confidence gating

IndicBERT-HPA: Reliability-Oriented Multilingual Orthopedic Decision Support with Selective Verification Deferral

This paper presents a framework for classifying free-text orthopedic clinical notes in English, Hindi, and Punjabi, introducing IndicBERT-HPA, a domain-adaptive encoder augmented with language-aware orthopedic adapter heads. The system is evaluated against multilingual transformers, a DistilBERT baseline, and zero-shot LLMs, with zero-shot LLMs found substantially less effective than task-adapted encoders for closed-set clinical classification. IndicBERT-HPA achieves Macro-F1 of 0.8792 and AUPRC of 0.902 under natural clinical prevalence. A deterministic selective-verification layer combining confidence gating, evidence-consistency checking, and language-risk screening improves accuracy from 71.5% to 84.4% at 72.3% coverage on a 5,000-record held-out set.