{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,13]],"date-time":"2026-06-13T01:07:39Z","timestamp":1781312859265,"version":"3.54.1"},"reference-count":35,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,3,18]],"date-time":"2025-03-18T00:00:00Z","timestamp":1742256000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"},{"start":{"date-parts":[[2025,3,18]],"date-time":"2025-03-18T00:00:00Z","timestamp":1742256000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"funder":[{"DOI":"10.13039\/100000133","name":"Agency for Healthcare Research and Quality","doi-asserted-by":"publisher","award":["R21HS029969"],"award-info":[{"award-number":["R21HS029969"]}],"id":[{"id":"10.13039\/100000133","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100006108","name":"National Center for Advancing Translational Sciences","doi-asserted-by":"publisher","award":["UL1TR001427"],"award-info":[{"award-number":["UL1TR001427"]}],"id":[{"id":"10.13039\/100006108","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["npj Digit. Med."],"DOI":"10.1038\/s41746-025-01556-8","type":"journal-article","created":{"date-parts":[[2025,3,18]],"date-time":"2025-03-18T08:24:05Z","timestamp":1742286245000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["Preliminary analysis of the impact of lab results on large language model generated differential diagnoses"],"prefix":"10.1038","volume":"8","author":[{"given":"Balu","family":"Bhasuran","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiao","family":"Jin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuzhang","family":"Xie","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carl","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karim","family":"Hanna","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Costa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cindy","family":"Shavor","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenshan","family":"Han","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhiyong","family":"Lu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhe","family":"He","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,3,18]]},"reference":[{"key":"1556_CR1","doi-asserted-by":"publisher","first-page":"115","DOI":"10.1016\/0004-3702(78)90014-0","volume":"11","author":"P Szolovits","year":"1978","unstructured":"Szolovits, P. & Pauker, G. S. Categorical and probabilistic reasoning in medical diagnosis. Artif. Intell. 11, 115\u2013144 (1978).","journal-title":"Artif. Intell."},{"key":"1556_CR2","doi-asserted-by":"publisher","unstructured":"Singh, H., Connor, D. M. & Dhaliwal, G. Five strategies for clinicians to advance diagnostic excellence. BMJ e068044 (2022) https:\/\/doi.org\/10.1136\/bmj-2021-068044.","DOI":"10.1136\/bmj-2021-068044"},{"key":"1556_CR3","doi-asserted-by":"publisher","first-page":"17","DOI":"10.1038\/s41746-020-0221-y","volume":"3","author":"RT Sutton","year":"2020","unstructured":"Sutton, R. T. et al. An overview of clinical decision support systems: benefits, risks, and strategies for success. npj Digit. Med. 3, 17 (2020).","journal-title":"npj Digit. Med."