionally, there is no mention of apixaban or its dosage in the provided summary. Therefore, the specific fact regarding the increase in metoprolol and apixaban dosages is not mentioned.
Explanation from deepseek-r1: The hospital course summary mentions ‘rate control with diltiazem and metoprolol’ and states that ‘rate improved with medication adjustments’ under Problem #2 (Atrial Fibrillation/Flutter). However, there is no explicit mention of a metoprolol dosage increase to 75 mg twice daily. Similarly, while anticoagulation is implied in the context of atrial fibrillation management, apixaban is never mentioned in the document, and no dosage adjustments for anticoagulants are described. The summary only references general ‘medication adjustments’ without specifying these exact dosage changes.

50. Patient 26, Fact 2:

Fact: Patient’s emesis may be related to chronic mesenteric ischemia, as CT angiography revealed superior mesenteric artery (SMA) stenosis.
Explanation from claude-3.5-sonnet-v2: While reviewing the hospital course summary, I found the following relevant information: 1. The summary mentions SMA (superior mesenteric artery) narrowing in Problem #1 under ‘Key Diagnostic Investigations and Results’: ‘CT showed SMA narrowing but ruled out acute ischemia.’ 2. The patient’s presenting symptoms included severe nausea, vomiting, and epigastric pain. 3. However, the summary does not explicitly state or suggest that the patient’s emesis may be related to chronic mesenteric ischemia. In fact, the CT findings specifically ruled out acute ischemia, and the symptoms are attributed to gastroparesis throughout the summary. 4. While SMA narrowing is mentioned, the connection between this finding and the patient’s symptoms is not made in the text.
Explanation from deepseek-r1: The hospital course summary explicitly mentions ‘CT showed SMA narrowing’ under Problem #1 (Gastroparesis/Dyspepsia) diagnostic investigations. However, it states this finding ‘ruled out acute ischemia’ and does not explicitly link the SMA stenosis to chronic mesenteric ischemia as a potential cause of emesis. While SMA stenosis is documented, the summary attributes the vomiting to gastroparesis (with planned GI follow up for this) rather than mesenteric ischemia. The connection between emesis and chronic mesenteric ischemia via SMA stenosis is not made in any section of the discharge plan, or problem based summaries.

51. Patient 27, Fact 0:

Fact: Patient admitted for neutropenic fever found to have coagulase negative strep bacteremia treated with PICC removal/replacement and antibiotics.
Explanation from llama4-scout: The hospital course summary details a [anonymized age] years old male with AML admitted for neutropenic fever. The summary indicates that blood cultures showed Coagulase Negative Staphylococci bacteremia, and the patient underwent PICC line removal as part of the therapeutic procedures for neutropenic fever. The patient was treated with various antibiotics, including a transition to linezolid after discharge. The fact to be verified is whether the patient was admitted for neutropenic fever found to have coagulase negative strep bacteremia and treated with PICC removal/replacement and antibiotics. The summary confirms admission for neutropenic fever and treatment with PICC removal and antibiotics. However, it specifies ‘Coagulase Negative Staphylococci bacteremia’ rather than ‘coagulase negative strep bacteremia,’ indicating a difference in the type of bacteria identified. The summary does mention PICC line removal but only implies replacement in the ‘Outstanding Issues/Follow Up’ section. The treatment included various antibiotics.
Explanation from deepseek-r1: The hospital course summary explicitly mentions neutropenic fever as the admission reason and details Coagulase Negative Staphylococci (CoNS) bacteremia identified via blood cultures. However, the fact specifies ‘coagulase negative strep’ (streptococcus), which is a different organism from Staphylococci. While PICC removal and antibiotic treatment (including vancomycin and linezolid) are documented, the summary does not mention streptococcus bacteremia. Since ‘strep’ and ‘staph’ are distinct genera with no clinical synonymity, the specific fact about coagulase negative strep bacteremia is not explicitly stated.

52. Patient 27, Fact 1:

Fact: TTE on [anonymized date] w/o evidence of mass or vegetations
Explanation from llama4-scout: The hospital course summary mentions that ‘TTE showed no vegetations’ under Problem #1: Neutropenic Fever. However, it does not specify the date of the TTE. The fact to be verified is ‘TTE on [anonymized date] w/o evidence of mass or vegetations.’ Since the date ‘[anonymized date]’ is not mentioned in the summary, and there’s no explicit mention of a TTE on that specific date, we cannot confirm the fact. The summary does mention a TTE without vegetations, but without the date, it’s not a direct match.

53. Patient 27, Fact 2:

Fact: Imaging and localizing sx suggestive of tonsilitis, treated with antibiotics.
Explanation from claude-3.5-sonnet-v2: The fact about tonsillitis imaging and treatment is partially mentioned in the summary. Specifically: 1. The CT maxillofacial imaging showing ‘signs suggestive of tonsillitis’ is explicitly mentioned under Problem #1 (Neutropenic Fever). 2. The summary mentions antibiotic treatment (initially Zosyn, then Cefepime and Vancomycin), but these were primarily started for neutropenic fever rather than being explicitly linked to treating tonsillitis. 3. While imaging findings of tonsillitis are mentioned, localizing symptoms are not explicitly described. 4. The antibiotics given could have treated tonsillitis, but the text doesn’t explicitly state this was their purpose. Since the complete combination of imaging, localizing symptoms, and explicit antibiotic treatment specifically for tonsillitis is not fully present, this fact cannot be considered completely mentioned.
Explanation from deepseek-r1: The hospital course summary explicitly mentions ‘CT maxillofacial showed […] signs suggestive of tonsillitis’ under Problem #1’s diagnostic investigations, fulfilling the imaging component. Antibiotic treatment (Zosyn, Cefepime, Vancomycin, and planned linezolid) is documented in therapeutic procedures. However, there is no explicit mention of localizing symptoms (e.g., sore throat, dysphagia) that prompted the imaging. While the imaging finding and antibiotic treatment are clearly stated, the absence of documented localizing symptoms means the full fact (imaging + symptoms + antibiotics) is not explicitly present.

