Can Large Language Models (LLMs) Predict the Appropriate Treatment of Acute Hip Fractures in Older Adults? Comparing Appropriate Use Criteria With Recommendations From ChatGPT.

BACKGROUND: Acute hip fractures are a public health problem affecting primarily older adults. Chat Generative Pretrained Transformer may be useful in providing appropriate clinical recommendations for beneficial treatment. OBJECTIVE: To evaluate the accuracy of Chat Generative Pretrained Transformer (ChatGPT)-4.0 by comparing its appropriateness scores for acute hip fractures with the American Academy of Orthopaedic Surgeons (AAOS) Appropriate Use Criteria given 30 patient scenarios. "Appropriateness" indicates the unexpected health benefits of treatment exceed the expected negative consequences by a wide margin. METHODS: Using the AAOS Appropriate Use Criteria as the benchmark, numerical scores from 1 to 9 assessed appropriateness. For each patient scenario, ChatGPT-4.0 was asked to assign an appropriate score for six treatments to manage acute hip fractures. RESULTS: Thirty patient scenarios were evaluated for 180 paired scores. Comparing ChatGPT-4.0 with AAOS scores, there was a positive correlation for multiple cannulated screw fixation, total hip arthroplasty, hemiarthroplasty, and long cephalomedullary nails. Statistically significant differences were observed only between scores for long cephalomedullary nails. CONCLUSION: ChatGPT-4.0 scores were not concordant with AAOS scores, overestimating the appropriateness of total hip arthroplasty, hemiarthroplasty, and long cephalomedullary nails, and underestimating the other three. ChatGPT-4.0 was inadequate in selecting an appropriate treatment deemed acceptable, most reasonable, and most likely to improve patient outcomes.

Beyond Words: Embracing Migration Percentage as the Universal Measurement for Hip Displacement in Children With Cerebral Palsy by Radiologists and Orthopedic Surgeons.

INTRODUCTION: Migration percentage (MP) is the standard radiographic measurement to quantify hip displacement in cerebral palsy (CP) hip surveillance programs. We aim to evaluate the use of MP and other descriptors of hip displacement in radiographic impressions by radiologists and orthopedic surgeons before and after the introduction of hip surveillance guidelines at our institution. METHODS: CP patients who underwent hip surveillance imaging at our institution in 2016 were retrospectively identified, and their radiographic impressions were collected between 2016 and 2019. Only patients with radiology and orthopedic impressions for the same image were included. The inclusion of MP was documented and compared between the two groups before and after the hip guidelines were implemented in 2018. We also examined the use of other qualitative descriptors for hip displacement within the impressions. Fisher's Exact test was used for statistical significance (p<0.05).  Results: Two hundred and fifty-one radiographs were analyzed. One radiology (0.40%) and 33 orthopedic impressions (13.15%) incorporated MP (p<0.001). No statistical significance was found between the inclusion of MP before and after 2018 in the radiology group. In contrast, the orthopedic group showed a significant increase in MP inclusion following guideline implementation, rising from 12 to 21 incidences (p=0.013). Descriptors for hip displacement were more commonly utilized than MP for both orthopedic surgeons and radiologists.  Conclusion: MP is underutilized in radiologic and orthopedic impressions in hip surveillance programs. Extensive education for both specialties regarding MP is crucial for the successful management of hip displacement in CP hip surveillance programs.