Abstract
Purpose
Clinical decision support systems (CDSS) are used to identify drugs with potential need for dose modification in patients with renal impairment. ChatGPT holds the potential to be integrated in the electronic health record (EHR) system to give such dosing advices. In this study, we aim to evaluate the performance of ChatGPT in clinical rule-guided dose interventions in hospitalized patients with renal impairment.
Methods
This cross-sectional study was performed at Tergooi Medical Center, the Netherlands. CDSS alerts regarding renal dysfunction were collected from the electronic health record (EHR) during a 2-week period and were presented to ChatGPT and an expert panel. Alerts were presented with and without patient variables. To evaluate the performance, suggested medication interventions were compared.
Results
In total, 172 CDDS alerts were generated for 80 patients. Indecisive responses by ChatGPT to alerts were excluded. For alerts presented without patient variables, ChatGPT provided “correct and identical” responses to 19.9%, “correct and different” responses to 26.7%, and “incorrect responses to 53.4% of the alerts. For alerts including patient variables, ChatGPT provided “correct and identical” responses to 16.7%, “correct and different” responses to 16.0%, and “incorrect responses to 67.3% of the alerts. Accuracy was better for newer drugs such as direct oral anticoagulants.
Conclusion
The performance of ChatGPT in clinical rule-guided dose interventions in hospitalized patients with renal dysfunction was poor. Based on these results, we conclude that ChatGPT, in its current state, is not appropriate for automatic integration into our EHR to handle CDSS alerts related to renal dysfunction.
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All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by MvN, JS, AE, and RW. Interpretation of the data was performed by MvN, AE, TE, and PvdL. The first draft of the manuscript was written by MvN and AE and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.
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van Nuland, M., Snoep, J.D., Egberts, T. et al. Poor performance of ChatGPT in clinical rule-guided dose interventions in hospitalized patients with renal dysfunction. Eur J Clin Pharmacol (2024). https://doi.org/10.1007/s00228-024-03687-5
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DOI: https://doi.org/10.1007/s00228-024-03687-5