54. Patient 28, Fact 1:

Fact: Bilirubin did not improve despite PTBD exchange, and pt/family opted to transition to home hospice.
Explanation from claude-3.5-sonnet-v2: Let’s analyze the text step by step: 1. The text mentions that the patient underwent ‘multiple biliary drain exchanges’ and had ‘persistent hyperbilirubinemia.’ 2. PTBD (percutaneous transhepatic biliary drainage) exchanges are specifically mentioned under Problem #1. 3. The text indicates that there was ‘limited further intervention potential’ and the patient was ‘transitioned to hospice care focusing on comfort.’ 4. While these elements align with the fact we’re looking for, the text does not explicitly state that the bilirubin failed to improve despite the PTBD exchanges. The temporal relationship between the persistent hyperbilirubinemia and the decision to transition to hospice is implied but not explicitly stated as cause and effect. 5. The transition to home hospice is clearly mentioned in multiple places, including the ‘Outstanding Issues/Follow Up’ section and the ‘Discharge Plan and Goals.’

55. Patient 28, Fact 2:

Fact: Hospital course complicated by sepsis requiring antibiotics and aggressive fluid resuscitation, delirium requiring pharmacotherapy, and urinary retention requiring urinary catheter.
Explanation from claude-3.5-sonnet-v2: Analyzing the hospital course summary for the specified complications: 1. Sepsis requiring antibiotics and fluid resuscitation: While the summary mentions dehydration and hypotension with IV fluid administration, it does not explicitly mention sepsis or antibiotic therapy 2. Delirium requiring pharmacotherapy: Delirium is mentioned in Problem #3, but the summary only states it was ‘managed with routine medication’ without specifying pharmacotherapy 3. Urinary retention requiring catheter: No mention of urinary retention or catheter placement anywhere in the summary While some elements are partially present (delirium, fluid administration), the specific combination of sepsis with antibiotics, delirium with pharmacotherapy, and urinary retention with catheter is not explicitly documented in the summary.
Explanation from llama4-scout: The hospital course summary provides a detailed overview of [Mr. anonymized name]’s hospitalization. To determine if the specific fact is mentioned, we need to check for mentions of ‘sepsis requiring antibiotics and aggressive fluid resuscitation’, ‘delirium requiring pharmacotherapy’, and ‘urinary retention requiring urinary catheter’. The summary indicates that the patient had dehydration and hypotension, for which he received IV fluids, suggesting fluid resuscitation. It also mentions delirium, which was managed with routine medication, indicating pharmacotherapy. However, there is no explicit mention of ‘sepsis requiring antibiotics’ or ‘urinary retention requiring urinary catheter’. Thus, the fact is not entirely mentioned.
Explanation from deepseek-r1: 1. Sepsis: The summary mentions ‘recurrent cholangitis’ (a biliary infection) and ‘aggressive IV fluids’ for hypotension/dehydration, but does not explicitly state ‘sepsis’ or mention antibiotics. While cholangitis can lead to sepsis, the term ‘sepsis’ itself is absent. 2. Delirium: Explicitly stated in Problem #3 with ‘managed with routine medication,’ satisfying the pharmacotherapy requirement. 3. Urinary retention: No mention of urinary retention or catheter placement in any section. Only 1/3 components (delirium) are explicitly documented. Since the fact components are conjunctive (all required), the full fact is not present.

56. Patient 29, Fact 1:

Fact: Management of pt’s metastatic nasopharyngeal carcinoma deferred to outpt oncologist per patient’s son’s wishes and patient’s delirium.
Explanation from claude-3.5-sonnet-v2: After reviewing the hospital course summary, while it mentions that the patient has nasopharyngeal carcinoma with cervical nodal metastases and experienced delirium during the admission, it does not explicitly state that management of the metastatic cancer was deferred to outpatient oncology due to the son’s wishes and patient’s delirium. The summary only mentions ‘Consider chemotherapy plan based on patient and family decision’ under Problem #1 and notes outpatient oncological follow up, but does not specifically indicate that management was deferred due to the son’s wishes or the patient’s delirium. While both delirium and cancer management are discussed separately, their causal relationship in deferring treatment is not explicitly stated.
Explanation from deepseek-r1: The hospital course summary states that chemotherapy planning for nasopharyngeal carcinoma is pending ‘patient and family decision’ and mentions the patient’s delirium. However, there is no explicit mention of management being deferred to the outpatient oncologist specifically due to the son’s wishes. While outpatient oncological follow up is planned, the text does not directly link this deferral to the son’s input or the patient’s delirium as a contributing factor. The family’s role in decision making is acknowledged, but the specific combination of ‘son’s wishes’ and ‘delirium’ as reasons for deferral is not clearly stated.

