ClinTraceBench: Source-Verifiable Longitudinal Clinical Reasoning over EHR-Derived Dialogues

Clinical LLM assistants must reason over multi-visit patient trajectories, yet whether the compact history representations used to scale them---retrieval, structured timelines, LLM summaries, agentic memory---preserve the longitudinal signal clinical reasoning needs has not been measured. We introduce ClinTraceBench: 385 MIMIC-IV-derived verified dialogues with event-ID provenance, a nine-task taxonomy (T1--T9), and L0--L4 deterministic + L5 human-audit validation (98.92\% agreement). We evaluate eight history representation strategies---a no-context floor, last-visit-only, full-context, BGE-M3 dense-retrieval, two compression schemes, and two agentic-memory systems (Mem0, A-Mem)---across four backbones (DeepSeek-V3, GPT-4o-mini, Haiku~4.5, Sonnet~4.6) on 6{,}271 questions: 32 cells, 200{,}672 predictions. Four findings: (SP4) a controlled T3 injection probe isolates compression-induced relation loss---with the attribution sentence present before construction, Mem0, A-Mem and llm-summary still recover only 0--5.3\% of the injected positives; (SP1) compressed strategies pay an aggregation tax on multi-visit trends and cross-patient comparisons; (SP2) the blind-to-full gap spans +29.8~pp (GPT-4o-mini) to +62.7~pp (Haiku); (SP3) abstention scales non-monotonically with context length. On the Pareto frontier Haiku dominates Sonnet under full-context (\25.76 vs. 106.21), inverting the ``biggest backbone wins'' heuristic.