{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T23:51:15Z","timestamp":1781740275678,"version":"3.54.5"},"reference-count":41,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,4,18]],"date-time":"2026-04-18T00:00:00Z","timestamp":1776470400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"},{"start":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T00:00:00Z","timestamp":1781740800000},"content-version":"vor","delay-in-days":61,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"funder":[{"name":"The Major Key Project of PCL","award":["No.: PCL2025A12"],"award-info":[{"award-number":["No.: PCL2025A12"]}]},{"name":"the Beijing Natural Science Foundation","award":["JQ24041"],"award-info":[{"award-number":["JQ24041"]}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"crossref","award":["82271507"],"award-info":[{"award-number":["82271507"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["npj Digit. Med."],"DOI":"10.1038\/s41746-026-02644-z","type":"journal-article","created":{"date-parts":[[2026,4,18]],"date-time":"2026-04-18T05:15:43Z","timestamp":1776489343000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Development and prospective shadow evaluation of a domain-specific large language model for emergency neurological diagnosis"],"prefix":"10.1038","volume":"9","author":[{"given":"Yibing","family":"Guo","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiangbin","family":"Meng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erlan","family":"Yu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wanwan","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yaodong","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hongrui","family":"Ma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chunli","family":"Shao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenyao","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rongjie","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haofei","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ran","family":"Meng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenbo","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhen","family":"Song","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xunming","family":"Ji","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chuanjie","family":"Wu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,4,18]]},"reference":[{"key":"2644_CR1","doi-asserted-by":"publisher","first-page":"1708","DOI":"10.1001\/jamainternmed.2018.4725","volume":"178","author":"MP Lin","year":"2018","unstructured":"Lin, M. P., Baker, O., Richardson, L. D. & Schuur, J. D. Trends in emergency department visits and admission rates among US acute care hospitals. JAMA Intern. Med. 178, 1708\u20131710 (2018).","journal-title":"JAMA Intern. Med."},{"key":"2644_CR2","doi-asserted-by":"publisher","first-page":"i2139","DOI":"10.1136\/bmj.i2139","volume":"353","author":"MA Makary","year":"2016","unstructured":"Makary, M. A. & Daniel, M. Medical error-the third leading cause of death in the US. BMJ 353, i2139 (2016).","journal-title":"BMJ"},{"key":"2644_CR3","doi-asserted-by":"publisher","first-page":"812","DOI":"10.1001\/jamainternmed.2018.0607","volume":"178","author":"Y Freund","year":"2018","unstructured":"Freund, Y. et al. Effect of systematic physician cross-checking on reducing adverse events in the emergency department: the CHARMED cluster randomized trial. JAMA Intern. Med. 178, 812\u2013819 (2018).","journal-title":"JAMA Intern. Med."},{"key":"2644_CR4","doi-asserted-by":"publisher","first-page":"750","DOI":"10.7326\/M14-1616","volume":"162","author":"R Duseja","year":"2015","unstructured":"Duseja, R. et al. Revisit rates and associated costs after an emergency department encounter: a multistate analysis. Ann. Intern. Med. 162, 750\u2013756 (2015).","journal-title":"Ann. Intern. Med."