57. Patient 29, Fact 2:

Fact: Patient developed temporary O2 requirement felt to be result of aspiration pneumonitis, made strict NPO by SLP.
Explanation from claude-3.5-sonnet-v2: While the summary mentions aspiration risk and aspiration precautions multiple times, it does not explicitly state that the patient developed a temporary oxygen requirement due to aspiration pneumonitis. The closest references are: 1) Under Problem #4, it mentions ‘maintaining oxygen requirements’ but doesn’t specify if this was new or temporary, 2) There’s mention of ‘aspiration and respiratory issues’ and ‘aspiration related atelectasis’ but not specifically pneumonitis, 3) The summary does note that the patient was made ‘Strict NPO’ with PEG feeding (in Outstanding Issues/Follow Up), but doesn’t explicitly connect this to an oxygen requirement or pneumonitis event. While there are hints at respiratory issues and aspiration concerns, the specific fact we’re looking for a temporary O2 requirement caused by aspiration pneumonitis leading to NPO status is not explicitly stated in the text.
Explanation from llama4-scout: The task is to determine if the fact ‘Patient developed temporary O2 requirement felt to be result of aspiration pneumonitis, made strict NPO by SLP’ is explicitly mentioned in the hospital course summary. The summary is analyzed in sections. The ‘Brief Description of Hospital Course’ mentions that the patient experienced ‘intermittent delirium and aspiration risk,’ which improved with management. Under ‘Problem #4: Aspiration and Respiratory Issues,’ it is noted that there were ‘concerns of aspiration related atelectasis’ and that the patient was ‘maintaining oxygen requirements.’ The ‘Outstanding Issues/Follow Up’ section includes ‘Aspiration precautions: Strict NPO with PEG feeding.’ While the summary does not directly state ‘aspiration pneumonitis,’ it implies aspiration related issues and mentions strict NPO status, aligning with parts of the fact. However, it does not explicitly mention ‘temporary O2 requirement felt to be result of aspiration pneumonitis.’ The closest relevant information is under ‘Problem #4,’ indicating the patient had oxygen requirements and concerns of aspiration related issues. The fact that the patient was made ‘strict NPO’ is directly mentioned, attributed to aspiration precautions. The absence of the specific phrase ‘felt to be result of aspiration pneumonitis’ and attribution to ‘SLP’ for making the patient ‘strict NPO’ means the fact is not explicitly mentioned in its entirety.
Explanation from deepseek-r1: 1. The summary mentions ‘strict NPO with PEG feeding’ under Aspiration precautions, which addresses the NPO component. 2. Under Problem #4 (Aspiration and Respiratory Issues), it states ‘maintaining oxygen requirements’ but attributes this to ‘aspiration related atelectasis’ rather than pneumonitis. 3. While aspiration risk and oxygen requirements are mentioned, the specific terms ‘aspiration pneumonitis’ and SLP involvement in NPO orders are not explicitly stated. 4. The oxygen requirement is linked to atelectasis (a different pathology) and SLP’s role in NPO implementation isn’t documented, making the fact as phrased not fully present.

B. Hospital course summaries contradicting important facts

Patient	Fact 0			Fact 1			Fact 2			Majority Vote
Patient	claude-3.5-sonnet-v2	llama4-scout	deepseek-r1	claude-3.5-sonnet-v2	llama4-scout	deepseek-r1	claude-3.5-sonnet-v2	llama4-scout	deepseek-r1	F0	F1	F2
Patient 0	No	No	No	Yes	Yes	Yes	No	No	No	No	Yes	No
Patient 1	No	No	Yes	No	No	No	No	No	No	No	No	No
Patient 2	No	No	No	No	No	Yes	No	No	No	No	No	No
Patient 3	No	No	No	No	No	Yes	No	No	No	No	No	No
Patient 4	No	No	No	No	No	No	No	No	Yes	No	No	No
Patient 5	No	No	No	No	No	No	No	No	No	No	No	No
Patient 6	No	Yes	No	Yes	Yes	Yes	No	No	No	No	Yes	No
Patient 7	No	No	Yes	No	No	No	No	No	Yes	No	No	No
Patient 8	No	No	Yes	No	No	Yes	No	No	No	No	No	No
Patient 9	Yes	Yes	Yes	No	No	No	No	No	No	Yes	No	No
Patient 10	No	No	Yes	No	No	No	No	No	No	No	No	No
Patient 11	No	No	No	No	No	No	No	No	No	No	No	No
Patient 12	No	Yes	Yes	No	No	No	No	No	No	Yes	No	No
Patient 13	No	No	No	No	No	No	Yes	Yes	Yes	No	No	Yes
Patient 14	No	No	No	No	No	No	No	No	No	No	No	No
Patient 15	Yes	No	Yes	No	No	No	No	No	Yes	Yes	No	No
Patient 16	No	No	No	No	No	No	No	No	No	No	No	No
Patient 17	No	No	Yes	No	No	No	No	No	No	No	No	No
Patient 18	Yes	Yes	Yes	No	No	Yes	Yes	Yes	Yes	Yes	No	Yes
Patient 19	Yes	No	No	No	No	No	No	No	No	No	No	No
Patient 20	No	No	Yes	No	No	Yes	No	No	No	No	No	No
Patient 21	No	No	Yes	Yes	Yes	Yes	No	No	No	No	Yes	No
Patient 22	No	No	Yes	No	No	Yes	No	No	Yes	No	No	No
Patient 23	No	No	Yes	No	No	Yes	No	No	Yes	No	No	No
Patient 24	No	No	No	No	No	No	No	No	No	No	No	No
Patient 25	No	No	No	No	No	No	No	No	No	No	No	No
Patient 26	No	No	No	No	No	Yes	Yes	No	Yes	No	No	Yes
Patient 27	No	No	Yes	No	No	No	No	No	No	No	No	No
Patient 28	No	No	No	No	No	No	No	No	Yes	No	No	No
Patient 29	No	No	No	Yes	Yes	No	No	No	Yes	No	Yes	No

All Inconsistent Facts and Explanations

1. Patient 0, Fact 1:

Fact: Left-sided abdominal JP drain left at time of discharge
Explanation from claude-3.5-sonnet-v2: 1. The summary mentions ‘drain removal’ in the Problem #1 section: ‘amylase levels normalized leading to drain removal’ 2. This directly contradicts the Important Fact stating that a ‘Left sided abdominal JP drain left at time of discharge’ 3. Both statements cannot be true either the drain was removed or it was left in place at discharge
Explanation from llama4-scout: The Hospital Course Summary does not mention the presence or status of a left sided abdominal JP drain at discharge. The ‘Important Fact’ states that a left sided abdominal JP drain was left at the time of discharge. The summary mentions that ‘amylase levels normalized leading to drain removal,’ which implies that at least one drain was removed, but it does not explicitly state that all drains were removed or specify the location and number of drains. However, the absence of any mention of a left sided JP drain being left in place at discharge suggests a potential inconsistency.
Explanation from deepseek-r1: 1. The Important Fact states a left sided abdominal JP drain was left at discharge. 2. The Hospital Course Summary under Problem #1’s Current Clinical Status explicitly states ‘amylase levels normalized leading to drain removal.’ 3. Removal of the drain directly contradicts the fact that it was left in place at discharge. Both statements cannot be true simultaneously.

2. Patient 1, Fact 0:

Fact: Hypoxia 2/2 recurrent R pleura effusion
Explanation from deepseek-r1: 1. Important Fact states hypoxia is due to recurrent right pleural effusion. 2. Summary’s Problem #2 attributes hypoxia to ‘baseline pulmonary status’ and post procedural desaturation, but Problem #1 confirms the effusion decreased post treatment and loculations persisted. 3. No explicit mention of recurrence of effusion causing hypoxia; instead, hypoxia is linked to unresolved loculations and OSA/CO2 retention. 4. Thus, the summary does not confirm hypoxia is specifically due to recurrent effusion, creating a contradiction with the fact.

