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This article proposes a conceptual framework for a diagnostic support system in emergency departments that leverages large language models, retrieval-augmented generation, and chain-of-thought reasoning. By combining triage notes and vital signs, the system generates a ranked differential diagnosis list to assist clinicians without replacing their judgment. The framework includes components like a triage note encoder, a vital sign encoder, a retrieval module, and a diagnosis ranker, using evidence from clinical guidelines, curated references, and de-identified prior cases. The approach grounds the model in authoritative knowledge while ensuring transparency and explainability in the diagnostic process. However, prospective validation, integration into workflows, and clinician oversight are crucial before implementation to ensure safety and effectiveness.

Emergency department chief complaints and triage notes are early indicators of health changes during infectious disease outbreaks. These records, made before confirmatory testing, provide a presyndromic view of population health. Traditional syndromic surveillance relies on predefined syndrome categories, which may not align with novel pathogens. Early outbreaks often present as sparse, ambiguous symptom clusters, resulting in few labeled examples for automated detection. This framework suggests using contrastive learning with prototypical networks for few-shot detection of emerging infectious disease syndromes from free-text notes. It leverages historical data to create a robust clinical text embedding space, with a small set of labeled examples defining new syndromes. The system includes a contrastive pre-training encoder, prototypical network, and few-shot classifier. The encoder learns from unlabelled historical notes, and the prototypical network creates syndrome prototypes from a few labeled examples. This framework is designed for situations where public health officials observe early suspect cases but lack mature labeled datasets. It can identify early clusters by comparing incoming notes to emerging syndrome prototypes. Contrastive learning with prototypical networks enables proactive presyndromic surveillance, allowing rapid adaptation during the early phase of an outbreak without relying on large labeled datasets.