},{"key":"1556_CR4","doi-asserted-by":"crossref","unstructured":"Geldmacher, D. S. & Whitehouse, P. J. Differential diagnosis of Alzheimer\u2019s disease. Neurology 48, 2S\u20139S (1997).","DOI":"10.1212\/WNL.48.5_Suppl_6.2S"},{"key":"1556_CR5","doi-asserted-by":"crossref","unstructured":"Gelfand, J. M. Multiple sclerosis. in Handbook of Clinical Neurology 122 269\u2013290 (Elsevier, 2014).","DOI":"10.1016\/B978-0-444-52001-2.00011-X"},{"key":"1556_CR6","doi-asserted-by":"publisher","first-page":"21","DOI":"10.3748\/wjg.v21.i1.21","volume":"21","author":"GE Tontini","year":"2015","unstructured":"Tontini, G. E. Differential diagnosis in inflammatory bowel disease colitis: State of the art and future perspectives. WJG 21, 21 (2015).","journal-title":"WJG"},{"key":"1556_CR7","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1016\/j.yebeh.2009.02.024","volume":"15","author":"S Benbadis","year":"2009","unstructured":"Benbadis, S. The differential diagnosis of epilepsy: a critical review. Epilepsy Behav. 15, 15\u201321 (2009).","journal-title":"Epilepsy Behav."},{"key":"1556_CR8","doi-asserted-by":"publisher","first-page":"114","DOI":"10.4997\/JRCPE.2013.205","volume":"43","author":"LM Gibson","year":"2013","unstructured":"Gibson, L. M. & Whiteley, W. The differential diagnosis of suspected stroke: a systematic review. J. R. Coll. Physicians Edinb. 43, 114\u2013118 (2013).","journal-title":"J. R. Coll. Physicians Edinb."},{"key":"1556_CR9","doi-asserted-by":"publisher","first-page":"e0148991","DOI":"10.1371\/journal.pone.0148991","volume":"11","author":"N Riches","year":"2016","unstructured":"Riches, N. et al. The effectiveness of electronic differential diagnoses (DDX) generators: A systematic review and meta-analysis. PLoS ONE 11, e0148991 (2016).","journal-title":"PLoS ONE"},{"key":"1556_CR10","doi-asserted-by":"publisher","first-page":"e31810","DOI":"10.2196\/31810","volume":"24","author":"ML Schmieding","year":"2022","unstructured":"Schmieding, M. L. et al. Triage accuracy of symptom checker apps: 5-year follow-up evaluation. J. Med. Internet Res. 24, e31810 (2022).","journal-title":"J. Med. Internet Res."},{"key":"1556_CR11","doi-asserted-by":"publisher","first-page":"626","DOI":"10.1148\/radiol.2020190283","volume":"295","author":"AM Rauschecker","year":"2020","unstructured":"Rauschecker, A. M. et al. Artificial intelligence system approaching neuroradiologist-level differential diagnosis accuracy at brain MRI. Radiology 295, 626\u2013637 (2020).","journal-title":"Radiology"},{"key":"1556_CR12","doi-asserted-by":"publisher","first-page":"100005","DOI":"10.1016\/j.jfop.2023.100005","volume":"1","author":"M Balas","year":"2023","unstructured":"Balas, M. & Ing, E. B. Conversational AI models for ophthalmic diagnosis: comparison of ChatGPT and the isabel pro differential diagnosis generator. JFO Open Ophthalmol. 1, 100005 (2023).","journal-title":"JFO Open Ophthalmol."},{"key":"1556_CR13","doi-asserted-by":"publisher","first-page":"900","DOI":"10.1038\/s41591-020-0842-3","volume":"26","author":"Y Liu","year":"2020","unstructured":"Liu, Y. et al. A deep learning system for differential diagnosis of skin diseases. Nat. Med. 26, 900\u2013908 (2020).","journal-title":"Nat. Med."},{"key":"1556_CR14","doi-asserted-by":"publisher","unstructured":"OpenAI. GPT-4 Technical Report. (2023) https:\/\/doi.org\/10.48550\/ARXIV.2303.08774.","DOI":"10.48550\/ARXIV.2303.08774"},{"key":"1556_CR15","doi-asserted-by":"publisher","first-page":"78","DOI":"10.1001\/jama.2023.8288","volume":"330","author":"Z Kanjee","year":"2023","unstructured":"Kanjee, Z., Crowe, B. & Rodman, A. Accuracy of a generative artificial intelligence model in a complex diagnostic challenge. JAMA 330, 78\u201380 (2023).","journal-title":"JAMA"},{"key":"1556_CR16","unstructured":"McDuff, D. et al. Towards accurate differential diagnosis with large language models. Preprint at http:\/\/arxiv.org\/abs\/2312.00164 (2023)."