3. Patient 2, Fact 1:

Fact: Adhesions between omentum and abdominal wall were taken down, and obstructing necrotic mass were removed. Small bowel resection with primary anastomosis was performed
Explanation from deepseek-r1: 1. Important Fact states ‘adhesions between omentum and abdominal wall were taken down’ and ‘obstructing necrotic mass removed’ alongside small bowel resection. 2. Hospital Summary explicitly mentions ‘laparoscopic small bowel resection with primary anastomosis’ and removal of a ‘necrotic mass in the small bowel’ but does not document adhesiolysis. 3. Since the summary omits adhesions being addressed (a distinct procedure from the resection itself), these statements cannot both be true.

4. Patient 3, Fact 1:

Fact: R-sided chest pain 2/2 port-associated thrombus
Explanation from deepseek-r1: 1. Important Fact states R sided chest pain is due to port associated thrombus (2/2 = secondary to). 2. Hospital Summary (Problem #2: Cancer related Pain) attributes R sided chest pain to metastases, not thrombus. 3. Port associated thrombus (Problem #3) is documented but not linked to chest pain in the summary. 4. Attribution of chest pain to metastases directly contradicts the fact’s stated cause (thrombus).

5. Patient 4, Fact 2:

Fact: AKI on CKD 2/2 urinary retention treated with foley catheter placement
Explanation from deepseek-r1: 1. The Important Fact states ‘AKI on CKD 2/2 urinary retention treated with foley catheter placement,’ indicating an acute kidney injury (AKI) superimposed on chronic kidney disease (CKD) caused by urinary retention. 2. The Hospital Course Summary documents CKD IV (stage IV) and urinary retention managed with a foley but does not mention AKI at any point. 3. Lab values (Cr 3.64 3.80 mg/dL) are presented as a stable range without reference to an acute rise from baseline, and the summary explicitly describes ‘stable kidney function post foley.’ 4. The absence of AKI documentation in the summary directly contradicts the assertion of AKI in the Important Fact.

6. Patient 6, Fact 0:

Fact: Adrenal crisis in a patient with primary adrenal insufficiency secondary to autoimmune ployglandular syndrome likely due to intolerance of PO prednisone.
Explanation from llama4-scout: The Important Fact states that the adrenal crisis was likely due to intolerance of PO prednisone. The Hospital Course Summary does not mention ‘PO prednisone’ or any issue related to prednisone intolerance. Instead, it details the patient’s treatment with intravenous hydrocortisone and subsequent transition to oral hydrocortisone, indicating a different management approach.

7. Patient 6, Fact 1:

Fact: Type 1 diabetes, insulin changed to lantus 15units twice a day.
Explanation from claude-3.5-sonnet-v2: 1. The summary states the patient is being discharged on ‘Levemir 16 UNITS BID’ (twice daily) 2. The Important Fact states lantus 15 units twice daily 3. These are different insulins (Levemir vs. Lantus) and different doses (16 units vs. 15 units) 4. While both are long acting insulins given twice daily, the specific medication and dosage differences make these statements contradictory
Explanation from llama4-scout: The Hospital Course Summary mentions that the patient was discharged on ‘Levemir 16 UNITS BID and Insulin 1:7 TID AC’, whereas the Important Fact states that insulin was changed to ‘lantus 15units twice a day’. The discrepancy lies in the type and dosage of insulin. Levemir and Lantus are both long acting insulins but are different brands. The dosage also differs (16 units vs 15 units). Therefore, the summary contradicts the fact.
Explanation from deepseek-r1: 1. Important Fact states insulin changed to Lantus 15 units twice daily. 2. Hospital Summary’s Problem #2 discharge plan specifies ‘Levemir 16 UNITS BID’ (a different basal insulin). 3. Lantus and Levemir are distinct insulin formulations. 4. Dosage (15 vs 16 units) and medication type (Lantus vs Levemir) both differ. 5. This constitutes a direct therapeutic regimen contradiction.

8. Patient 7, Fact 0:

Fact: Left renal cell carcinoma status-post neoadjuvant chemotherapy and now post-op left nephrectomy, IVC thrombectomy.
Explanation from deepseek-r1: 1. The Important Fact mentions ‘status post neoadjuvant chemotherapy’ for renal cell carcinoma. 2. The Hospital Course Summary describes the patient’s surgery (nephrectomy/IVC thrombectomy) but never references neoadjuvant chemotherapy in the Problem #1 section, Therapeutic Procedures, or Medical History. 3. Since neoadjuvant chemotherapy is a major pretreatment modality that would typically be documented in a surgical summary if administered, its absence creates a direct contradiction.

9. Patient 7, Fact 2:

Fact: Continued on apixaban post-op
Explanation from deepseek-r1: 1. The Important Fact states the patient ‘continued on apixaban post op.’ 2. The Hospital Course Summary explicitly states under ‘Outstanding Issues/Follow Up’ to ‘Restart home apixaban (Eliquis) for DVT prevention’ and under Problem #1’s Discharge Plan to ‘resume apixaban.’ 3. ‘Restart’ and ‘resume’ imply a temporary discontinuation (e.g., perioperative hold) followed by re initiation, which conflicts with the assertion of uninterrupted continuation (‘continued on’).

10. Patient 8, Fact 0:

Fact: Down’s syndrome, neurogenic bladder, admitted for pneumonia, treated with CAP regimen and vancomycin due to positive sputum culture for MRSA
Explanation from deepseek-r1: 1. Important Fact states MRSA was found in sputum culture, prompting vancomycin. 2. Hospital Summary reports sputum culture showed ‘rare staph aureus’ but specifies vancomycin was added due to MRSA nares positivity. 3. Sputum culture in summary does not confirm MRSA, conflicting with the fact’s assertion of MRSA in sputum.

