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# ER-Reason: A Benchmark Dataset for LLM-Based Clinical Reasoning in the Emergency Room
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## ER-Reason: A Benchmark Dataset for LLM-Based Clinical Reasoning in the Emergency Room
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**Advancing the evaluation of clinical reasoning in emergency care**
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Large language models (LLMs) are increasingly applied to the field of medicine, but most benchmarks focus on narrow, exam-style medical question-answering rather than the evaluation of full clinical reasoning. ER-REASON captures the end-to-end ER decision-making pipeline, and is designed to test how well LLMs can approximate the complex, real-world reasoning of clinicians in a high-stakes settings.
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Large language models (LLMs) are increasingly applied to the field of medicine, but most benchmarks focus on narrow, exam-style medical question-answering rather than full clinical reasoning. ER-Reason captures the end-to-end emergency room (ER) decision-making pipeline, designed to test how well LLMs can approximate the complex, real-world reasoning of clinicians in high-stakes settings.
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## Key Components
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### Dataset
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- Contains de-identified longitudinal notes from **3,984 patients** across **3,984 ER encounters**, totaling **25,174 clinical notes**.
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- Diverse note types: discharge summaries, progress notes, imaging reports, consult notes, echocardiography reports, and ER provider documentation.
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- **3,984 patients** across **3,984 ER encounters**
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- **25,174 de-identified clinical notes**
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- Diverse note types: discharge summaries, progress notes, imaging reports, consult notes, echocardiography reports, and ER provider documentation
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### Workflow-Aligned Tasks
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This benchmark is structured around **five key stages of the emergency room workflow**, allowing realistic evaluation of reasoning at each stage:
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This benchmark is structured around **five key stages of the ER workflow**:
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1. **Triage Intake:** Initial review of patient presentation and acuity scoring
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2. **Assessment:** Summarization of patient history in longitudinal notes
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3. **Treatment Planning:** Assessment of differential diagnoses and clinical decision factors
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4. **Disposition:** Determination of whether the patient should be discharged, admitted, observed, or transferred
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5. **Final Diagnosis:** Formulation of the final patient diagnosis
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1. **Triage Intake:** initial review of patient presentation and acuity scoring
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2. **Assessment:** summarization of patient's medical history in longitudinal notes
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3. **Treatment Planning:** assessment of differential diagnoses and clinical decision factors
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4. **Disposition:** determination of whether the patient should be discharged, admitted, observed, or transferred
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5. **Final Diagnosis:** formulation of the patient's final diagnosis
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### Physician-Authored Rationales
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- Includes **72 expert-authored rationales** explaining their clinical decision-making process.
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- Provides a unique "gold standard" for evaluating reasoning in medical decisions, which is often missing from traditional EHR data.
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- Includes **72 expert-authored rationales** explaining their clinical decision-making process
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- Provides a rare "gold standard" for evaluating reasoning in medical decisions, often a missing component in traditional EHR data
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This benchmark is a significant step forward in evaluating the real-world applicability of LLMs in emergency care by moving beyond factual recall to assess **true clinical reasoning, pattern recognition, and decision-making** under realistic conditions.
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ER-Reason represents a major step forward in benchmarking the real-world applicability of LLMs in emergency care. By moving beyond factual recall, it evaluates models on **true clinical reasoning, pattern recognition, and decision-making** under realistic conditions.
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