fix: Trend alert matching uses fragile LIKE pattern

VigilCareClinicalAPI/Data/Configurations/ClinicalAlertConfiguration.cs

@@ -51,6 +51,7 @@ public class ClinicalAlertConfiguration : IEntityTypeConfiguration<ClinicalAlert
                 v => AlertSeverityExtensions.FromDbString(v))
             .IsRequired();
         builder.Property(a => a.Details).HasColumnName("details").IsRequired();
+        builder.Property(a => a.ObservationCode).HasColumnName("observation_code").HasMaxLength(50);
         builder.Property(a => a.Status)
             .HasColumnName("status")
             .HasMaxLength(20)
@@ -73,5 +74,7 @@ public class ClinicalAlertConfiguration : IEntityTypeConfiguration<ClinicalAlert
         builder.HasIndex(a => new { a.PatientId, a.TriggeredAt });
         builder.HasIndex(a => new { a.Severity, a.TriggeredAt })
             .HasFilter("status = 'OPEN'");
+        builder.HasIndex(a => new { a.EncounterId, a.AlertType, a.ObservationCode })
+            .HasFilter("status IN ('OPEN', 'ESCALATED')");
     }
 }

VigilCareClinicalAPI/Domains/Entities/ClinicalAlert.cs

@@ -7,6 +7,7 @@ public class ClinicalAlert
     public AlertType AlertType { get; set; }
     public AlertSeverity Severity { get; set; }
     public string Details { get; set; } = null!;
+    public string? ObservationCode { get; set; }
     public AlertStatus Status { get; set; } = AlertStatus.Open;
     public DateTimeOffset? AcknowledgedAt { get; set; }
     public string? AcknowledgedBy { get; set; }

VigilCareClinicalAPI/Migrations/20260621083919_AddAlertObservationCode.cs

@@ -0,0 +1,52 @@
+using Microsoft.EntityFrameworkCore.Migrations;
+
+#nullable disable
+
+namespace VigilCareClinicalAPI.Migrations
+{
+    /// <inheritdoc />
+    public partial class AddAlertObservationCode : Migration
+    {
+        /// <inheritdoc />
+        protected override void Up(MigrationBuilder migrationBuilder)
+        {
+            migrationBuilder.AddColumn<string>(
+                name: "observation_code",
+                table: "clinical_alerts",
+                type: "character varying(50)",
+                maxLength: 50,
+                nullable: true);
+
+            migrationBuilder.Sql(@"
+                UPDATE clinical_alerts
+                SET observation_code = CASE
+                    WHEN details LIKE '%HEART_RATE%'  THEN 'HEART_RATE'
+                    WHEN details LIKE '%RESP_RATE%'   THEN 'RESP_RATE'
+                    WHEN details LIKE '%SYSTOLIC_BP%' THEN 'SYSTOLIC_BP'
+                    WHEN details LIKE '%TEMP_C%'      THEN 'TEMP_C'
+                    WHEN details LIKE '%SPO2%'        THEN 'SPO2'
+                END
+                WHERE alert_type = 'RAPID_DETERIORATION'
+                  AND observation_code IS NULL;
+            ");
+
+            migrationBuilder.CreateIndex(
+                name: "IX_clinical_alerts_encounter_id_alert_type_observation_code",
+                table: "clinical_alerts",
+                columns: new[] { "encounter_id", "alert_type", "observation_code" },
+                filter: "status IN ('OPEN', 'ESCALATED')");
+        }
+
+        /// <inheritdoc />
+        protected override void Down(MigrationBuilder migrationBuilder)
+        {
+            migrationBuilder.DropIndex(
+                name: "IX_clinical_alerts_encounter_id_alert_type_observation_code",
+                table: "clinical_alerts");
+
+            migrationBuilder.DropColumn(
+                name: "observation_code",
+                table: "clinical_alerts");
+        }
+    }
+}

VigilCareClinicalAPI/Migrations/AppDbContextModelSnapshot.cs

@@ -113,6 +113,11 @@ namespace VigilCareClinicalAPI.Migrations
                         .HasColumnType("uuid")
                         .HasColumnName("encounter_id");
 