11. Patient 8, Fact 1:

Fact: Potential aspiration event prior to discharge, 1/4 bottles positive for GPC, speciation not complete by time of discharge
Explanation from deepseek-r1: 1. Important Fact states ‘1/4 bottles positive for GPC, speciation not complete by discharge.’ 2. Hospital Summary reports sputum culture identified ‘rare staph aureus’ (a Gram positive coccus), which constitutes completed speciation. 3. This directly contradicts the claim that speciation was not completed at discharge. 4. No mention of aspiration event in summary, but does not conflict as absence ≠ contradiction.

12. Patient 9, Fact 0:

Fact: Sepsis from urinary source with potential pyelonephritis, finishing a 7-day course of cipro on discharge. Started on finasteride in an attempt to prevent future UTIs.
Explanation from claude-3.5-sonnet-v2: 1. The summary states patient is on Zosyn at discharge with pending sensitivities, while the fact states patient is finishing a 7 day course of Cipro 2. Summary indicates Klebsiella pneumoniae infection treated with Zosyn, while fact mentions Cipro treatment 3. Summary does not mention finasteride initiation that is stated in the fact 4. These treatment details directly contradict each other as they represent different antibiotic choices and treatment plans
Explanation from llama4-scout: The Hospital Course Summary indicates the patient was discharged with plans to continue Zosyn as an outpatient with pending sensitivities, whereas the Important Fact states the patient was finishing a 7 day course of cipro on discharge. These statements are contradictory because they mention different antibiotics (Zosyn vs. cipro) being used at discharge. Additionally, the Important Fact mentions starting finasteride to prevent future UTIs, which is not mentioned in the Hospital Course Summary. However, the primary contradiction lies in the antibiotic used at discharge.
Explanation from deepseek-r1: 1. Important Fact states patient was ‘finishing a 7 day course of cipro on discharge’ and ‘started on finasteride’. 2. Hospital Summary specifies discharge plan was to ‘Continue Zosyn as outpatient’ (no mention of cipro) and contains no reference to finasteride initiation. 3. These medication discrepancies represent direct therapeutic contradictions.

13. Patient 10, Fact 0:

Fact: The patient with polysubstance use disorder (alcohol, meth) was admitted to the hospital due to concerns for acute alcohol withdrawal and received inpatient treatment for alcohol use disorder as well as linkages to outpatient MAT treatment.
Explanation from deepseek-r1: 1. The Important Fact states the patient received ‘linkages to outpatient MAT treatment.’ 2. The Hospital Course Summary’s discharge plan under Problem #1 mentions ‘outpatient follow up with addiction medicine’ but does not specify MAT (medication assisted treatment), which is a specific pharmacological intervention. 3. MAT is a distinct component of addiction treatment, and its absence in the summary’s documentation creates a direct conflict with the stated fact.

14. Patient 12, Fact 0:

Fact: Patient sent to the hospital from home for symptoms of tachycardia, hypotension, found to have a new gallbladder enteric fistula
Explanation from llama4-scout: The Hospital Course Summary indicates that the patient was admitted due to hypotension and tachycardia suspected from a new gallbladder enteric fistula. However, under Problem #2: Gallbladder Enteric Fistula, it is stated that ‘No definitive fistula was detected’ on CT imaging, although pneumobilia was initially present. This indicates a contradiction because the summary initially suggests the presence of a new gallbladder enteric fistula, while later it clarifies that no definitive fistula was detected on imaging.
Explanation from deepseek-r1: 1. Important Fact states the gallbladder enteric fistula was ‘found to have a new gallbladder enteric fistula.’ 2. Hospital Summary under Problem #2 explicitly states ‘No definitive fistula was detected’ in CT imaging, though pneumobilia was noted. 3. The absence of definitive fistula visualization in imaging directly conflicts with the assertion that it was confirmed (‘found’).

15. Patient 13, Fact 2:

Fact: It does not appear her chronic medical conditions including DM2 were worsened perioperatively
Explanation from claude-3.5-sonnet-v2: 1. The summary indicates blood glucose was elevated and required management with insulin sliding scale during the hospital stay 2. Under Problem #3, it specifically notes ‘hyperglycemia being managed’ 3. These findings directly contradict the fact stating that DM2 was not worsened perioperatively 4. The need for ongoing glucose management with ‘moderate sliding scale insulin’ suggests perioperative worsening of diabetes control
Explanation from llama4-scout: The Hospital Course Summary mentions that the patient had ‘blood glucose elevated’ and was managed with a ‘moderate sliding scale insulin regimen’, indicating that her Type 2 Diabetes Mellitus (DM2) was being actively managed perioperatively due to hyperglycemia. This contradicts the Important Fact that states ‘It does not appear her chronic medical conditions including DM2 were worsened perioperatively’ because the summary implies that DM2 was affected as evidenced by the need for insulin management.
Explanation from deepseek-r1: 1. The Important Fact states DM2 was not worsened perioperatively. 2. The Hospital Summary notes ‘blood glucose elevated’ and ‘hyperglycemia being managed’ under Problem #3. 3. Elevated glucose and active management (sliding scale insulin) indicate perioperative exacerbation of DM2. 4. This directly conflicts with the Important Fact’s assertion.

16. Patient 15, Fact 0:

Fact: Principal diagnosis at discharge: viral gastroenteritis.
Explanation from claude-3.5-sonnet-v2: 1. The hospital course summary details AKI secondary to nausea/vomiting as the main diagnosis, with problems focusing on: Nausea/vomiting Acute kidney injury Hypotension Heart failure Diabetes 2. Nowhere in the summary is viral gastroenteritis mentioned as a diagnosis or cause 3. The nausea/vomiting is described in context of causing AKI, but no viral etiology is specified 4. The summary attributes the patient’s condition to pre renal causes and possible ATN, not a viral infection
Explanation from deepseek-r1: 1. The Important Fact states the principal diagnosis at discharge was viral gastroenteritis. 2. The Hospital Course Summary attributes AKI to nausea/vomiting but never identifies viral gastroenteritis as the underlying cause. 3. All problem summaries (e.g., Problem #1: Nausea/Vomiting) describe management and resolution of symptoms without mentioning viral etiology. 4. Discharge plans focus on renal monitoring and symptom management, not infectious causes. 5. The absence of any reference to viral testing, infection control measures, or antiviral treatment contradicts the stated principal diagnosis.

