Assessing acuity in pediatric emergency department triage: performance of a large language model.

Pediatric triage performance varies across emergency departments (ED), contributing to ongoing challenges in pediatric emergency care. There is growing interest in using large language models (LLMs) to support more consistent triage decision-making in children. We evaluated an LLM's (GPT-5-mini) ability to identify the higher-acuity child from pairs of de-identified clinical notes. Across 228,104 pediatric ED visits, the LLM achieved an overall accuracy of 0.73 (95% CI, 0.73-0.74) in identifying the higher-acuity child, with accuracy improving as acuity differences between visits increased. The LLM was less likely to be correct when the higher-acuity child was older (odds ratio, 0.62, 95% CI, 0.61-0.63) and when the age difference between children was large (0.75, 95% CI, 0.70-0.79). The LLM showed moderate overall accuracy in assessing pediatric acuity and demonstrated a tendency to prioritize younger children, similar to human performance. These findings highlight the need for pediatric-specific LLM evaluation and optimization before clinical use.