Neurospine.  2024 Mar;21(1):128-146. 10.14245/ns.2347310.655.

Performance of a Large Language Model in the Generation of Clinical Guidelines for Antibiotic Prophylaxis in Spine Surgery

• Zaidat B
• Shrestha N
• Rosenberg AM
• Ahmed W
• Rajjoub R
• Hoang T
• Mejia MR
• Duey AH
• Tang JE
• Kim JS
• Cho SK

• KMID: 2553914
• DOI: http://doi.org/10.14245/ns.2347310.655

Abstract

Objective
Large language models, such as chat generative pre-trained transformer (ChatGPT), have great potential for streamlining medical processes and assisting physicians in clinical decision-making. This study aimed to assess the potential of ChatGPT’s 2 models (GPT-3.5 and GPT-4.0) to support clinical decision-making by comparing its responses for antibiotic prophylaxis in spine surgery to accepted clinical guidelines.
Methods
ChatGPT models were prompted with questions from the North American Spine Society (NASS) Evidence-based Clinical Guidelines for Multidisciplinary Spine Care for Antibiotic Prophylaxis in Spine Surgery (2013). Its responses were then compared and assessed for accuracy.
Results
Of the 16 NASS guideline questions concerning antibiotic prophylaxis, 10 responses (62.5%) were accurate in ChatGPT’s GPT-3.5 model and 13 (81%) were accurate in GPT-4.0. Twenty-five percent of GPT-3.5 answers were deemed as overly confident while 62.5% of GPT-4.0 answers directly used the NASS guideline as evidence for its response.
Conclusion
ChatGPT demonstrated an impressive ability to accurately answer clinical questions. GPT-3.5 model’s performance was limited by its tendency to give overly confident responses and its inability to identify the most significant elements in its responses. GPT-4.0 model’s responses had higher accuracy and cited the NASS guideline as direct evidence many times. While GPT-4.0 is still far from perfect, it has shown an exceptional ability to extract the most relevant research available compared to GPT-3.5. Thus, while ChatGPT has shown far-reaching potential, scrutiny should still be exercised regarding its clinical use at this time.

Keyword

Artificial intelligence; Antibiotic prophylaxis; Orthopedic surgery