17. Patient 15, Fact 2:

Fact: Immunosuppressant medications (tacrolimus, mycophenolate, and prednisone) were temporarily stopped when the patient initially came to the hospital.
Explanation from deepseek-r1: 1. Important Fact states immunosuppressants (tacrolimus, mycophenolate, prednisone) were stopped. 2. Summary (Problem #2 AKI) explicitly mentions ‘held tacrolimus and mycophenolate’ but does not mention stopping prednisone. 3. Since prednisone discontinuation is part of the Important Fact but not documented in the summary, this creates a direct contradiction.

18. Patient 17, Fact 0:

Fact: Delirium tremens requiring intravenous benzodiazepines and phenobarbital for symptom control
Explanation from deepseek-r1: 1. The Important Fact states ‘delirium tremens’ requiring IV benzodiazepines and phenobarbital. 2. The summary documents ‘acute alcohol withdrawal with hallucinations and tremors’ treated with phenobarbital and ativan (a benzodiazepine), but never explicitly diagnoses delirium tremens. 3. Delirium tremens is a specific, severe form of alcohol withdrawal characterized by autonomic hyperactivity and altered mental status beyond perceptual disturbances. 4. The summary’s omission of this diagnosis while describing treatment appropriate for less severe withdrawal (CIWA protocol) creates a conflict, as both cannot simultaneously be true.

19. Patient 18, Fact 0:

Fact: Persistent fever with suspected pulmonary infection despite negative infectious workups
Explanation from claude-3.5-sonnet-v2: 1. The summary states the patient had non neutropenic fever with negative infectious workup (blood cultures NGTD, CXR and CT Abdomen showed no infectious focus) 2. The fact mentions ‘suspected pulmonary infection’ but the summary’s imaging specifically showed no infectious focus on CXR 3. While both mention fever and negative workup, the summary indicates the fever resolved (patient was ‘afebrile 24 hours prior to discharge’) rather than being persistent 4. The summary attributes the fever to suspected increased tumor burden, not to a pulmonary infection
Explanation from llama4-scout: The Hospital Course Summary indicates that the patient was admitted for non neutropenic fever and treated with broad spectrum antibiotics due to suspicion of increased tumor burden. The infectious workup revealed no significant findings (e.g., ‘Blood cultures: NGTD’, ‘CXR and CT Abdomen: No infectious focus’). The patient became afebrile 24 hours prior to discharge. The Important Fact states ‘Persistent fever with suspected pulmonary infection despite negative infectious workups’. The summary does not mention a pulmonary infection or persistent fever at discharge, as it states the patient was ‘Afebrile 24 hours prior to discharge’. Therefore, the summary contradicts the fact because it indicates the fever resolved, whereas the fact implies ongoing fever.
Explanation from deepseek-r1: 1. Important Fact states ‘persistent fever with suspected pulmonary infection despite negative infectious workups.’ 2. Summary under Problem #2 notes ‘afebrile 24 hours prior to discharge’ and ‘CXR and CT Abdomen: No infectious focus,’ indicating resolved fever and no evidence of pulmonary infection. 3. Antibiotics were administered due to tumor burden suspicion, not confirmed infection. 4. The summary explicitly contradicts the ‘persistent fever’ and ‘suspected pulmonary infection’ in the fact.

20. Patient 18, Fact 1:

Fact: Diffuse Large B-Cell Lymphoma recently complicated by progression to CNS lymphoma
Explanation from deepseek-r1: 1. The Important Fact states ‘Diffuse Large B Cell Lymphoma (DLBCL)’ with CNS progression. 2. The Hospital Summary specifies ‘high grade B cell lymphoma with [anonymized genetic information]’ and ‘CNS lymphoma’ in its medical history and Problem #5. 3. High grade B cell lymphoma with [anonymized genetic information] is a distinct entity from DLBCL per WHO classification, making these diagnoses mutually exclusive. 4. The summary’s lymphoma subtype directly conflicts with the DLBCL mentioned in the Important Fact.

21. Patient 18, Fact 2:

Fact: Acute kidney injury with hypokalemia resolved during admission
Explanation from claude-3.5-sonnet-v2: 1. The Important Fact states that AKI with hypokalemia resolved during admission 2. The summary shows: AKI did resolve (Creatinine went from 0.80 to 0.52) However, hypokalemia remained unresolved at discharge (potassium levels consistently low at 3.3 3.4) 3. Since the hypokalemia was still present and being treated at discharge (requiring ongoing potassium supplementation and monitoring), this contradicts the fact stating both conditions resolved
Explanation from llama4-scout: The Hospital Course Summary states that the patient experienced acute kidney injury, which resolved with fluid resuscitation, and hypokalemia, which was responsive to potassium supplementation. However, the potassium levels were ‘consistently low (3.3 3.4)’ at discharge, indicating that hypokalemia was not fully resolved. The Important Fact states that ‘Acute kidney injury with hypokalemia resolved during admission.’ Since the summary indicates that hypokalemia was not resolved, this contradicts the Important Fact.
Explanation from deepseek-r1: 1. Important Fact states both AKI and hypokalemia resolved. 2. Summary’s Problem #3 confirms AKI resolved (creatinine 0.80→0.52, ‘Resolved AKI’). 3. Summary’s Problem #4 shows hypokalemia was ‘responsive to treatment’ with ongoing supplementation and discharge plan for electrolyte monitoring, but doesn’t state resolution. 4. Persistent hypokalemia management at discharge contradicts the claim that hypokalemia resolved.