},{"key":"1556_CR17","doi-asserted-by":"publisher","first-page":"303","DOI":"10.1007\/s00296-023-05464-6","volume":"44","author":"M Krusche","year":"2024","unstructured":"Krusche, M., Callhoff, J., Knitza, J. & Ruffer, N. Diagnostic accuracy of a large language model in rheumatology: comparison of physician and ChatGPT-4. Rheumatol. Int 44, 303\u2013306 (2024).","journal-title":"Rheumatol. Int"},{"key":"1556_CR18","doi-asserted-by":"publisher","first-page":"e13207","DOI":"10.1111\/bpa.13207","volume":"34","author":"S Koga","year":"2024","unstructured":"Koga, S., Martin, N. B. & Dickson, D. W. Evaluating the performance of large language models: ChatGPT and Google Bard in generating differential diagnoses in clinicopathological conferences of neurodegenerative disorders. Brain Pathol. 34, e13207 (2024).","journal-title":"Brain Pathol."},{"key":"1556_CR19","doi-asserted-by":"publisher","first-page":"100213","DOI":"10.1016\/j.jtauto.2023.100213","volume":"7","author":"J Pillai","year":"2023","unstructured":"Pillai, J. & Pillai, K. Accuracy of generative artificial intelligence models in differential diagnoses of familial Mediterranean fever and deficiency of Interleukin-1 receptor antagonist. J. Transl. Autoimmun. 7, 100213 (2023).","journal-title":"J. Transl. Autoimmun."},{"key":"1556_CR20","doi-asserted-by":"publisher","first-page":"e273","DOI":"10.1097\/PCC.0000000000003468","volume":"25","author":"A Akhondi-Asl","year":"2024","unstructured":"Akhondi-Asl, A. et al. Comparing the Quality of Domain-Specific Versus General Language Models for Artificial Intelligence-Generated Differential Diagnoses in PICU Patients. Pediatr. Crit. Care Med. 25, e273\u2013e282 (2024).","journal-title":"Pediatr. Crit. Care Med."},{"key":"1556_CR21","doi-asserted-by":"publisher","first-page":"e48808","DOI":"10.2196\/48808","volume":"11","author":"T Hirosawa","year":"2023","unstructured":"Hirosawa, T. et al. ChatGPT-generated differential diagnosis lists for complex case\u2013derived clinical vignettes: Diagnostic accuracy evaluation. JMIR Med. Inf. 11, e48808 (2023).","journal-title":"JMIR Med. Inf."},{"key":"1556_CR22","doi-asserted-by":"publisher","first-page":"e49324","DOI":"10.2196\/49324","volume":"25","author":"TI Wilhelm","year":"2023","unstructured":"Wilhelm, T. I., Roos, J. & Kaczmarczyk, R. Large language models for therapy recommendations across 3 clinical specialties: Comparative study. J. Med. Internet Res 25, e49324 (2023).","journal-title":"J. Med. Internet Res"},{"key":"1556_CR23","doi-asserted-by":"publisher","first-page":"205","DOI":"10.1038\/s41746-024-01208-3","volume":"7","author":"R Kaczmarczyk","year":"2024","unstructured":"Kaczmarczyk, R., Wilhelm, T. I., Martin, R. & Roos, J. Evaluating multimodal AI in medical diagnostics. npj Digit. Med. 7, 205 (2024).","journal-title":"npj Digit. Med."},{"key":"1556_CR24","doi-asserted-by":"publisher","first-page":"2680","DOI":"10.3390\/ai5040128","volume":"5","author":"J Roos","year":"2024","unstructured":"Roos, J., Wilhelm, T. I., Martin, R. & Kaczmarczyk, R. From language models to medical diagnoses: Assessing the potential of GPT-4 and GPT-3.5-turbo in digital health. AI 5, 2680\u20132692 (2024).","journal-title":"AI"},{"key":"1556_CR25","doi-asserted-by":"publisher","first-page":"83","DOI":"10.1016\/j.annemergmed.2023.08.003","volume":"83","author":"HT Berg","year":"2024","unstructured":"Berg, H. T. et al. ChatGPT and generating a differential diagnosis early in an emergency department presentation. Ann. Emerg. Med. 83, 83\u201386 (2024).","journal-title":"Ann. Emerg. Med."