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原文摘要

Integrating external medical knowledge into longitudinal electronic health record modeling is a prevailing paradigm to mitigate clinical data sparsity. However, existing approaches face a reliability-timeliness dilemma, struggling to balance the structural authority of static ontologies with the reasoning flexibility of large language models. Furthermore, most frameworks overlook the risk of relative negative transfer, where indiscriminately fusing task-irrelevant knowledge can introduce noise or even cause conflicts that weakens patient-specific signals. In this paper, we propose TrustKE, a Trustworthy Knowledge Enhancement framework. First, we construct a dual-layer knowledge graph that anchors dynamic, evidence-based chain-of-thought reasoning from medical literature within the stable structure of medical knowledge graph. Second, we introduce a task-adaptive knowledge selection mechanism that dynamically optimizes the graph, retaining only task-specific signals. Extensive experiments on MIMIC-III and MIMIC-IV across four clinical tasks show that TrustKE outperforms state-of-the-art baselines. Our analysis confirms that TrustKE effectively mitigates negative transfer while offering transparent reasoning for clinical decision-making.