22. Patient 19, Fact 0:

Fact: Hydronephrosis is complicated by urinary tract infections (ESBL E. coli, Klebsiella, and Enterococcus faecalis).
Explanation from claude-3.5-sonnet-v2: 1. The summary mentions only E. faecalis in urine cultures, while the fact states there were three organisms (ESBL E. coli, Klebsiella, and E. faecalis) 2. While the summary mentions ‘past ESBL producing organisms,’ it does not confirm current ESBL E. coli or Klebsiella infection 3. The summary indicates a single organism (E. faecalis) was found in current cultures, which contradicts the fact stating all three organisms were present 4. The summary does not mention hydronephrosis, though it notes a filling defect in left renal pole

23. Patient 20, Fact 0:

Fact: HHT with new PE/DVT s/p IVC filter placement as well as changed to fondaparinux
Explanation from deepseek-r1: 1. Important fact states anticoagulation was changed to fondaparinux. 2. Hospital summary documents initial transition from heparin to fondaparinux, but later states ‘switched to apixaban’ in Problem #1 therapeutic procedures. 3. Discharge plan specifies continuing apixaban, not fondaparinux. This creates direct contradiction in anticoagulation regimen.

24. Patient 20, Fact 1:

Fact: worsening thrombocytopenia, s/p prednisone taper initiation
Explanation from deepseek-r1: 1. Important fact states ‘worsening thrombocytopenia, s/p prednisone taper initiation’. 2. Hospital course shows thrombocytopenia was treated with prednisone 40 mg initially, then increased to 100 mg daily (not a taper). 3. Summary explicitly states ‘platelet count improved’ with this regimen and discharge plan is to continue 100 mg daily. 4. ‘Taper initiation’ implies dose reduction, but summary shows dose escalation and maintenance. 5. Both worsening thrombocytopenia and prednisone taper cannot coexist with documented platelet improvement and dose increase.

25. Patient 21, Fact 0:

Fact: recurrent falls of unknown etiology despite extensive workup inpatient
Explanation from deepseek-r1: 1. The Important Fact states ‘recurrent falls of unknown etiology despite extensive workup inpatient.’ 2. The Hospital Course explicitly notes telemetry revealed ‘runs of nonsustained SVT’ during the fall evaluation (Problem #1). 3. SVT is a documented potential cardiac cause of falls, contradicting the claim that the etiology remains unknown after workup.

26. Patient 21, Fact 1:

Fact: T6 wedge compression fracture that likely happened before most recent fall
Explanation from claude-3.5-sonnet-v2: 1. The summary states ‘CT showed a new T6 compression deformity’ under Problem #2 2. The summary describes this injury as resulting from the current admission’s fall (‘admitted following a fall resulting in a T6 compression fracture’) 3. This directly contradicts the Important Fact stating the fracture ‘likely happened before most recent fall’ 4. The temporal relationship between the fracture and fall is clearly different between the two sources
Explanation from llama4-scout: The Hospital Course Summary states that [Mrs. anonymized name] was admitted following a fall resulting in a T6 compression fracture and that CT showed a new T6 compression deformity. This indicates that the T6 compression fracture occurred during the recent fall. The Important Fact states that the T6 wedge compression fracture likely happened before the most recent fall. These two statements are contradictory because the summary suggests the fracture was new and happened during the fall, while the fact suggests it happened before the fall.
Explanation from deepseek-r1: 1. The Important Fact states the T6 fracture ‘likely happened before most recent fall.’ 2. The Hospital Summary states under Problem #2: ‘CT showed a new T6 compression deformity’ and describes it as resulting from ‘a fall’ (singular) that caused admission. 3. The term ‘new’ in imaging implies acute/recent injury, directly linking it to the index fall event that prompted hospitalization. This contradicts the Important Fact’s assertion of a pre existing fracture.

27. Patient 22, Fact 0:

Fact: Post procedural cholangitis following recent biliary stent exchange
Explanation from deepseek-r1: 1. The Important Fact states ‘post procedural cholangitis following recent biliary stent exchange.’ 2. The Hospital Course Summary attributes cholangitis to a ‘biliary drain exchange’ (Brief Description) and ‘drain exchange’ (Problem #1), with no mention of a stent. 3. Biliary drain exchanges (external percutaneous drains) and stent exchanges (internal biliary stents) are distinct procedures. 4. The summary explicitly links cholangitis to a drain exchange, conflicting with the stent exchange in the fact, making both statements incompatible.

28. Patient 22, Fact 1:

Fact: should continue and re-eval further continuation of augmentin therapy prior to the 14 day completion
Explanation from deepseek-r1: 1. The Important Fact specifies ‘augmentin therapy’ needing re evaluation before 14 day completion. 2. The Hospital Course Summary states the patient was treated with intravenous Zosyn (piperacillin tazobactam), not Augmentin. 3. Continuing Zosyn instead of Augmentin directly conflicts with the fact, as they are different antibiotics. 4. No mention of Augmentin in the summary implies a contradiction with the fact’s specified therapy.

29. Patient 22, Fact 2:

Fact: patient should follow up with Advanced Practice Provider (Nurse Practitioner/ Physician Assistant) in 1 week and [anonymized name], MD in in 2 weeks
Explanation from deepseek-r1: 1. The Important Fact specifies follow up with an Advanced Practice Provider (APP) in 1 week and [Dr. anonymized name] in 2 weeks. 2. The Hospital Course Summary’s ‘Outstanding Issues/Follow Up’ and discharge plans mention follow ups with SLP, Nutrition Cancer Center, oncology, and endocrine, but do not reference APP or [Dr. anonymized name]. 3. The absence of these specific follow up appointments in the summary creates a direct contradiction with the Important Fact.

30. Patient 23, Fact 0:

Fact: large pleural effusion s/p thoracentesis
Explanation from deepseek-r1: 1. The Important Fact states ‘large pleural effusion s/p thoracentesis’ (status post procedure). 2. The Hospital Course Summary explicitly documents ‘large right pleural effusion noted on imaging’ (pre procedure) and ‘thoracentesis performed with removal of 1.75L serosanguinous fluid’ followed by ‘significant improvement post thoracentesis’. 3. These records confirm the pleural effusion was addressed through thoracentesis with clinical improvement, making the post procedural ‘large’ designation in the Important Fact contradictory to the documented outcome.

