# Vital Trace: Protocol-Constrained Patient-State Reasoning for Longitudinal Clinical Trajectories

arXiv: https://arxiv.org/abs/2602.12833 · HTML: https://mlsanity.com/paper/2602.12833/

## Key facts

- Cited by 1 papers in the map (data through 14 Oct 2026).
- Placed in Clinical and biomedical applications, one of 17 directions in LLM reasoning.
- Builds on 13 of its 27 references that are in the map.
- First posted on arXiv 13 Feb 2026.

## Placed in

- LLM reasoning / [Clinical and biomedical applications](https://mlsanity.com/lr/clinical-and-biomedical-applications/)

## Builds on (most cited first, 13 of 13)

- [The Llama 3 Herd of Models](https://mlsanity.com/paper/2407.21783/) (2024)
- [Qwen3 Technical Report](https://mlsanity.com/paper/2505.09388/) (2025)
- [Mixtral of Experts](https://mlsanity.com/paper/2401.04088/) (2024)
- [MemGPT: Towards LLMs as Operating Systems](https://mlsanity.com/paper/2310.08560/) (2023)
- [gpt-oss-120b & gpt-oss-20b Model Card](https://mlsanity.com/paper/2508.10925/) (2025)
- [Capabilities of GPT-4 on Medical Challenge Problems](https://mlsanity.com/paper/2303.13375/) (2023)
- [Agentic Context Engineering: Evolving Contexts for Self-Improving Language Models](https://mlsanity.com/paper/2510.04618/) (2025)
- [MEDITRON-70B: Scaling Medical Pretraining for Large Language Models](https://mlsanity.com/paper/2311.16079/) (2023)
- [Dynamic Cheatsheet: Test-Time Learning with Adaptive Memory](https://mlsanity.com/paper/2504.07952/) (2025)
- [Clinical Camel: An Open Expert-Level Medical Language Model with Dialogue-Based Knowledge Encoding](https://mlsanity.com/paper/2305.12031/) (2023)
- [Context Clues: Evaluating Long Context Models for Clinical Prediction Tasks on EHRs](https://mlsanity.com/paper/2412.16178/) (2024)
- [Generative Medical Event Models Improve with Scale](https://mlsanity.com/paper/2508.12104/) (2025)
- [MediEval: A Unified Medical Benchmark for Patient-Contextual and Knowledge-Grounded Reasoning in LLMs](https://mlsanity.com/paper/2512.20822/) (2025)

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

- [A Living Benchmark for Information Retrieval from Electronic Health Records](https://mlsanity.com/paper/2609.30205/) (2026)

## Abstract (arXiv)

Longitudinal clinical reasoning over electronic health records requires tracking evolving physiological measurements, laboratory results, and interventions across extended patient trajectories. Existing LLM-based clinical reasoning systems often rely on repeatedly serializing patient histories or exchanging unconstrained textual agent messages, leading to context drift, unstable reasoning, and growing inference cost over long horizons. We present Vital Trace, a protocol-constrained multi-agent framework for future clinical risk prediction over evolving ICU trajectories. Instead of maintaining unbounded textual histories, Vital Trace uses a compact persistent patient-state memory together with staged reasoning performed by four coordinated agents: a Router, Reasoner, Auditor, and Steward. To support temporally coherent reasoning, we introduce a manually curated Global Protocol containing physiological state-transition rules and a dynamic patient-state representation that tracks hemodynamic, respiratory, renal, metabolic, and inflammatory instability over time. We evaluate Vital Trace on MIMIC-IV and eICU using future vasopressor-support, respiratory-support, renal-support, and deterioration prediction tasks. Results show that structured protocol-constrained reasoning improves temporal consistency, communication stability, calibration, and interpretability compared with free-form multi-agent baselines while achieving strong predictive performance across long ICU trajectories.