# Trajectory-Derived Confidence for Reliable, Resource-Aware Clinical Text-to-SQL Agents

arXiv: https://arxiv.org/abs/2610.04156 · HTML: https://mlsanity.com/paper/2610.04156/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Placed in Medical and scientific domain agents, one of 16 directions in LLM agents and tool use.
- Builds on 33 of its 49 references that are in the map.
- First posted on arXiv 2 Oct 2026.

## Placed in

- LLM agents and tool use / [Medical and scientific domain agents](https://mlsanity.com/agents/medical-and-scientific-domain-agents/)

## Builds on (most cited first, 30 of 33)

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- [Spider: A Large-Scale Human-Labeled Dataset for Complex and Cross-Domain Semantic Parsing and Text-to-SQL Task](https://mlsanity.com/paper/1809.08887/) (2018)
- [Language Models Don't Always Say What They Think: Unfaithful Explanations in Chain-of-Thought Prompting](https://mlsanity.com/paper/2305.04388/) (2023)
- [Can LLMs Express Their Uncertainty? An Empirical Evaluation of Confidence Elicitation in LLMs](https://mlsanity.com/paper/2306.13063/) (2023)
- [FrugalGPT: How to Use Large Language Models While Reducing Cost and Improving Performance](https://mlsanity.com/paper/2305.05176/) (2023)
- [Selective Classification for Deep Neural Networks](https://mlsanity.com/paper/1705.08500/) (2017)
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- [Seq2SQL: Generating Structured Queries from Natural Language using Reinforcement Learning](https://mlsanity.com/paper/1709.00103/) (2017)
- [Smarter, Better, Faster, Longer: A Modern Bidirectional Encoder for Fast, Memory Efficient, and Long Context Finetuning and Inference](https://mlsanity.com/paper/2412.13663/) (2024)
- [Phi-4-Mini Technical Report: Compact yet Powerful Multimodal Language Models via Mixture-of-LoRAs](https://mlsanity.com/paper/2503.01743/) (2025)
- [Compositional Semantic Parsing on Semi-Structured Tables](https://mlsanity.com/paper/1508.00305/) (2015)
- [DIN-SQL: Decomposed In-Context Learning of Text-to-SQL with Self-Correction](https://mlsanity.com/paper/2304.11015/) (2023)
- [Selective Question Answering under Domain Shift](https://mlsanity.com/paper/2006.09462/) (2020)
- [Chain-of-Table: Evolving Tables in the Reasoning Chain for Table Understanding](https://mlsanity.com/paper/2401.04398/) (2024)
- [Machine Learning with a Reject Option: A survey](https://mlsanity.com/paper/2107.11277/) (2021)
- [Robust Text-to-SQL Generation with Execution-Guided Decoding](https://mlsanity.com/paper/1807.03100/) (2018)
- [EHRSQL: A Practical Text-to-SQL Benchmark for Electronic Health Records](https://mlsanity.com/paper/2301.07695/) (2023)
- [TrustSQL: Benchmarking Text-to-SQL Reliability with Penalty-Based Scoring](https://mlsanity.com/paper/2403.15879/) (2024)
- [SQLens: An End-to-End Framework for Error Detection and Correction in Text-to-SQL](https://mlsanity.com/paper/2506.04494/) (2025)
- [Overview of the EHRSQL 2024 Shared Task on Reliable Text-to-SQL Modeling on Electronic Health Records](https://mlsanity.com/paper/2405.06673/) (2024)
- [Confidence Estimation for Error Detection in Text-to-SQL Systems](https://mlsanity.com/paper/2501.09527/) (2025)
- [ProbGate at EHRSQL 2024: Enhancing SQL Query Generation Accuracy through Probabilistic Threshold Filtering and Error Handling](https://mlsanity.com/paper/2404.16659/) (2024)
- [TABQAWORLD: Optimizing Multimodal Reasoning for Multi-Turn Table Question Answering](https://mlsanity.com/paper/2604.03393/) (2026)

## Abstract (arXiv)

LLM agents for clinical text-to-SQL applications reason autonomously over multiple steps but cannot assess whether their own reasoning or outputs can be trusted. In high leverage applications such as healthcare, this presents a critical risk where system mistakes can be costly. These reliability failures are also resource failures: an incorrect reasoning trajectory spends computation budget on outputs that must be discarded. We introduce Sentinel, a trajectory-derived, classifier-based confidence layer that analyzes an agent's reasoning, code and database outputs to decide at three points whether to stop: refusing unanswerable questions before the agent runs, halting doomed trajectories mid-run, and withholding untrustworthy answers at delivery. Here, utilizing Chow's rule, we optimize decisions under the EHRSQL shared task's Reliability Score, which penalizes incorrect answers given a utility weighting, and find on the benchmark EHRSQL that Sentinel raises this score from +0.08 to +0.24 when mistakes have a low utility weighting, well above the +0.03 earned by refusing every question, with delivered-answer accuracy rising from 54% to 69% as coverage falls from 84% to 55%. At higher stakes the agents we test rarely answer reliably enough to deliver, and Sentinel detects this on its own, abstaining to that same +0.03 where the unmonitored agent scores -3.02. The same stopping decisions cut computation: at low stakes, where the system still answers, Sentinel eliminates 13-28% of agent steps at little or no reliability cost.