31. Patient 23, Fact 1:

Fact: in setting of progressing CLL and mitral valvulopathy
Explanation from deepseek-r1: 1. The Important Fact mentions ‘progressing CLL’, but the Hospital Course Summary states under Problem #1: ‘Current Clinical Status: Disease is stable’. 2. The summary explicitly describes CLL as stable (not progressing) and confirms continuation of existing management. 3. Mitral valvulopathy is addressed as ‘Mitral Valve Stenosis’ in the summary (gradient of 25 on TTE), which aligns with the fact. The contradiction specifically applies to CLL progression status.

32. Patient 23, Fact 2:

Fact: Cardiology will help coordinate close follow up with the Heart Failure team to discuss transcatheter MVR iso likely new clinical trial drug [anonymized date]
Explanation from deepseek-r1: 1. The Important Fact states Cardiology will coordinate with the Heart Failure team regarding a transcatheter MVR and clinical trial drug ([anonymized date]). 2. The Hospital Summary’s cardiology follow up plan (under Problem #2) mentions ‘comprehensive valve disease management’ and scheduled trans thoracic echocardiogram, but no reference to: Heart Failure team collaboration Transcatheter MVR Clinical trial drug involvement 3. The only medication mentioned in discharge plans is Duvelisib (CLL treatment), unrelated to heart failure trials. 4. This creates a direct contradiction as the specific interventions/coordination in the fact are absent in the summary.

33. Patient 26, Fact 1:

Fact: Metoprolol dosage increased to 75 mg twice daily for improved rate control; Apixaban dosage increased to 5 mg twice daily for anticoagulation.
Explanation from deepseek-r1: 1. The Important Fact states metoprolol was increased to 75 mg twice daily and apixaban to 5 mg twice daily. 2. The Hospital Course Summary mentions ‘rate control with diltiazem and metoprolol’ but does not specify any dosage increase for metoprolol. 3. Apixaban (an anticoagulant) is not mentioned at all in the entire summary, despite being part of the Important Fact. 4. Both the absence of apixaban documentation and lack of metoprolol dosage specification create contradictions with the stated fact.

34. Patient 26, Fact 2:

Fact: Patient’s emesis may be related to chronic mesenteric ischemia, as CT angiography revealed superior mesenteric artery (SMA) stenosis.
Explanation from claude-3.5-sonnet-v2: 1. The summary mentions CT showing SMA narrowing but explicitly states it ‘ruled out acute ischemia’ 2. The summary attributes the patient’s symptoms primarily to gastroparesis, not chronic mesenteric ischemia 3. While both documents mention SMA findings, they differ in their clinical interpretation the Important Fact suggests mesenteric ischemia as the cause while the summary rules it out 4. This represents a direct contradiction in the clinical interpretation of the patient’s condition
Explanation from deepseek-r1: 1. The Important Fact states that emesis may be related to chronic mesenteric ischemia due to SMA stenosis. 2. The Hospital Summary under Problem #1 explicitly notes ‘CT showed SMA narrowing but ruled out acute ischemia’ and attributes symptoms to gastroparesis/dyspepsia. 3. While SMA stenosis is confirmed, the summary does not mention chronic mesenteric ischemia as a potential contributor to emesis, instead resolving symptoms with gastroparesis focused care. 4. The absence of acknowledgment of chronic ischemia as a possible etiology (despite SMA findings) creates a conflict with the Important Fact’s assertion of a potential relationship.

35. Patient 27, Fact 0:

Fact: Patient admitted for neutropenic fever found to have coagulase negative strep bacteremia treated with PICC removal/replacement and antibiotics.
Explanation from deepseek-r1: 1. Important Fact states bacteremia was due to coagulase negative strep. 2. Hospital Summary (Problem #1) reports blood cultures showed Coagulase Negative Staphylococci bacteremia. 3. Staphylococci and Streptococci are distinct bacterial groups; coagulase negative strep does not exist. 4. This constitutes a direct microbiological contradiction.

36. Patient 28, Fact 2:

Fact: Hospital course complicated by sepsis requiring antibiotics and aggressive fluid resuscitation, delirium requiring pharmacotherapy, and urinary retention requiring urinary catheter.
Explanation from deepseek-r1: 1. The Important Fact mentions sepsis requiring antibiotics and aggressive fluid resuscitation, but the summary does not mention sepsis or antibiotic use. 2. The summary confirms delirium managed with pharmacotherapy, aligning with the fact. 3. The Important Fact states urinary retention requiring a catheter, which is absent in the summary. Since two of three key complications (sepsis, urinary retention) are unmentioned, the summary conflicts with the fact.

37. Patient 29, Fact 1:

Fact: Management of pt’s metastatic nasopharyngeal carcinoma deferred to outpt oncologist per patient’s son’s wishes and patient’s delirium.
Explanation from claude-3.5-sonnet-v2: 1. The summary describes active management of nasopharyngeal carcinoma with specific plans: PET/CT scheduled for evaluation of cervical nodal disease Explicit mention of ‘Consider chemotherapy plan based on patient and family decision’ Coordination for outpatient oncological follow up 2. While delirium is mentioned as a problem that improved with treatment, there’s no indication that cancer management was deferred because of it 3. The summary shows ongoing cancer management decisions and planning, contradicting the fact that management was deferred
Explanation from llama4-scout: The Hospital Course Summary indicates that there was a ‘coordination for outpatient oncological follow up’ and ‘consider chemotherapy plan based on patient and family decision’, which implies that the management of the patient’s metastatic nasopharyngeal carcinoma was not entirely deferred to the outpatient oncologist. Instead, there were ongoing plans and considerations during the hospital stay. This contradicts the Important Fact that management was deferred to the outpatient oncologist per the patient’s son’s wishes and patient’s delirium.

38. Patient 29, Fact 2:

Fact: Patient developed temporary O2 requirement felt to be result of aspiration pneumonitis, made strict NPO by SLP.
Explanation from deepseek-r1: 1. Important Fact states O2 requirement was due to aspiration pneumonitis. 2. Hospital Summary (Problem #4) attributes respiratory issues to ‘aspiration related atelectasis’ (CXR showed no consolidation) and notes ‘maintaining oxygen requirements’ without mentioning pneumonitis. 3. Pneumonitis (inflammatory) and atelectasis (mechanical) are distinct etiologies. 4. This creates a diagnostic contradiction regarding the cause of O2 requirement.