Paper Detail

Reliable Multilingual Orthopedic Decision Support from Clinical Narratives: Language-Aware Adaptation and Verification-Guided Deferral

Danish Ali, Li Xiaojian, Sundas Iqbal, Farrukh Zaidi

arxiv Score 6.8

Published 2026-05-29 · First seen 2026-06-01

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Abstract

Multilingual orthopedic decision support remains challenging in low-resource healthcare settings, where clinical narratives contain specialized terminology, mixed scripts, incomplete evidence, label imbalance and language-dependent documentation patterns. This article presents a reliability-oriented framework for classifying free-text orthopedic notes in English, Hindi and Punjabi. We compare task-aligned multilingual transformer encoders, a task-fine-tuned DistilBERT baseline, zero-shot instruction-tuned large language models (LLMs) and a domain-adaptive encoder, IndicBERT-HPA. IndicBERT-HPA augments IndicBERT with language-aware orthopedic adapter heads to support clinically relevant multilingual representation learning. Evaluation extends beyond aggregate accuracy to per-class performance, ROC-AUC, AUPRC, expected calibration error, cross-language stability and robustness under controlled balanced and natural-prevalence distributions. The evaluated zero-shot LLMs remain substantially less effective than task-adapted encoders for closed-set classification, with language-dependent instability. Under natural clinical prevalence, IndicBERT-HPA achieves the strongest overall performance, reaching an averaged Macro-F1 of 0.8792, Macro-AUROC of 0.894 and AUPRC of 0.902. We further implement a deterministic selective-verification layer combining confidence gating, evidence-consistency checking and language-risk screening. On a randomly selected held-out 5,000-record subset, it achieves 84.4% selective accuracy and 0.76 selective Macro-F1 at 72.3% coverage, compared with 71.5% accuracy and 0.65 Macro-F1 for accept-all prediction. These results support reliability-oriented multilingual clinical decision support with explicit deferral.

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BibTeX

@article{ali2026reliable,
  title = {Reliable Multilingual Orthopedic Decision Support from Clinical Narratives: Language-Aware Adaptation and Verification-Guided Deferral},
  author = {Danish Ali and Li Xiaojian and Sundas Iqbal and Farrukh Zaidi},
  year = {2026},
  abstract = {Multilingual orthopedic decision support remains challenging in low-resource healthcare settings, where clinical narratives contain specialized terminology, mixed scripts, incomplete evidence, label imbalance and language-dependent documentation patterns. This article presents a reliability-oriented framework for classifying free-text orthopedic notes in English, Hindi and Punjabi. We compare task-aligned multilingual transformer encoders, a task-fine-tuned DistilBERT baseline, zero-shot instruc},
  url = {https://arxiv.org/abs/2605.31512},
  keywords = {cs.CL},
  eprint = {2605.31512},
  archiveprefix = {arXiv},
}

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