What Embedding-Based Guideline-Literature Drift Measures (and What It Doesn't): A Proof-of-Concept and Mechanistic Dissection of TIDE in Orthopedic Surgery
- 1Loma Linda University School of Medicine, Loma Linda, CA, USA
Abstract
PurposeWe introduce the Temporal Index of Divergent Evidence (TIDE), a metric that evaluates how the topic center of gravity of a corresponding corpus of literature aligns with, or shifts relative to, a recommendations semantics over time.
MethodsTIDE computes annual mean cosine similarity using MedCPT embedding vectors between a recommendation and corresponding PubMed records binned by year (2000-2024), testing for monotonic temporal trend (Kendall {tau}). Three recommendations with expected divergent, stable, and convergent trajectories were examined: two-stage exchange for periprosthetic joint infection (PJI), emergent fasciotomy for acute compartment syndrome (ACS), and non-operative management of distal radius fractures (DRF) in adults [≥] 65 years. The signal was characterized by an additive per-token attribution, an isolated vs. in-context analysis, and an adversarial minimal-pair test.
ResultsPJI diverged ({tau} = -0.84, year-shuffle p = 0.001), DRF converged ({tau} = +0.42, p = 0.005), and ACS showed no detectable trend ({tau} = -0.07, p = 0.66). The two significant directions (PJI, DRF) held under matched input [CLS] pooling, while ACS remained near zero. Publication volume baselines did not distinguish the three trajectories (publication count was universally positive, {tau} = +0.77 to +0.97). A reversed-meaning minimal-pair control showed little cosine sensitivity to reversal. Paper-level TF-IDF recovered the qualitative three-case pattern.
ConclusionEmbedding-based drift analysis is a proof-of-concept candidate pre-triage signal that tracks topical alignment, not evidentiary direction; superiority over TF-IDF remains unproven. The present study is hypothesis-generating, showing potential use of embedding representations as an analytical unit rather than simply for retrieval.
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BibTeX
@misc{grames2026what,
title = {{What Embedding-Based Guideline-Literature Drift Measures (and What It Doesn't): A Proof-of-Concept and Mechanistic Dissection of TIDE in Orthopedic Surgery}},
author = {C. Grames and P. Zakarian and C. Franquemont and A. Cabrera and J. Elsissy},
howpublished = {medRxiv},
year = {2026},
month = sep,
doi = {10.64898/2026.09.28.26364191},
url = {https://www.medrxiv.org/content/10.64898/2026.09.28.26364191v1},
note = {CC BY},
}
RIS
TY - UNPB
TI - What Embedding-Based Guideline-Literature Drift Measures (and What It Doesn't): A Proof-of-Concept and Mechanistic Dissection of TIDE in Orthopedic Surgery
AU - C. Grames
AU - P. Zakarian
AU - C. Franquemont
AU - A. Cabrera
AU - J. Elsissy
PY - 2026
DA - 2026/09/28
PB - medRxiv
DO - 10.64898/2026.09.28.26364191
UR - https://www.medrxiv.org/content/10.64898/2026.09.28.26364191v1
AB - PurposeWe introduce the Temporal Index of Divergent Evidence (TIDE), a metric that evaluates how the topic center of gravity of a corresponding corpus of literature aligns with, or shifts relative to, a recommendations semantics over time. MethodsTIDE computes annual mean cosine similarity using MedCPT embedding vectors between a recommendation and corresponding PubMed records binned by year (2000-2024), testing for monotonic temporal trend (Kendall {tau}). Three recommendations with expected divergent, stable, and convergent trajectories were examined: two-stage exchange for periprosthetic joint infection (PJI), emergent fasciotomy for acute compartment syndrome (ACS), and non-operative management of distal radius fractures (DRF) in adults [≥] 65 years. The signal was characterized by an additive per-token attribution, an isolated vs. in-context analysis, and an adversarial minimal-pair test. ResultsPJI diverged ({tau} = -0.84, year-shuffle p = 0.001), DRF converged ({tau} = +0.42, p = 0.005), and ACS showed no detectable trend ({tau} = -0.07, p = 0.66). The two significant directions (PJI, DRF) held under matched input [CLS] pooling, while ACS remained near zero. Publication volume baselines did not distinguish the three trajectories (publication count was universally positive, {tau} = +0.77 to +0.97). A reversed-meaning minimal-pair control showed little cosine sensitivity to reversal. Paper-level TF-IDF recovered the qualitative three-case pattern. ConclusionEmbedding-based drift analysis is a proof-of-concept candidate pre-triage signal that tracks topical alignment, not evidentiary direction; superiority over TF-IDF remains unproven. The present study is hypothesis-generating, showing potential use of embedding representations as an analytical unit rather than simply for retrieval.
ER -