},{"key":"2644_CR5","doi-asserted-by":"publisher","first-page":"454","DOI":"10.1001\/jama.2020.26345","volume":"325","author":"M Ebinger","year":"2021","unstructured":"Ebinger, M. et al. Association between dispatch of mobile stroke units and functional outcomes among patients with acute ischemic stroke in Berlin. JAMA 325, 454\u2013466 (2021).","journal-title":"JAMA"},{"key":"2644_CR6","doi-asserted-by":"publisher","first-page":"895","DOI":"10.1212\/01.WNL.0000115103.49326.5E","volume":"62","author":"LB Morgenstern","year":"2004","unstructured":"Morgenstern, L. B. et al. A population-based study of acute stroke and TIA diagnosis. Neurology 62, 895\u2013900 (2004).","journal-title":"Neurology"},{"key":"2644_CR7","doi-asserted-by":"publisher","first-page":"1163","DOI":"10.1056\/NEJM200004203421603","volume":"342","author":"JH Pope","year":"2000","unstructured":"Pope, J. H. et al. Missed diagnoses of acute cardiac ischemia in the emergency department. N. Engl. J. Med. 342, 1163\u20131170 (2000).","journal-title":"N. Engl. J. Med."},{"key":"2644_CR8","doi-asserted-by":"publisher","first-page":"582","DOI":"10.7326\/0003-4819-109-7-582","volume":"109","author":"RW Dubois","year":"1988","unstructured":"Dubois, R. W. & Brook, R. H. Preventable deaths: who, how often, and why? Ann. Intern. Med. 109, 582\u2013589 (1988).","journal-title":"Ann. Intern. Med."},{"key":"2644_CR9","doi-asserted-by":"publisher","first-page":"1522","DOI":"10.1161\/STROKEAHA.108.530352","volume":"40","author":"DT Winkler","year":"2009","unstructured":"Winkler, D. T. et al. Thrombolysis in stroke mimics: frequency, clinical characteristics, and outcome. Stroke 40, 1522\u20131525 (2009).","journal-title":"Stroke"},{"key":"2644_CR10","doi-asserted-by":"publisher","first-page":"1340","DOI":"10.1212\/WNL.0b013e3181dad5a6","volume":"74","author":"OY Chernyshev","year":"2010","unstructured":"Chernyshev, O. Y. et al. Safety of tPA in stroke mimics and neuroimaging-negative cerebral ischemia. Neurology 74, 1340\u20131345 (2010).","journal-title":"Neurology"},{"key":"2644_CR11","doi-asserted-by":"publisher","first-page":"1080","DOI":"10.1161\/STROKEAHA.111.000126","volume":"44","author":"SM Zinkstok","year":"2013","unstructured":"Zinkstok, S. M. et al. Safety of thrombolysis in stroke mimics: results from a multicenter cohort study. Stroke 44, 1080\u20131084 (2013).","journal-title":"Stroke"},{"key":"2644_CR12","doi-asserted-by":"publisher","first-page":"102400","DOI":"10.1016\/j.compmedimag.2024.102400","volume":"116","author":"MS Iqbal","year":"2024","unstructured":"Iqbal, M. S. et al. Progress and trends in neurological disorders research based on deep learning. Comput. Med. Imaging Graph. 116, 102400 (2024).","journal-title":"Comput. Med. Imaging Graph."},{"key":"2644_CR13","doi-asserted-by":"crossref","unstructured":"Meng, X. et al. Med-aligner empowers LLM medical applications for complex medical scenarios. Innovation 6, 101002 (2025).","DOI":"10.1016\/j.xinn.2025.101002"},{"key":"2644_CR14","doi-asserted-by":"publisher","first-page":"102522","DOI":"10.1016\/j.media.2022.102522","volume":"80","author":"T Cai","year":"2022","unstructured":"Cai, T. et al. DeepStroke: an efficient stroke screening framework for emergency rooms with multimodal adversarial deep learning. Med. Image Anal. 80, 102522 (2022).","journal-title":"Med. Image Anal."},{"key":"2644_CR15","doi-asserted-by":"publisher","first-page":"2316","DOI":"10.1161\/STROKEAHA.123.044072","volume":"54","author":"Y Liu","year":"2023","unstructured":"Liu, Y. et al. Functional outcome prediction in acute ischemic stroke using a fused imaging and clinical deep learning model. Stroke 54, 2316\u20132327 (2023).","journal-title":"Stroke"},{"key":"2644_CR16","doi-asserted-by":"publisher","first-page":"369","DOI":"10.1136\/jnnp-2022-330230","volume":"94","author":"DY Kim","year":"2023","unstructured":"Kim, D. Y. et al. Deep learning-based personalised outcome prediction after acute ischaemic stroke. J. Neurol. Neurosurg. Psychiatry 94, 369\u2013378 (2023).","journal-title":"J. Neurol. Neurosurg. Psychiatry"},{"key":"2644_CR17","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2020.0772","volume":"3","author":"Y Yu","year":"2020","unstructured":"Yu, Y. et al. Use of deep learning to predict final ischemic stroke lesions from initial magnetic resonance imaging. JAMA Netw. Open 3, e200772 (2020).","journal-title":"JAMA Netw. Open"},{"key":"2644_CR18","doi-asserted-by":"publisher","first-page":"2792","DOI":"10.7150\/ijms.111780","volume":"22","author":"E Yu","year":"2025","unstructured":"Yu, E. et al. Large language models in medicine: applications, challenges, and future directions. Int. J. Med Sci. 22, 2792\u20132801 (2025).","journal-title":"Int. J. Med Sci."