# Diagnosing Hallucination Risk in AI Surgical Decision-Support: A Sequential Framework for Sequential Validation

arXiv: https://arxiv.org/abs/2511.00588 · HTML: https://mlsanity.com/paper/2511.00588/

## Key facts

- Cited by 1 papers in the map (data through 14 Oct 2026).
- Placed in Hallucination detection and mitigation, one of 17 directions in LLM reasoning.
- Builds on 10 of its 47 references that are in the map.
- First posted on arXiv 1 Nov 2025.

## Placed in

- LLM reasoning / [Hallucination detection and mitigation](https://mlsanity.com/lr/hallucination-detection-and-mitigation/)

## Builds on (most cited first, 10 of 10)

- [Chain-of-Thought Prompting Elicits Reasoning in Large Language Models](https://mlsanity.com/paper/2201.11903/) (2022)
- [DeepSeek-R1: Incentivizing Reasoning Capability in LLMs via Reinforcement Learning](https://mlsanity.com/paper/2501.12948/) (2025)
- [Measuring Faithfulness in Chain-of-Thought Reasoning](https://mlsanity.com/paper/2307.13702/) (2023)
- [The Illusion of Thinking: Understanding the Strengths and Limitations of Reasoning Models via the Lens of Problem Complexity](https://mlsanity.com/paper/2506.06941/) (2025)
- [MME-CoT: Benchmarking Chain-of-Thought in Large Multimodal Models for Reasoning Quality, Robustness, and Efficiency](https://mlsanity.com/paper/2502.09621/) (2025)
- [A Survey of LLM-based Agents in Medicine: How far are we from Baymax?](https://mlsanity.com/paper/2502.11211/) (2025)
- [Benchmarking large language models for biomedical natural language processing applications and recommendations](https://mlsanity.com/paper/2305.16326/) (2023)
- [Are Reasoning Models More Prone to Hallucination?](https://mlsanity.com/paper/2505.23646/) (2025)
- [HealthQ: Unveiling Questioning Capabilities of LLM Chains in Healthcare Conversations](https://mlsanity.com/paper/2409.19487/) (2024)
- [Reliable and diverse evaluation of LLM medical knowledge mastery](https://mlsanity.com/paper/2409.14302/) (2024)

## Built on by (most cited first, 1 of 1)

- [Assessing the Reliability of Large Language Models in the Bengali Legal Context: A Comparative Evaluation Using LLM-as-Judge and Legal Experts](https://mlsanity.com/paper/2511.05627/) (2025)

## Abstract (arXiv)

Large language models (LLMs) offer transformative potential for clinical decision support in spine surgery but pose significant risks through hallucinations, which are factually inconsistent or contextually misaligned outputs that may compromise patient safety. This study introduces a clinician-centered framework to quantify hallucination risks by evaluating diagnostic precision, recommendation quality, reasoning robustness, output coherence, and knowledge alignment. We assessed six leading LLMs across 30 expert-validated spinal cases. DeepSeek-R1 demonstrated superior overall performance (total score: 86.03 ± 2.08), particularly in high-stakes domains such as trauma and infection. A critical finding reveals that reasoning-enhanced model variants did not uniformly outperform standard counterparts: Claude-3.7-Sonnet's extended thinking mode underperformed relative to its standard version (80.79 ± 1.83 vs. 81.56 ± 1.92), indicating extended chain-of-thought reasoning alone is insufficient for clinical reliability. Multidimensional stress-testing exposed model-specific vulnerabilities, with recommendation quality degrading by 7.4% under amplified complexity. This decline contrasted with marginal improvements in rationality (+2.0%), readability (+1.7%) and diagnosis (+4.7%), highlighting a concerning divergence between perceived coherence and actionable guidance. Our findings advocate integrating interpretability mechanisms (e.g., reasoning chain visualization) into clinical workflows and establish a safety-aware validation framework for surgical LLM deployment.