Abstract
BACKGROUND: With the rapid development of artificial intelligence (AI) technology, especially generative AI, large language models (LLMs) have shown great potential in the medical field. Through massive medical data training, it can understand complex medical texts and can quickly analyze medical records and provide health counseling and diagnostic advice directly, especially in rare diseases. However, no study has yet compared and extensively discussed the diagnostic performance of LLMs with that of physicians. OBJECTIVE: This study systematically reviewed the accuracy of LLMs in clinical diagnosis and provided reference for further clinical application. METHODS: We conducted searches in CNKI (China National Knowledge Infrastructure), VIP Database, SinoMed, PubMed, Web of Science, Embase, and CINAHL (Cumulative Index to Nursing and Allied Health Literature) from January 1, 2017, to the present. A total of 2 reviewers independently screened the literature and extracted relevant information. The risk of bias was assessed using the Prediction Model Risk of Bias Assessment Tool (PROBAST), which evaluates both the risk of bias and the applicability of included studies. RESULTS: A total of 30 studies involving 19 LLMs and a total of 4762 cases were included. The quality assessment indicated a high risk of bias in the majority of studies, primary cause is known case diagnosis. For the optimal model, the accuracy of the primary diagnosis ranged from 25% to 97.8%, while the triage accuracy ranged from 66.5% to 98%. CONCLUSIONS: LLMs have demonstrated considerable diagnostic capabilities and significant potential for application across various clinical cases. Although their accuracy still falls short of that of clinical professionals, if used cautiously, they have the potential to become one of the best intelligent assistants in the field of human health care.