},{"key":"2644_CR19","doi-asserted-by":"publisher","first-page":"172","DOI":"10.1038\/s41586-023-06291-2","volume":"620","author":"K Singhal","year":"2023","unstructured":"Singhal, K. et al. Large language models encode clinical knowledge. Nature 620, 172\u2013180 (2023).","journal-title":"Nature"},{"key":"2644_CR20","doi-asserted-by":"publisher","first-page":"e179","DOI":"10.1016\/S2589-7500(23)00048-1","volume":"5","author":"SR Ali","year":"2023","unstructured":"Ali, S. R., Dobbs, T. D., Hutchings, H. A. & Whitaker, I. S. Using ChatGPT to write patient clinic letters. Lancet Digital Health 5, e179\u2013e181 (2023).","journal-title":"Lancet Digital Health"},{"key":"2644_CR21","doi-asserted-by":"crossref","unstructured":"Meng, X. et al. The application of large language models in medicine: a scoping review. Iscience 27, 109713 (2024).","DOI":"10.1016\/j.isci.2024.109713"},{"key":"2644_CR22","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":"2644_CR23","doi-asserted-by":"publisher","first-page":"1028","DOI":"10.1001\/jamainternmed.2023.2909","volume":"183","author":"E Strong","year":"2023","unstructured":"Strong, E. et al. Chatbot vs medical student performance on free-response clinical reasoning examinations. JAMA Intern. Med. 183, 1028\u20131030 (2023).","journal-title":"JAMA Intern. Med."},{"key":"2644_CR24","doi-asserted-by":"publisher","DOI":"10.2196\/59069","volume":"27","author":"K Zhang","year":"2025","unstructured":"Zhang, K. et al. Revolutionizing health care: the transformative impact of large language models in medicine. J. Med. Internet Res. 27, e59069 (2025).","journal-title":"J. Med. Internet Res."},{"key":"2644_CR25","doi-asserted-by":"publisher","first-page":"631","DOI":"10.1001\/jama.2023.0577","volume":"329","author":"JA Edlow","year":"2023","unstructured":"Edlow, J. A. & Pronovost, P. J. Misdiagnosis in the emergency department: time for a system solution. JAMA 329, 631\u2013632 (2023).","journal-title":"JAMA"},{"key":"2644_CR26","doi-asserted-by":"crossref","unstructured":"Newman-Toker, D. E. et al. in Diagnostic Errors in the Emergency Department: A Systematic Review (Agency for Healthcare Research and Quality (US), 2022).","DOI":"10.23970\/AHRQEPCCER258"},{"key":"2644_CR27","doi-asserted-by":"publisher","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 Digital Med. 3, 17 (2020).","journal-title":"NPJ Digital Med."},{"key":"2644_CR28","doi-asserted-by":"publisher","DOI":"10.2196\/63377","volume":"27","author":"GD Giebel","year":"2025","unstructured":"Giebel, G. D. et al. Problems and barriers related to the use of AI-based clinical decision support systems: interview study. J. Med. Internet Res. 27, e63377 (2025).","journal-title":"J. Med. Internet Res."},{"key":"2644_CR29","doi-asserted-by":"publisher","first-page":"943","DOI":"10.1038\/s41591-024-03423-7","volume":"31","author":"K Singhal","year":"2025","unstructured":"Singhal, K. et al. Toward expert-level medical question answering with large language models. Nat. Med. 31, 943\u2013950 (2025).","journal-title":"Nat. Med."},{"key":"2644_CR30","doi-asserted-by":"publisher","first-page":"589","DOI":"10.1001\/jamainternmed.2023.1838","volume":"183","author":"JW Ayers","year":"2023","unstructured":"Ayers, J. W. et al. Comparing physician and artificial intelligence Chatbot responses to patient questions posted to a public social media forum. JAMA Intern. Med. 183, 589\u2013596 (2023).","journal-title":"JAMA Intern. Med."},{"key":"2644_CR31","doi-asserted-by":"publisher","first-page":"2613","DOI":"10.1038\/s41591-024-03097-1","volume":"30","author":"P Hager","year":"2024","unstructured":"Hager, P. et al. Evaluation and mitigation of the limitations of large language models in clinical decision-making. Nat. Med. 30, 2613\u20132622 (2024).","journal-title":"Nat. Med."