Language Artificial Intelligence Models as Pioneers in Diagnostic Medicine? A Retrospective Analysis on Real-Time Patients

<b>Background/Objectives:</b> GPT-3.5 and GPT-4 has shown promise in assisting healthcare professionals with clinical questions. However, their performance in real-time clinical scenarios remains underexplored. This study aims to evaluate their precision and reliability compared to board-certified emergency department attendings, highlighting their potential in improving patient care. We hypothesized that board-certified emergency department attendings at Maimonides Medical Center exhibit higher accuracy and reliability than GPT-3.5 and GPT-4 in generating differentials based on history and physical examination for patients presenting to the emergency department. <b>Methods:</b> Real-time patient data from Maimonides Medical Center's emergency department, collected from 1 January 2023 to 1 March 2023 were analyzed. Demographic details, symptoms, medical history, and discharge diagnoses recorded by emergency room attendings were examined. AI algorithms (ChatGPT-3.5 and GPT-4) generated differential diagnoses, which were compared with those by attending physicians. Accuracy was determined by comparing each rater's diagnoses with the gold standard discharge diagnosis, calculating the proportion of correctly identified cases. Precision was assessed using Cohen's kappa coefficient and Intraclass Correlation Coefficient to measure agreement between raters. <b>Results:</b> Mean age of patients was 49.12 years, with 57.3% males and 42.7% females. Chief complaints included fever/sepsis (24.7%), gastrointestinal issues (17.7%), and cardiovascular problems (16.4%). Diagnostic accuracy against discharge diagnoses was highest for ChatGPT-4 (85.5%), followed by ChatGPT-3.5 (84.6%) and ED attendings (83%). Cohen's kappa demonstrated moderate agreement (0.7) between AI models, with lower agreement observed for ED attendings. Stratified analysis revealed higher accuracy for gastrointestinal complaints with Chat GPT-4 (87.5%) and cardiovascular complaints with Chat GPT-3.5 (81.34%). <b>Conclusions:</b> Our study demonstrates that Chat GPT-4 and GPT-3.5 exhibit comparable diagnostic accuracy to board-certified emergency department attendings, highlighting their potential to aid decision-making in dynamic clinical settings. The stratified analysis revealed comparable reliability and precision of the AI chat bots for cardiovascular complaints which represents a significant proportion of the high-risk patients presenting to the emergency department and provided targeted insights into rater performance within specific medical domains. This study contributes to integrating AI models into medical practice, enhancing efficiency and effectiveness in clinical decision-making. Further research is warranted to explore broader applications of AI in healthcare.