feature: Trend Detection & Alert Suppression Windows

2026-06-18 21:18:13 +08:00
parent e6f7989298
commit 3c54feb38a
31 changed files with 2751 additions and 18 deletions
@@ -0,0 +1,147 @@
+using FluentAssertions;
+using Microsoft.EntityFrameworkCore;
+using Microsoft.Extensions.DependencyInjection;
+using StackExchange.Redis;
+
+[Collection("Integration")]
+public class TrendDetectorTests : IAsyncLifetime
+{
+    private readonly ApiFixture _fixture;
+    private Guid _encounterId;
+    private Guid _patientId;
+    private static readonly DateTimeOffset BaseTime =
+        new(2026, 6, 18, 10, 0, 0, TimeSpan.Zero);
+
+    public TrendDetectorTests(ApiFixture fixture) => _fixture = fixture;
+
+    public async Task InitializeAsync()
+    {
+        using var scope = _fixture.Services.CreateScope();
+        var db = scope.ServiceProvider.GetRequiredService<AppDbContext>();
+        await DbResetHelper.ResetAsync(db);
+
+        var patient = new Patient
+        {
+            Id = Guid.NewGuid(), Mrn = "MRN-TREND-001", FirstName = "Trend", LastName = "Test",
+            DateOfBirth = new DateOnly(1970, 3, 1), Gender = "F",
+            CreatedAt = DateTimeOffset.UtcNow
+        };
+        var encounter = new Encounter
+        {
+            Id = Guid.NewGuid(), PatientId = patient.Id, EncounterType = EncounterType.Inpatient,
+            Status = EncounterStatus.Active, Department = Department.Icu,
+            AttendingPhysician = "Dr. Trend", AdmittedAt = DateTimeOffset.UtcNow,
+            CreatedAt = DateTimeOffset.UtcNow
+        };
+        db.Patients.Add(patient);
+        db.Encounters.Add(encounter);
+        await db.SaveChangesAsync();
+
+        _patientId = patient.Id;
+        _encounterId = encounter.Id;
+
+        await ClearTrendHistoryAsync(scope.ServiceProvider);
+    }
+
+    public Task DisposeAsync() => Task.CompletedTask;
+
+    [Fact]
+    public async Task RapidHeartRateClimb_CreatesAlert()
+    {
+        using var scope = _fixture.Services.CreateScope();
+        var detector = scope.ServiceProvider.GetRequiredService<TrendDetector>();
+
+        await detector.ProcessObservationAsync(
+            _encounterId, _patientId, "HEART_RATE", 72m, BaseTime);
+        var result = await detector.ProcessObservationAsync(
+            _encounterId, _patientId, "HEART_RATE", 95m, BaseTime.AddMinutes(10));
+
+        result.Outcome.Should().Be(TrendOutcome.RapidDeterioration);
+        result.AlertCreated.Should().BeTrue();
+        result.RatePerMinute.Should().Be(2.3m);
+
+        var db = scope.ServiceProvider.GetRequiredService<AppDbContext>();
+        var alert = await db.ClinicalAlerts.SingleAsync();
+        alert.AlertType.Should().Be(AlertType.RapidDeterioration);
+        alert.Severity.Should().Be(AlertSeverity.Warning);
+        alert.Details.Should().Contain("HEART_RATE");
+    }
+
+    [Fact]
+    public async Task StableHighHeartRate_NoTrendAlert()
+    {
+        using var scope = _fixture.Services.CreateScope();
+        var detector = scope.ServiceProvider.GetRequiredService<TrendDetector>();
+
+        await detector.ProcessObservationAsync(
+            _encounterId, _patientId, "HEART_RATE", 95m, BaseTime);
+        await detector.ProcessObservationAsync(
+            _encounterId, _patientId, "HEART_RATE", 95m, BaseTime.AddMinutes(10));
+        var result = await detector.ProcessObservationAsync(
+            _encounterId, _patientId, "HEART_RATE", 95m, BaseTime.AddMinutes(20));
+
+        result.Outcome.Should().Be(TrendOutcome.Stable);
+        result.AlertCreated.Should().BeFalse();
+
+        var db = scope.ServiceProvider.GetRequiredService<AppDbContext>();
+        (await db.ClinicalAlerts.CountAsync()).Should().Be(0);
+    }
+
+    [Fact]
+    public async Task InsufficientHistory_NoAlert()
+    {
+        using var scope = _fixture.Services.CreateScope();
+        var detector = scope.ServiceProvider.GetRequiredService<TrendDetector>();
+
+        var result = await detector.ProcessObservationAsync(
+            _encounterId, _patientId, "HEART_RATE", 72m, BaseTime);
+
+        result.Outcome.Should().Be(TrendOutcome.InsufficientHistory);
+        result.AlertCreated.Should().BeFalse();
+    }
+
+    [Fact]
+    public async Task NonTrendCode_Ignored()
+    {
+        using var scope = _fixture.Services.CreateScope();
+        var detector = scope.ServiceProvider.GetRequiredService<TrendDetector>();
+        var redis = scope.ServiceProvider.GetRequiredService<IConnectionMultiplexer>();
+
+        var result = await detector.ProcessObservationAsync(
+            _encounterId, _patientId, "POTASSIUM_MEQ_L", 4.0m, BaseTime);
+
+        result.Outcome.Should().Be(TrendOutcome.NotTrendCode);
+
+        var key = TrendCalculator.HistoryKey(_encounterId, "POTASSIUM_MEQ_L");
+        (await redis.GetDatabase().KeyExistsAsync(key)).Should().BeFalse();
+    }
+
+    [Fact]
+    public async Task DuplicateTrendAlert_Idempotent()
+    {
+        using var scope = _fixture.Services.CreateScope();
+        var detector = scope.ServiceProvider.GetRequiredService<TrendDetector>();
+        var db = scope.ServiceProvider.GetRequiredService<AppDbContext>();
+
+        await detector.ProcessObservationAsync(
+            _encounterId, _patientId, "HEART_RATE", 72m, BaseTime);
+        await detector.ProcessObservationAsync(
+            _encounterId, _patientId, "HEART_RATE", 95m, BaseTime.AddMinutes(10));
+
+        var second = await detector.ProcessObservationAsync(
+            _encounterId, _patientId, "HEART_RATE", 98m, BaseTime.AddMinutes(20));
+
+        second.Outcome.Should().Be(TrendOutcome.AlertAlreadyOpen);
+        second.AlertCreated.Should().BeFalse();
+        (await db.ClinicalAlerts.CountAsync()).Should().Be(1,
+            "second rapid climb must not duplicate while first RAPID_DETERIORATION is open");
+    }
+
+    private async Task ClearTrendHistoryAsync(IServiceProvider services)
+    {
+        var redis = services.GetRequiredService<IConnectionMultiplexer>();
+        var cache = redis.GetDatabase();
+        foreach (var key in TrendCalculator.AllHistoryKeys(_encounterId))
+            await cache.KeyDeleteAsync(key);
+    }
+}