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Ischemic stroke
Original research
Assessing the clinical reasoning of ChatGPT for mechanical thrombectomy in patients with stroke
  1. Tse Chiang Chen1,
  2. Mitchell W Couldwell1,
  3. Jorie Singer1,
  4. Alyssa Singer1,
  5. Laila Koduri1,
  6. Emily Kaminski1,
  7. Khoa Nguyen1,
  8. Evan Multala1,
  9. Aaron S Dumont2,
  10. Arthur Wang2
  1. 1 Tulane University School of Medicine, New Orleans, Louisiana, USA
  2. 2 Department of Neurological Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
  1. Correspondence to Dr Arthur Wang, Neurological Surgery, Tulane University School of Medicine, New Orleans, LA 70112, USA; awang15{at}tulane.edu

Abstract

Background Artificial intelligence (AI) has become a promising tool in medicine. ChatGPT, a large language model AI Chatbot, shows promise in supporting clinical practice. We assess the potential of ChatGPT as a clinical reasoning tool for mechanical thrombectomy in patients with stroke.

Methods An internal validation of the abilities of ChatGPT was first performed using artificially created patient scenarios before assessment of real patient scenarios from the medical center’s stroke database. All patients with large vessel occlusions who underwent mechanical thrombectomy at Tulane Medical Center between January 1, 2022 and December 31, 2022 were included in the study. The performance of ChatGPT in evaluating which patients should undergo mechanical thrombectomy was compared with the decisions made by board-certified stroke neurologists and neurointerventionalists. The interpretation skills, clinical reasoning, and accuracy of ChatGPT were analyzed.

Results 102 patients with large vessel occlusions underwent mechanical thrombectomy. ChatGPT agreed with the physician’s decision whether or not to pursue thrombectomy in 54.3% of the cases. ChatGPT had mistakes in 8.8% of the cases, consisting of mathematics, logic, and misinterpretation errors. In the internal validation phase, ChatGPT was able to provide nuanced clinical reasoning and was able to perform multi-step thinking, although with an increased rate of making mistakes.

Conclusion ChatGPT shows promise in clinical reasoning, including the ability to factor a patient’s underlying comorbidities when considering mechanical thrombectomy. However, ChatGPT is prone to errors as well and should not be relied on as a sole decision-making tool in its present form, but it has potential to assist clinicians with more efficient work flow.

  • Thrombectomy
  • Stroke

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

https://doi.org/10.1136/jnis-2023-021163

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    Data availability statement

    All data relevant to the study are included in the article or uploaded as supplementary information.

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    Footnotes

    • Contributors TCC: Writing – review and editing, investigation. MWC, JS, AS, LK, EK, KN, EM: Writing – original draft, writing – review and editing, investigation. ASD: Writing – review and editing. AW: Conceptualization, supervision, writing – review and editing, methodology, investigation, project administration. AW accepts full responsibility for the work and/or the conduct of the study, had access to the data, had access to the data, and controlled the decision to publish

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.