{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T15:14:09Z","timestamp":1788362049251,"version":"build-2803163510"},"reference-count":29,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T00:00:00Z","timestamp":1788134400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/100007812","name":"University of Washington","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100007812","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Can J Psychiatry"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>We evaluated whether summaries and large language models (LLMs) preserve predictive performance for inpatient violence risk and assessed performance across demographics.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective study of inpatient encounters at Harborview Medical Center between March 2021 and September 2023. Cases were inpatient behavioural violence events, and each was matched to 10 control encounters. For each encounter, we used clinical notes from the 72\u2005hours before the event for cases and a matched window for controls. We compared Clinical-Longformer trained on original notes with pipelines that first generated summaries and then classified risk. Summaries were either general or guided by clinician-defined risk entities. We also tested Llama-3.1\u20138B and MedGemma-27B in zero-shot (ZS) and fine-tuned settings. Primary endpoints were positive-class precision, recall, and F1. We also reported overall and subgroup area under the receiver operating characteristic curve (AUROC) with bootstrap confidence intervals for sex, race, ethnicity, age, and mental health flag.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Clinical-Longformer on original notes achieved the strongest performance (F1\u2009=\u20090.776, AUROC\u2009=\u20090.959). Replacing original notes with general or entity-guided summaries reduced performance (F1\u2009=\u20090.465 and 0.510). Llama-3.1\u20138B improved with sequence-classification fine-tuning on original notes but remained below Clinical-Longformer (F1\u2009=\u20090.701; AUROC\u2009=\u20090.933), while ZS prompting performed poorly. MedGemma-27B also remained inferior, with its best performance from sequence-classification fine-tuning on original notes (F1\u2009=\u20090.612, AUROC\u2009=\u20090.947). Subgroup AUROCs were high across sex, race, ethnicity, and age, with lower performance among patients with a documented mental health flag.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Direct classification of original notes remained the most reliable strategy. Summaries of clinical notes may compress or alter cues needed for discrimination, and off-the-shelf prompting was inadequate as a stand-alone predictor. A practical path is to anchor risk scoring in long-context discriminative models and use LLMs for auditable, clinician-facing summaries or rationales. Prospective and external validation are needed before clinical deployment.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/07067437261479118","type":"journal-article","created":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T15:33:57Z","timestamp":1788190437000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Investigating Whether Summarizing Raw Clinical Text Affects the Prediction of In-Hospital Violence: A Retrospective Case Study: \u00c9valuation de l\u2019effet du r\u00e9sum\u00e9 des textes cliniques bruts sur la pr\u00e9diction de la violence en milieu hospitalier : \u00e9tude de cas r\u00e9trospective"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1235-7299","authenticated-orcid":false,"given":"Zixuan","family":"Yu","sequence":"first","affiliation":[{"name":"University of Washington"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-9200-4541","authenticated-orcid":false,"given":"Jacqueline","family":"Chipkin","sequence":"additional","affiliation":[{"name":"University of Washington"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-5845-0597","authenticated-orcid":false,"given":"Julia","family":"Siar","sequence":"additional","affiliation":[{"name":"University of Washington"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1464-0001","authenticated-orcid":false,"given":"Suelynn","family":"Emily Ren","sequence":"additional","affiliation":[{"name":"University of Washington"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6015-6064","authenticated-orcid":false,"given":"Fei","family":"Xia","sequence":"additional","affiliation":[{"name":"University