BACKGROUND: Artificial intelligence (AI), more specifically large language models (LLMs), holds significant potential in revolutionizing emergency care delivery by optimizing clinical workflows and enhancing the quality of decision-making. Although enthusiasm for integrating LLMs into emergency medicine (EM) is growing, the existing literature is characterized by a disparate collection of individual studies, conceptual analyses, and preliminary implementations. Given these complexities and gaps in understanding, a cohesive framework is needed to comprehend the existing body of knowledge on the application of LLMs in EM.
OBJECTIVE: Given the absence of a comprehensive framework for exploring the roles of LLMs in EM, this scoping review aims to systematically map the existing literature on LLMs\' potential applications within EM and identify directions for future research. Addressing this gap will allow for informed advancements in the field.
METHODS: Using PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) criteria, we searched Ovid MEDLINE, Embase, Web of Science, and Google Scholar for papers published between January 2018 and August 2023 that discussed LLMs\' use in EM. We excluded other forms of AI. A total of 1994 unique titles and abstracts were screened, and each full-text paper was independently reviewed by 2 authors. Data were abstracted independently, and 5 authors performed a collaborative quantitative and qualitative synthesis of the data.
RESULTS: A total of 43 papers were included. Studies were predominantly from 2022 to 2023 and conducted in the United States and China. We uncovered four major themes: (1) clinical decision-making and support was highlighted as a pivotal area, with LLMs playing a substantial role in enhancing patient care, notably through their application in real-time triage, allowing early recognition of patient urgency; (2) efficiency, workflow, and information management demonstrated the capacity of LLMs to significantly boost operational efficiency, particularly through the automation of patient record synthesis, which could reduce administrative burden and enhance patient-centric care; (3) risks, ethics, and transparency were identified as areas of concern, especially regarding the reliability of LLMs\' outputs, and specific studies highlighted the challenges of ensuring unbiased decision-making amidst potentially flawed training data sets, stressing the importance of thorough validation and ethical oversight; and (4) education and communication possibilities included LLMs\' capacity to enrich medical training, such as through using simulated patient interactions that enhance communication skills.
CONCLUSIONS: LLMs have the potential to fundamentally transform EM, enhancing clinical decision-making, optimizing workflows, and improving patient outcomes. This review sets the stage for future advancements by identifying key research areas: prospective validation of LLM applications, establishing standards for responsible use, understanding provider and patient perceptions, and improving physicians\' AI literacy. Effective integration of LLMs into EM will require collaborative efforts and thorough evaluation to ensure these technologies can be safely and effectively applied.

OBJECTIVE: To review the current literature on the application, accuracy, and performance of Chatbot Generative Pre-Trained Transformer (ChatGPT) in Otolaryngology-Head and Neck Surgery.
METHODS: PubMED, Cochrane Library, and Scopus.
METHODS: A comprehensive review of the literature on the applications of ChatGPT in otolaryngology was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-analyses statement.
CONCLUSIONS: ChatGPT provides imperfect patient information or general knowledge related to diseases found in Otolaryngology-Head and Neck Surgery. In clinical practice, despite suboptimal performance, studies reported that the model is more accurate in providing diagnoses, than in suggesting the most adequate additional examinations and treatments related to clinical vignettes or real clinical cases. ChatGPT has been used as an adjunct tool to improve scientific reports (referencing, spelling correction), to elaborate study protocols, or to take student or resident exams reporting several levels of accuracy. The stability of ChatGPT responses throughout repeated questions appeared high but many studies reported some hallucination events, particularly in providing scientific references.
CONCLUSIONS: To date, most applications of ChatGPT are limited in generating disease or treatment information, and in the improvement of the management of clinical cases. The lack of comparison of ChatGPT performance with other large language models is the main limitation of the current research. Its ability to analyze clinical images has not yet been investigated in otolaryngology although upper airway tract or ear images are an important step in the diagnosis of most common ear, nose, and throat conditions. This review may help otolaryngologists to conceive new applications in further research.

OBJECTIVE: Despite advanced technologies in breast cancer management, challenges remain in efficiently interpreting vast clinical data for patient-specific insights. We reviewed the literature on how large language models (LLMs) such as ChatGPT might offer solutions in this field.
METHODS: We searched MEDLINE for relevant studies published before December 22, 2023. Keywords included: \"large language models\", \"LLM\", \"GPT\", \"ChatGPT\", \"OpenAI\", and \"breast\". The risk bias was evaluated using the QUADAS-2 tool.
RESULTS: Six studies evaluating either ChatGPT-3.5 or GPT-4, met our inclusion criteria. They explored clinical notes analysis, guideline-based question-answering, and patient management recommendations. Accuracy varied between studies, ranging from 50 to 98%. Higher accuracy was seen in structured tasks like information retrieval. Half of the studies used real patient data, adding practical clinical value. Challenges included inconsistent accuracy, dependency on the way questions are posed (prompt-dependency), and in some cases, missing critical clinical information.
CONCLUSIONS: LLMs hold potential in breast cancer care, especially in textual information extraction and guideline-driven clinical question-answering. Yet, their inconsistent accuracy underscores the need for careful validation of these models, and the importance of ongoing supervision.

OBJECTIVE: This paper offers a mini-review of OpenAI\'s language model, ChatGPT, detailing its mechanisms, applications in healthcare, and comparisons with other large language models (LLMs).
METHODS: The underlying technology of ChatGPT is outlined, focusing on its neural network architecture, training process, and the role of key elements such as input embedding, encoder, decoder, attention mechanism, and output projection. The advancements in GPT-4, including its capacity for internet connection and the integration of plugins for enhanced functionality are discussed.
RESULTS: ChatGPT can generate creative, coherent, and contextually relevant sentences, making it a valuable tool in healthcare for patient engagement, medical education, and clinical decision support. Yet, like other LLMs, it has limitations, including a lack of common sense knowledge, a propensity for hallucination of facts, a restricted context window, and potential privacy concerns.
CONCLUSIONS: Despite the limitations, LLMs like ChatGPT offer transformative possibilities for healthcare. With ongoing research in model interpretability, common-sense reasoning, and handling of longer context windows, their potential is vast. It is crucial for healthcare professionals to remain informed about these technologies and consider their ethical integration into practice.

ChatGPT, a new language model developed by OpenAI, has garnered significant attention in various fields since its release. This literature review provides an overview of early ChatGPT literature across multiple disciplines, exploring its applications, limitations, and ethical considerations. The review encompasses Scopus-indexed publications from November 2022 to April 2023 and includes 156 articles related to ChatGPT. The findings reveal a predominance of negative sentiment across disciplines, though subject-specific attitudes must be considered. The review highlights the implications of ChatGPT in many fields including healthcare, raising concerns about employment opportunities and ethical considerations. While ChatGPT holds promise for improved communication, further research is needed to address its capabilities and limitations. This literature review provides insights into early research on ChatGPT, informing future investigations and practical applications of chatbot technology, as well as development and usage of generative AI.