{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T23:06:10Z","timestamp":1792019170436,"version":"4.4.0"},"reference-count":30,"publisher":"MDPI AG","issue":"14","license":[{"start":{"date-parts":[[2025,7,15]],"date-time":"2025-07-15T00:00:00Z","timestamp":1752537600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Native vertebral osteomyelitis (NVO) presents diagnostic and therapeutic challenges requiring adherence to complex clinical guidelines. The emergence of large language models (LLMs) offers new avenues for real-time clinical decision support, yet their utility in managing NVO has not been formally assessed. Methods: This study evaluated four LLMs\u2014Consensus, Gemini, ChatGPT-4o Mini, and ChatGPT-4o\u2014using 13 standardized questions derived from the 2015 IDSA guidelines. Each model generated 13 responses (n = 52), which were independently assessed by three orthopedic surgeons for accuracy (4-point scale) and comprehensiveness (five-point scale). Results: ChatGPT-4o produced the longest responses (428.0 \u00b1 45.4 words), followed by ChatGPT-4o Mini (392.2 \u00b1 97.4), Gemini (358.2 \u00b1 60.5), and Consensus (213.2 \u00b1 68.8). Accuracy ratings showed that ChatGPT-4o and Gemini achieved the highest proportion of \u201cExcellent\u201d responses (54% and 51%, respectively), while Consensus received only 20%. Comprehensiveness scores mirrored this trend, with ChatGPT-4o (3.95 \u00b1 0.79) and Gemini (3.82 \u00b1 0.68) significantly outperforming Consensus (2.87 \u00b1 0.66). Domain-specific analysis revealed that ChatGPT-4o achieved a 100% \u201cExcellent\u201d accuracy rating in therapy-related questions. Statistical analysis confirmed significant inter-model differences (p &lt; 0.001). Conclusions: Advanced LLMs\u2014especially ChatGPT-4o and Gemini\u2014demonstrated high accuracy and depth in interpreting clinical guidelines for NVO. These findings highlight their potential as effective tools in augmenting evidence-based decision-making and improving consistency in clinical care.<\/jats:p>","DOI":"10.3390\/jcm14144996","type":"journal-article","created":{"date-parts":[[2025,7,15]],"date-time":"2025-07-15T11:52:58Z","timestamp":1752580378000},"page":"4996","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Assessing LLMs on IDSA Practice Guidelines for the Diagnosis and Treatment of Native Vertebral Osteomyelitis: A Comparison Study"],"prefix":"10.3390","volume":"14","author":[{"given":"Filip","family":"Milicevic","sequence":"first","affiliation":[{"name":"Department of Orthopaedics and Trauma Surgery, Helios University Hospital, University Witten\/Herdecke, 42283 Wuppertal, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6374-0626","authenticated-orcid":false,"given":"Maher","family":"Ghandour","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Trauma Surgery, Helios University Hospital, University Witten\/Herdecke, 42283 Wuppertal, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Moh\u2019d Yazan","family":"Khasawneh","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Trauma Surgery, Helios University Hospital, University Witten\/Herdecke, 42283 Wuppertal, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amir R.","family":"Ghasemi","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Trauma Surgery, Helios University Hospital, University Witten\/Herdecke, 42283 Wuppertal, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2993-4224","authenticated-orcid":false,"given":"Ahmad","family":"Al Zuabi","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Trauma Surgery, Helios University Hospital, University Witten\/Herdecke, 42283 Wuppertal, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-8243-4385","authenticated-orcid":false,"given":"Samir","family":"Smajic","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Trauma Surgery, Helios University Hospital, University Witten\/Herdecke, 42283 Wuppertal, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-2621-3165","authenticated-orcid":false,"given":"Mohamad Agha","family":"Mahmoud","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Trauma Surgery, Helios University Hospital, University Witten\/Herdecke, 42283 Wuppertal, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1458-2825","authenticated-orcid":false,"given":"Koroush","family":"Kabir","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Trauma Surgery, Helios University Hospital, University Witten\/Herdecke, 42283 Wuppertal, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6125-6040","authenticated-orcid":false,"given":"\u00dcmit","family":"Mert","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Trauma Surgery, Helios University Hospital, University Witten\/Herdecke, 42283 Wuppertal, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,7,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"E102","DOI":"10.1097\/BSD.0000000000000597","article-title":"The epidemiology of vertebral osteomyelitis in the United States from 1998 to 2013","volume":"31","author":"Issa","year":"2018","journal-title":"Clin. 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