Analysis of ChatGPT in the Triage of Common Spinal Complaints

Abstract

ChatGPT is a natural language processing chatbot with a significant prevalence in modern media with a clear application in the medical triage workflow. ChatGPT has shown significant capacity for understanding clinical vignettes, radiology reports, and even passing the American Board of Neurological Surgery board examination. There has never been an evaluation of the chatbot in triage and diagnosing spinal vignettes common to primary and urgent care practice. Fifteen clinical scenarios were created to mimic spinal complaints common to primary and urgent care scenarios. GPT-4 was instructed to assess the situation as if it was in a primary care office and determine diagnosis, imaging recommendations, and if emergency room (ER) or operative referral was necessary. Answers were recorded and the results compared to those of attending and resident respondents. GPT-4 provided the most likely diagnosis in each scenario. Additionally, it recommended reasonable clinical management of each scenario which would fall within standard practice guidelines. ChatGPT tended toward over-referral to the ER; however, this was not significant. GPT-4 was noninferior in all categories when compared to respondents. ChatGPT is a powerful tool for primary triage of spinal issues. It can rapidly and accurately evaluate clinical scenarios and provide clear diagnostic reasoning. GPT-4 is not designed for medical use and will provide a disclaimer as such. It did tend toward over-referring patients to the ER. With specific training, it is likely that artificial intelligence and natural language processing chatbots will become widely used in primary triage of spinal issues.