{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,4]],"date-time":"2026-07-04T08:18:16Z","timestamp":1783153096873,"version":"3.54.6"},"reference-count":21,"publisher":"SAGE Publications","issue":"7","license":[{"start":{"date-parts":[[2025,9,18]],"date-time":"2025-09-18T00:00:00Z","timestamp":1758153600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Hand (New York, N,Y.)"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>The use of large language models (LLMs) such as ChatGPT and Gemini in clinical settings has surged, presenting potential benefits in reducing administrative workload and enhancing patient communication. However, concerns about the clinical accuracy of these tools persist. This study evaluated the concordance of ChatGPT and Gemini\u2019s recommendations with American Academy of Orthopedic Surgeons (AAOS) clinical practice guidelines (CPGs) for carpal tunnel syndrome, distal radius fractures, and glenohumeral joint osteoarthritis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>ChatGPT (version 4o) and Gemini (version 1.5 Flash) were queried using structured text-based prompts aligned with AAOS CPGs. The LLMs\u2019 outputs were analyzed by blinded reviewers to determine concordance with the guidelines. Concordance rates were compared across models, topics, and guideline strength using descriptive statistics and McNemar\u2019s test. The transparency of responses, including source citation, was also assessed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      A total of 174 recommendations were generated, with an overall concordance rate of 62.1%. When comparing concordance rates between LLMs, there was no statistically significant difference between ChatGPT and Gemini (66.7% vs 57.5%,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .131). Concordance varied by topic and guideline strength, with ChatGPT performing best for moderately supported guidelines. Both models demonstrated low citation transparency. Gemini provided sources for 39.1% of recommendations, significantly more than ChatGPT\u2019s 3.5% (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .0001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Despite modest concordance rates, both models exhibited significant limitations, including variability across topics and guideline strengths, as well as insufficient citation transparency. These findings highlight the challenges in integrating LLMs into clinical practice and emphasize the need for further refinement and evaluation before adoption in hand surgery.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/15589447251371089","type":"journal-article","created":{"date-parts":[[2025,9,18]],"date-time":"2025-09-18T09:43:03Z","timestamp":1758188583000},"page":"1178-1183","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Do ChatGPT and Gemini\u2019s Recommendations Align With Established Guidelines for Hand and Upper Extremity Surgery?"],"prefix":"10.1177","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2546-6790","authenticated-orcid":false,"given":"Yibin B.","family":"Zhang","sequence":"first","affiliation":[{"name":"Harvard Medical School, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6994-5120","authenticated-orcid":false,"given":"Fielding S.","family":"Fischer","sequence":"additional","affiliation":[{"name":"Harvard Medical School, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8084-3515","authenticated-orcid":false,"given":"Matthew V.","family":"Abola","sequence":"additional","affiliation":[{"name":"Hospital for Special Surgery, New York, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel A.","family":"Osei","sequence":"additional","affiliation":[{"name":"Hospital for Special Surgery, New York, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5717-8668","authenticated-orcid":false,"given":"Scott W.","family":"Wolfe","sequence":"additional","affiliation":[{"name":"Hospital for Special Surgery, New York, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Troy B.","family":"Amen","sequence":"additional","affiliation":[{"name":"Hospital for Special Surgery, New York, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,9,18]]},"reference":[{"issue":"3","key":"e_1_3_2_2_2","first-page":"436","article-title":"ChatGPT-4 can help hand surgeons communicate better with patients","volume":"6","author":"Browne R","year":"2024","unstructured":"Browne R, Gull K, Hurley CM, Sugrue RM, O\u2019Sullivan JB. ChatGPT-4 can help hand surgeons communicate better with patients. J Hand Surg Glob Online. 2024;6(3):436-438.","journal-title":"J Hand Surg Glob Online"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.23.01417"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.3390\/jcm13102832"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1093\/jamia\/ocae052"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1080\/08820538.2023.2209166"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.23.00043"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1097\/BSD.0000000000001600"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.23.00209"},{"issue":"5","key":"e_1_3_2_10_2","article-title":"Quality of ChatGPT responses to frequently asked questions in carpal tunnel release surgery","volume":"12","author":"Amen TB","year":"2024","unstructured":"Amen TB, Torabian KA, Subramanian T, Yang BW, Liimakka A, Fufa D. Quality of ChatGPT responses to frequently asked questions in carpal tunnel release surgery. Plast Reconstr Surg Glob Open. 2024;12(5):e5822.","journal-title":"Plast Reconstr Surg Glob Open"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.2196\/47621"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arthro.2024.07.040"},{"key":"e_1_3_2_13_2","unstructured":"American Academy of Orthopaedic Surgeons. Management of carpal tunnel syndrome evidence-based clinical practice guideline 2024. Accessed June 18 2025. www.aaos.org\/cts2cpg"},{"key":"e_1_3_2_14_2","unstructured":"American Academy of Orthopaedic Surgeons. Management of glenohumeral joint osteoarthritis evidence-based clinical practice guideline. Published March 23 2020. Accessed June 18 2025. www.aaos.org\/gjocpg"},{"key":"e_1_3_2_15_2","unstructured":"American Academy of Orthopaedic Surgeons Board of Directors. Management of distal radius fractures evidence-based clinical practice guideline 2020. Accessed June 18 2025. www.aaos.org\/drfcpg"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1201\/b14674-113"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1109\/ACCESS.2021.3084050"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41591-023-02594-z"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41586-023-06291-2"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arthro.2024.09.047"},{"key":"e_1_3_2_21_2","doi-asserted-by":"publisher","DOI":"10.1097\/CORR.0000000000003234"},{"key":"e_1_3_2_22_2","doi-asserted-by":"publisher","DOI":"10.1097\/CORR.0000000000002995"}],"container-title":["HAND"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/15589447251371089","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/15589447251371089","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/15589447251371089","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,4]],"date-time":"2026-07-04T07:47:16Z","timestamp":1783151236000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/15589447251371089"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,18]]},"references-count":21,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2026,8]]}},"alternative-id":["10.1177\/15589447251371089"],"URL":"https:\/\/doi.org\/10.1177\/15589447251371089","relation":{},"ISSN":["1558-9447","1558-9455"],"issn-type":[{"value":"1558-9447","type":"print"},{"value":"1558-9455","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,18]]}}}