INCLAIR: Inception-Based Longitudinal Clinical Anomaly Detection with Informed Reasoning

Detecting anomalies in longitudinal clinical profiles is clinically important but difficult: abnormal evidence is often sparse, patient histories have unequal length, and expert explanations are costly. We propose INCLAIR, a framework that scores each observation against multiple historical contexts, aggregates evidence at the profile level, and generates grounded natural-language explanations under limited expert supervision. Under stated within-profile exchangeability assumptions, the complete mean subsequence score takes an order-l U-statistic form, yielding a variance decomposition and an incomplete-subset approximation that controls combinatorial inference cost independently of profile length. The same analysis shows that mean aggregation attenuates localized anomalies by a factor set by the anomaly support and profile length, motivating validation-selected top-k pooling. Across three clinical datasets, INCLAIR consistently outperforms state-of-the-art baselines. We further validate practical relevance through a case study on longitudinal steroid profiles, comparing INCLAIR's predictions and explanations against domain-expert assessments supported by DNA analysis. The results show that INCLAIR enables clinically actionable anomaly detection under limited expert supervision.