},{"key":"1556_CR26","doi-asserted-by":"publisher","DOI":"10.1038\/s41597-023-02814-8","volume":"10","author":"Z Zhao","year":"2023","unstructured":"Zhao, Z., Jin, Q., Chen, F., Peng, T. & Yu, S. A large-scale dataset of patient summaries for retrieval-based clinical decision support systems. Sci. Data 10, 909 (2023).","journal-title":"Sci. Data"},{"key":"1556_CR27","doi-asserted-by":"publisher","unstructured":"Ouyang, L. et al. Training language models to follow instructions with human feedback. (2022) https:\/\/doi.org\/10.48550\/ARXIV.2203.02155.","DOI":"10.48550\/ARXIV.2203.02155"},{"key":"1556_CR28","unstructured":"Touvron, H. et al. Llama 2: Open Foundation and Fine-Tuned Chat Models. Preprint at http:\/\/arxiv.org\/abs\/2307.09288 (2023)."},{"key":"1556_CR29","unstructured":"Anthropic. Claude 2 Announcement. (2024)."},{"key":"1556_CR30","unstructured":"Jiang, A. Q. et al. Mixtral of Experts. Preprint at http:\/\/arxiv.org\/abs\/2401.04088 (2024)."},{"key":"1556_CR31","doi-asserted-by":"publisher","unstructured":"Sy, A. M., Omobomi, O., Lenox, T. & Bergasa, N. V. Acute cytomegalovirus hepatitis in an immunocompetent host. BMJ Case Reports bcr2013201939 https:\/\/doi.org\/10.1136\/bcr-2013-201939 (2013).","DOI":"10.1136\/bcr-2013-201939"},{"key":"1556_CR32","doi-asserted-by":"crossref","unstructured":"Xie, Y. et al. PromptLink: Leveraging Large Language Models for Cross-Source Biomedical Concept Linking. in Proceedings of the 47th International ACM SIGIR Conference on Research and Development in Information Retrieval 2019 2589\u20132593 (ACM, Washington DC USA, 2024).","DOI":"10.1145\/3626772.3657904"},{"key":"1556_CR33","doi-asserted-by":"publisher","unstructured":"Liu, F., Shareghi, E., Meng, Z., Basaldella, M. & Collier, N. Self-Alignment Pretraining for Biomedical Entity Representations. in Proceedings of the 2021 Conference of the North American Chapter of the Association for Computational Linguistics: Human Language Technologies (Association for Computational Linguistics, Online, 2021). https:\/\/doi.org\/10.18653\/v1\/2021.naacl-main.334.","DOI":"10.18653\/v1\/2021.naacl-main.334"},{"key":"1556_CR34","doi-asserted-by":"crossref","unstructured":"Su, C. et al. Biomedical discovery through the integrative biomedical knowledge hub (iBKH). iScience 26, 106460 (2023).","DOI":"10.1016\/j.isci.2023.106460"},{"key":"1556_CR35","first-page":"1","volume":"1695","author":"G Csardi","year":"2006","unstructured":"Csardi, G. & Nepusz, T. The igraph software package for complex network research. InterJournal, Complex Syst. 1695, 1\u20139 (2006).","journal-title":"InterJournal, Complex Syst."}],"container-title":["npj Digital Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41746-025-01556-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41746-025-01556-8","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41746-025-01556-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,3,18]],"date-time":"2025-03-18T20:13:29Z","timestamp":1742328809000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41746-025-01556-8"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,18]]},"references-count":35,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["1556"],"URL":"https:\/\/doi.org\/10.1038\/s41746-025-01556-8","relation":{},"ISSN":["2398-6352"],"issn-type":[{"value":"2398-6352","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,3,18]]},"assertion":[{"value":"1 November 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"7 March 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"18 March 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare no competing interests.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"166"}}