+                    b.Property<string>("ObservationCode")
+                        .HasMaxLength(50)
+                        .HasColumnType("character varying(50)")
+                        .HasColumnName("observation_code");
+
                     b.Property<Guid?>("ObservationId")
                         .HasColumnType("uuid")
                         .HasColumnName("observation_id");
@@ -154,6 +159,9 @@ namespace VigilCareClinicalAPI.Migrations
                     b.HasIndex("Severity", "TriggeredAt")
                         .HasFilter("status = 'OPEN'");
 
+                    b.HasIndex("EncounterId", "AlertType", "ObservationCode")
+                        .HasFilter("status IN ('OPEN', 'ESCALATED')");
+
                     b.ToTable("clinical_alerts", null, t =>
                         {
                             t.HasCheckConstraint("chk_clinical_alerts_alert_type", "alert_type IN ('SEPSIS_WARNING', 'CRITICAL_HEART_RATE', 'CRITICAL_TEMP_C', 'CRITICAL_POTASSIUM_MEQ_L', 'CRITICAL_SPO2', 'CRITICAL_RESP_RATE', 'CRITICAL_WBC_K_UL', 'CRITICAL_SYSTOLIC_BP', 'CRITICAL_DIASTOLIC_BP', 'CRITICAL_LACTATE_MMOL_L', 'CRITICAL_AVPU', 'CRITICAL_GLUCOSE_MG_DL', 'CRITICAL_PAO2_MMHG', 'CRITICAL_PLATELET_K_UL', 'CRITICAL_BILIRUBIN_MG_DL', 'CRITICAL_CREATININE_MG_DL', 'WARNING_HEART_RATE', 'WARNING_TEMP_C', 'WARNING_POTASSIUM_MEQ_L', 'WARNING_SPO2', 'WARNING_RESP_RATE', 'WARNING_WBC_K_UL', 'WARNING_SYSTOLIC_BP', 'WARNING_DIASTOLIC_BP', 'WARNING_LACTATE_MMOL_L', 'WARNING_GLUCOSE_MG_DL', 'WARNING_PAO2_MMHG', 'WARNING_PLATELET_K_UL', 'WARNING_BILIRUBIN_MG_DL', 'WARNING_CREATININE_MG_DL', 'NEWS2_WARNING', 'NEWS2_EMERGENCY', 'RAPID_DETERIORATION', 'QSOFA_WARNING', 'QSOFA_SCREEN', 'GCS_CRITICAL', 'GCS_WARNING', 'SOFA_SEPSIS', 'SOFA_WARNING')");

VigilCareClinicalAPI/Trend/TrendDetector.cs

@@ -101,15 +101,15 @@ public class TrendDetector
 
         var affected = await db.Database.ExecuteSqlInterpolatedAsync($"""
             INSERT INTO clinical_alerts
-                (id, encounter_id, patient_id, alert_type, severity, details, status, triggered_at)
+                (id, encounter_id, patient_id, alert_type, severity, details, observation_code, status, triggered_at)
             SELECT {alertId}, {encounterId}, {patientId},
-                   'RAPID_DETERIORATION', 'WARNING', {fullDetails}, 'OPEN', {triggeredAt}
+                   'RAPID_DETERIORATION', 'WARNING', {fullDetails}, {observationCode}, 'OPEN', {triggeredAt}
             WHERE NOT EXISTS (
                 SELECT 1 FROM clinical_alerts
-                WHERE  encounter_id = {encounterId}
-                  AND  alert_type   = 'RAPID_DETERIORATION'
-                  AND  details      LIKE {$"%{observationCode}%"}
-                  AND  status       IN ('OPEN', 'ESCALATED')
+                WHERE  encounter_id    = {encounterId}
+                  AND  alert_type      = 'RAPID_DETERIORATION'
+                  AND  observation_code = {observationCode}
+                  AND  status          IN ('OPEN', 'ESCALATED')
             )
             """, ct);