aiqbench analysis
This research introduces DeToxR, the first application of reinforcement learning to emergency toxicology, which significantly outperforms standard LLMs in fusing unstructured narratives with structured medical data for multi-label substance prediction. By optimizing reasoning directly through clinical performance rewards, the model effectively reduces hallucinations and missed co-ingestants in high-stakes diagnostic environments. The study demonstrates that RL-aligned approaches are critical for enhancing decision support where simple baselines fail under uncertainty.
Learning Diagnostic Reasoning for Decision Support in Toxicology
arXiv:2603.29608v2 Announce Type: replace Abstract: Acute poly-substance intoxication requires rapid, life-saving decisions under substantial uncertainty, as clinicians must rely on incomplete ingestion details and nonspecific symptoms. Effective diagnostic reasoning in this chaotic environment requires fusing unstructured, non-medical narratives (e.g. paramedic scene descriptions and unreliable patient self-reports or known histories), with structured medical data like vital signs. While Large Language Models (LLMs) show potential for processing such heterogeneous inputs, they struggle in this setting, often underperforming simple baselines that rely solely on patient histories. To address this, we present DeToxR (Decision-support for Toxicology with Reasoning), the first adaptation of Reinforcement Learning (RL) to emergency toxicology. We design a robust data-fusion engine for multi-label prediction across 14 substance classes based on an LLM finetuned with Group Relative Policy Optimization (GRPO). We optimize the model's reasoning directly using a clinical performance reward. By formulating a multi-label agreement metric as the reward signal, the model is explicitly penalized for missing co-ingested substances and hallucinating absent poisons. Our model significantly outperforms its unadapted base LLM counterpart and supervised baselines. Furthermore, in a preliminary clinical validation study, the model indicates a clinical advantage by achieving higher micro-F1 (0.644 vs 0.473) and recall in identifying the correct poisons. These results demonstrate the potential of RL-aligned LLMs to synthesize unstructured pre-clinical narratives and structured medical data for decision support in high-stakes environments.
Abstract:Acute poly-substance intoxication requires rapid, life-saving decisions under substantial uncertainty, as clinicians must rely on incomplete ingestion details and nonspecific symptoms. Effective diagnostic reasoning in this chaotic environment requires fusing unstructured, non-medical narratives (e.g. paramedic scene descriptions and unreliable patient self-reports or known histories), with structured medical data like vital signs. While Large Language Models (LLMs) show potential for processing such heterogeneous inputs, they struggle in this setting, often underperforming simple baselines that rely solely on patient histories. To address this, we present DeToxR (Decision-support for Toxicology with Reasoning), the first adaptation of Reinforcement Learning (RL) to emergency toxicology. We design a robust data-fusion engine for multi-label prediction across 14 substance classes based on an LLM finetuned with Group Relative Policy Optimization (GRPO). We optimize the model's reasoning directly using a clinical performance reward. By formulating a multi-label agreement metric as the reward signal, the model is explicitly penalized for missing co-ingested substances and hallucinating absent poisons. Our model significantly outperforms its unadapted base LLM counterpart and supervised baselines. Furthermore, in a preliminary clinical validation study, the model indicates a clinical advantage by achieving higher micro-F1 (0.644 vs 0.473) and recall in identifying the correct poisons. These results demonstrate the potential of RL-aligned LLMs to synthesize unstructured pre-clinical narratives and structured medical data for decision support in high-stakes environments.
Computation and Language (cs.CL)
arXiv:2603.29608 [cs.CL]
(or arXiv:2603.29608v2 [cs.CL] for this version)
https://doi.org/10.48550/arXiv.2603.29608 Focus to learn more arXiv-issued DOI via DataCite
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Full text under the publisher's open licence · 312 words
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