},{"key":"2644_CR32","doi-asserted-by":"publisher","DOI":"10.1038\/s41746-023-00939-z","volume":"6","author":"JA Omiye","year":"2023","unstructured":"Omiye, J. A., Lester, J. C., Spichak, S., Rotemberg, V. & Daneshjou, R. Large language models propagate race-based medicine. NPJ Digital Med. 6, 195 (2023).","journal-title":"NPJ Digital Med."},{"key":"2644_CR33","doi-asserted-by":"publisher","first-page":"176","DOI":"10.1038\/s43856-024-00601-z","volume":"4","author":"Y Yang","year":"2024","unstructured":"Yang, Y., Liu, X., Jin, Q., Huang, F. & Lu, Z. Unmasking and quantifying racial bias of large language models in medical report generation. Commun. Med. 4, 176 (2024).","journal-title":"Commun. Med."},{"key":"2644_CR34","doi-asserted-by":"publisher","DOI":"10.1038\/s41746-023-00837-4","volume":"6","author":"N Bienefeld","year":"2023","unstructured":"Bienefeld, N. et al. Solving the explainable AI conundrum by bridging clinicians\u2019 needs and developers\u2019 goals. NPJ Digital Med. 6, 94 (2023).","journal-title":"NPJ Digital Med."},{"key":"2644_CR35","doi-asserted-by":"publisher","DOI":"10.1038\/s41746-025-01958-8","volume":"8","author":"S Hur","year":"2025","unstructured":"Hur, S. et al. Comparison of SHAP and clinician friendly explanations reveals effects on clinical decision behaviour. NPJ Digital Med. 8, 578 (2025).","journal-title":"NPJ Digital Med."},{"key":"2644_CR36","doi-asserted-by":"crossref","unstructured":"Park, M. H. et al. Clinical effectiveness of an artificial intelligence-based prediction model for cardiac arrest in general ward-admitted patients: a non-randomized controlled trial. Diagnostics 16, 335 (2026).","DOI":"10.3390\/diagnostics16020335"},{"key":"2644_CR37","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2025.26021","volume":"8","author":"S Bedi","year":"2025","unstructured":"Bedi, S., Jiang, Y., Chung, P., Koyejo, S. & Shah, N. Fidelity of medical reasoning in large language models. JAMA Netw. Open 8, e2526021 (2025).","journal-title":"JAMA Netw. Open"},{"key":"2644_CR38","doi-asserted-by":"publisher","first-page":"141","DOI":"10.1038\/s43856-023-00370-1","volume":"3","author":"J Clusmann","year":"2023","unstructured":"Clusmann, J. et al. The future landscape of large language models in medicine. Commun. Med. 3, 141 (2023).","journal-title":"Commun. Med."},{"key":"2644_CR39","doi-asserted-by":"publisher","first-page":"1930","DOI":"10.1038\/s41591-023-02448-8","volume":"29","author":"AJ Thirunavukarasu","year":"2023","unstructured":"Thirunavukarasu, A. J. et al. Large language models in medicine. Nat. Med. 29, 1930\u20131940 (2023).","journal-title":"Nat. Med."},{"key":"2644_CR40","doi-asserted-by":"crossref","unstructured":"Caliskan, A., Bryson, J. J. & Narayanan, A. Semantics derived automatically from language corpora contain human-like biases. Science 356, 183\u2013186 (2017).","DOI":"10.1126\/science.aal4230"},{"key":"2644_CR41","doi-asserted-by":"publisher","first-page":"99","DOI":"10.1080\/15265161.2023.2250319","volume":"23","author":"CW Ho","year":"2023","unstructured":"Ho, C. W. Generative AI and the foregrounding of epistemic injustice in bioethics. Am. J. Bioeth. 23, 99\u2013102 (2023).","journal-title":"Am. J. Bioeth."}],"container-title":["npj Digital Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41746-026-02644-z","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41746-026-02644-z.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41746-026-02644-z.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T22:56:50Z","timestamp":1781737010000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41746-026-02644-z"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,18]]},"references-count":41,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["2644"],"URL":"https:\/\/doi.org\/10.1038\/s41746-026-02644-z","relation":{},"ISSN":["2398-6352"],"issn-type":[{"value":"2398-6352","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,18]]},"assertion":[{"value":"7 November 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"6 April 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"18 April 2026","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":"470"}}