of Washington"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9919-9811","authenticated-orcid":false,"given":"Meliha","family":"Yetisgen","sequence":"additional","affiliation":[{"name":"University of Washington"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3598-8747","authenticated-orcid":false,"given":"Nicholas J.","family":"Dobbins","sequence":"additional","affiliation":[{"name":"University of Washington"},{"name":"National Institutes of Health"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-5660-2697","authenticated-orcid":false,"given":"Taylor M.","family":"Black","sequence":"additional","affiliation":[{"name":"University of Washington"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,8,31]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2024.43160"},{"key":"e_1_3_3_3_2","volume-title":"Workplace violence in healthcare","author":"Ma P","year":"2023","unstructured":"Ma P, Thomas J Workplace violence in healthcare. Treasure Island, FL, USA: StatPearls Publishing; 2023. Accessed November 30, 2025. https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK592384\/."},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.psym.2018.04.007"},{"key":"e_1_3_3_5_2","unstructured":"U.S. Bureau of Labor Statistics. Workplace violence 2021\u20132022. 2024. Accessed November 30 2025. https:\/\/www.bls.gov\/iif\/factsheets\/workplace-violence-2021-2022.htm."},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12960-025-01026-y"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12912-023-01226-8"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaclp.2021.01.005"},{"key":"e_1_3_3_9_2","volume-title":"Brockville risk checklist (3rd version): interdisciplinary clinical risk assessment and management tool","author":"Ahmed AG","year":"2004","unstructured":"Ahmed AG, Adamson D, Laprade K. Brockville risk checklist (3rd version): interdisciplinary clinical risk assessment and management tool. Brockville, ON: Brockville Mental Health Centre; 2004."},{"key":"e_1_3_3_10_2","doi-asserted-by":"crossref","unstructured":"Starzomski A Wilson K. Imminent risk rating scale (IRRS). 2015. doi:10.1037\/t39308-000.","DOI":"10.1037\/t39308-000"},{"key":"e_1_3_3_11_2","volume-title":"HCR-20: assessing risk for violence (version 2).","author":"Webster CD","year":"1997","unstructured":"Webster CD, Douglas KS, Eaves D, Hart SD HCR-20: assessing risk for violence (version 2). Burnaby, British Columbia, Canada: Mental Health, Law, and Policy Institute, Simon Fraser University; 1997."},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1111\/inm.12645"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1093\/jamiaopen\/ooab011"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.inffus.2025.103145"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41586-023-06160-y"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41591-024-02855-5"},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.63317\/2fcovvb4zao3"},{"key":"e_1_3_3_18_2","doi-asserted-by":"publisher","DOI":"10.1109\/JBHI.2025.3574254"},{"key":"e_1_3_3_19_2","doi-asserted-by":"publisher","DOI":"10.3233\/SHTI251241"},{"key":"e_1_3_3_20_2","doi-asserted-by":"publisher","DOI":"10.18653\/v1\/2024.clinicalnlp-1.9"},{"key":"e_1_3_3_21_2","doi-asserted-by":"publisher","DOI":"10.1038\/s44184-024-00105-7"},{"key":"e_1_3_3_22_2","unstructured":"Grattafiori A Dubey A Jauhri A et al. The Llama 3 Herd of Models. Preprint posted online 2024. doi:https:\/\/doi.org\/10.48550\/arXiv.2407.21783."},{"key":"e_1_3_3_23_2","unstructured":"Meta AI. Meta Llama 3.1\u20138B instruct. 2024. https:\/\/huggingface.co\/meta-llama\/Llama-3.1-8B-Instruct."},{"key":"e_1_3_3_24_2","unstructured":"Sellergren A Kazemzadeh S Jaroensri T et al. MedGemma technical report. Preprint posted online 2025. doi:https:\/\/doi.org\/10.48550\/arXiv.2507.05201."},{"key":"e_1_3_3_25_2","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph20010196"},{"key":"e_1_3_3_26_2","doi-asserted-by":"publisher","DOI":"10.1155\/2019\/5430870"},{"key":"e_1_3_3_27_2","doi-asserted-by":"publisher","DOI":"10.1177\/07067437221076723"},{"key":"e_1_3_3_28_2","doi-asserted-by":"crossref","unstructured":"Emanuel N Welle P Bolotnyy V. A danger to self and others: health and criminal consequences of involuntary hospitalization. Federal Reserve Bank of New York Staff Reports no. 1158. 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