Cross-Model Variability in Large Language Model Triage Behavior for Potential Stroke Symptoms
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Background
Stroke is a time-sensitive neurological emergency in which early EMS activation and presentation to definitive care are cornerstones of effective therapy. Large language models (LLMs) are increasingly consulted by the public for medical advice, but the veracity of the guidance provided by commercially available models responding to potential stroke symptoms is not well understood.
Methods
We performed a cross-model benchmarking study comparing the triage choices of three frontier LLMs (Claude Sonnet 4.6, GPT-4o, and Llama 3.3-70b-versatile) on first-person vignettes describing a unilateral arm symptom on waking, across 10 symptom descriptors, and two clinical phases (before and after a partially reassuring self-examination), with or without a clinical distractor (n=50 per condition).
Results
Claude sought emergency care most often, Llama least, and GPT-4o in between, diverging most sharply in the post-examination phase where Claude called 911 in 100% of runs, Llama called for non-emergency help in 100%, and GPT-4o was symptom-dependent. A distractor shifted behavior away from emergency care in almost all conditions: calling 911 fell from 37.9% to 14.6% and waiting rose from 0% to 45.9% in the post-examination vignette. Responses were also sensitive to symptom word: weak, limp, heavy, and clumsy generated higher alarm, whereas numb, tingly, odd, strange, and weird generated less urgent responses.
Conclusions
The increasing use of LLMs for medical advice has significant public health implications. Commercially available LLMs show significant model-to-model variability and framing sensitivity when confronted with potential stroke symptoms, including under-recognition of canonical CDC warning descriptors, underscoring the need for systematic benchmarking as these tools become de facto first points of contact for patients experiencing neurological emergencies.
