feature: Simulator Scenarios + Clinical Validation: SOFA/GCS

2026-06-21 04:55:39 +08:00
parent bf46e6554a
commit 3638dd0669
39 changed files with 1619 additions and 213 deletions
@@ -0,0 +1,112 @@
+using System.Text.Json;
+using FluentAssertions;
+using Microsoft.EntityFrameworkCore;
+using Microsoft.Extensions.DependencyInjection;
+using StackExchange.Redis;
+
+[Collection("Integration")]
+public class ClinicalRefactorEndToEndTests : IAsyncLifetime
+{
+    private readonly ApiFixture _fixture;
+    private readonly HttpClient _client;
+
+    public ClinicalRefactorEndToEndTests(ApiFixture fixture)
+    {
+        _fixture = fixture;
+        _client = fixture.CreateClient();
+    }
+
+    public async Task InitializeAsync()
+    {
+        using var scope = _fixture.Services.CreateScope();
+        var db = scope.ServiceProvider.GetRequiredService<AppDbContext>();
+        await DbResetHelper.ResetAsync(db);
+
+        var redis = scope.ServiceProvider.GetRequiredService<IConnectionMultiplexer>();
+        await DataSeeder.SeedThresholdsOnlyAsync(db, redis);
+    }
+
+    public Task DisposeAsync() => Task.CompletedTask;
+
+    [Fact]
+    public async Task SofaProgressionScenario_EndToEnd()
+    {
+        var scenario = ScenarioReplayHelper.Load("sepsis-sofa-progression-01.json");
+        var (_, encounterId) = await ScenarioReplayHelper.ReplayObservationsAsync(_client, scenario);
+
+        await ScenarioReplayHelper.WaitForAlertTypeAsync(
+            _fixture.Services, encounterId, AlertType.QsofaScreen, TimeSpan.FromSeconds(30));
+
+        await ScenarioReplayHelper.WaitForAlertTypeAsync(
+            _fixture.Services, encounterId, AlertType.SofaSepsis, TimeSpan.FromSeconds(30));
+
+        using var scope = _fixture.Services.CreateScope();
+        var db = scope.ServiceProvider.GetRequiredService<AppDbContext>();
+        var bundle = await db.SepsisBundles.SingleAsync(b => b.EncounterId == encounterId);
+        bundle.TriggeringAlertType.Should().Be("SOFA_SEPSIS");
+    }
+
+    [Fact]
+    public async Task GcsDeclineScenario_EndToEnd()
+    {
+        var scenario = ScenarioReplayHelper.Load("neurological-decline-gcs-01.json");
+        var (_, encounterId) = await ScenarioReplayHelper.ReplayObservationsAsync(_client, scenario);
+
+        await ScenarioReplayHelper.WaitForAlertTypeAsync(
+            _fixture.Services, encounterId, AlertType.GcsWarning, TimeSpan.FromSeconds(30));
+
+        await ScenarioReplayHelper.WaitForAlertTypeAsync(
+            _fixture.Services, encounterId, AlertType.GcsCritical, TimeSpan.FromSeconds(30));
+
+        await ScenarioReplayHelper.AssertNoAlertTypeAsync(
+            _fixture.Services, encounterId, AlertType.SofaSepsis, TimeSpan.FromSeconds(5));
+
+        await ScenarioReplayHelper.AssertNoAlertTypeAsync(
+            _fixture.Services, encounterId, AlertTypeExtensions.FromDbString("SEPSIS_WARNING"), TimeSpan.FromSeconds(1));
+    }
+
+    [Fact]
+    public async Task PartialSofaScenario_StalenessFlags()
+    {
+        var scenario = ScenarioReplayHelper.Load("sofa-partial-spo2-fallback-01.json");
+        var (_, encounterId) = await ScenarioReplayHelper.ReplayObservationsAsync(_client, scenario);
+
+        var sofa = await ScenarioReplayHelper.WaitForSofaScoreAsync(
+            _fixture.Services, encounterId, TimeSpan.FromSeconds(45));
+
+        sofa.StalenessFlags.Should().NotBeNullOrEmpty();
+        var flags = JsonSerializer.Deserialize<SofaStalenessFlags>(
+            sofa.StalenessFlags!,
+            new JsonSerializerOptions { PropertyNameCaseInsensitive = true });
+        flags!.UsedSpO2Fallback.Should().BeTrue("expected SpO2/FiO2 proxy for respiratory SOFA");
+    }
+
+    [Theory]
+    [InlineData("stable-baseline-01.json")]
+    [InlineData("cardiac-arrest-post-mi-01.json")]
+    [InlineData("post-op-hemorrhage-01.json")]
+    [InlineData("respiratory-failure-asthma-01.json")]
+    [InlineData("dka-electrolyte-01.json")]
+    [InlineData("medication-false-alarm-01.json")]
+    [InlineData("hypothermia-elderly-01.json")]
+    [InlineData("uti-sepsis-elderly-01.json")]
+    public void ExistingScenarios_ValidateWithoutErrors(string fileName)
+    {
+        var scenario = ScenarioReplayHelper.Load(fileName);
+        var errors = ScenarioValidator.Validate(scenario);
+        errors.Should().BeEmpty(string.Join("; ", errors));
+    }
+
+    [Fact]
+    public async Task UtiSepsisScenario_NowUsesSofa()
+    {
+        var scenario = ScenarioReplayHelper.Load("uti-sepsis-elderly-01.json");
+        var (_, encounterId) = await ScenarioReplayHelper.ReplayObservationsAsync(_client, scenario);
+
+        await ScenarioReplayHelper.WaitForAlertTypeAsync(
+            _fixture.Services, encounterId, AlertType.SofaSepsis, TimeSpan.FromSeconds(45));
+
+        await ScenarioReplayHelper.AssertNoAlertTypeAsync(
+            _fixture.Services, encounterId, AlertTypeExtensions.FromDbString("SEPSIS_WARNING"), TimeSpan.FromSeconds(5));
+    }
+}