EQUITRIAGE: A Fairness Audit of Gender Bias in LLM-Based Emergency Department Triage

Emergency department triage assigns patients an acuity score that determines treatment priority, and clinical evidence documents persistent gender disparities in human acuity assessment. As hospitals pilot large language models (LLMs) as triage decision support, a critical question is whether these models reproduce or mitigate known biases. We present EQUITRIAGE, a fairness audit of LLM-based ESI assignment evaluating five models (Gemini-3-Flash, Nemotron-3-Super, DeepSeek-V3.1, Mistral-Small-3.2, GPT-4.1-Nano) across 374,275 evaluations on 18,714 MIMIC-IV-ED vignettes under four prompt strategies. Of 9,368 originals, 9,346 are paired with a gender-swapped counterfactual. All five models produced flip rates above a pre-registered 5% threshold (9.9% to 43.8%). Two showed directional female undertriage (DeepSeek F/M 2.15:1, Gemini 1.34:1); two were near-parity; one had high sensitivity with weak male-direction asymmetry. DeepSeek's directional bias coexisted with a low outcome-linked calibration gap (0.013 against MIMIC-IV admission), a Chouldechova-style dissociation between within-group calibration and between-pair counterfactual invariance. Demographic blinding reduced Gemini's flip rate to 0.5%; an age-preserving blind variant left DeepSeek with residual F/M 1.25, implicating age as a residual channel. Chain-of-thought prompting degraded accuracy for all five models. A two-model ablation reveals opposite underlying mechanisms for the same directional phenotype: in Gemini the signal is emergent in the combined name+gender swap, while in DeepSeek the gender token alone carries it. EQUITRIAGE shows that group parity, counterfactual invariance, and gender calibration are distinct fairness properties, that intervention effectiveness is model-dependent, and that per-model counterfactual auditing should precede clinical deployment.

CardioEmbed: Domain-Specialized Text Embeddings for Clinical Cardiology

Biomedical text embeddings have primarily been developed using research literature from PubMed, yet clinical cardiology practice relies heavily on procedural knowledge and specialized terminology found in comprehensive textbooks rather than research abstracts. This research practice gap limits the effectiveness of existing embedding models for clinical applications incardiology. This study trained CardioEmbed, a domain-specialized embedding model based on Qwen3-Embedding-8B, using contrastive learning on a curated corpus of seven comprehensive cardiology textbooks totaling approximately 150,000 sentences after deduplication. The model employs InfoNCE loss with in-batch negatives and achieves 99.60% retrieval accuracy on cardiac-specific semantic retrieval tasks, a +15.94 percentage point improvement over MedTE, the current state-of-the-art medical embedding model. On MTEB medical benchmarks, the model obtained BIOSSES 0.77 Spearman and SciFact 0.61 NDCG@10, indicating competitive performance on related biomedical domains. Domain-specialized training on comprehensive clinical textbooks yields near-perfect cardiology retrieval (99.60% Acc@1), improving over MedTE by +15.94 percentage points.