feature: qSOFA Scoring & Sepsis Bundle Compliance
This commit is contained in:
voltsrage
@@ -0,0 +1,34 @@
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using StackExchange.Redis;
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public static class QsofaCalculator
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{
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public static readonly IReadOnlyList<string> QsofaCodes = new[]
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{
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"RESP_RATE", "SYSTOLIC_BP", "AVPU"
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};
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public static readonly IReadOnlySet<string> QsofaCodeSet =
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new HashSet<string>(QsofaCodes);
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// qSOFA criteria (Sepsis-3 consensus):
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// - Respiratory rate ≥ 22 breaths/min
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// - Systolic blood pressure ≤ 100 mmHg
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// - Altered mentation: AVPU score ≥ 1 (any non-Alert state)
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public static bool MeetsCriterion(string observationCode, decimal value) =>
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observationCode switch
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{
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"RESP_RATE" => value >= 22m,
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"SYSTOLIC_BP" => value <= 100m,
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"AVPU" => value >= 1m,
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_ => false
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};
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public static string CriterionKey(Guid encounterId, string code) =>
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$"qsofa:{encounterId}:{code}";
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public static RedisKey[] AllCriterionKeys(Guid encounterId) =>
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QsofaCodes.Select(c => (RedisKey)CriterionKey(encounterId, c)).ToArray();
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public static int CountActiveCriteria(RedisValue[] values) =>
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values.Count(v => v.HasValue);
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}
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@@ -0,0 +1,160 @@
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using System.Text.Json;
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using Microsoft.EntityFrameworkCore;
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using Serilog.Context;
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using StackExchange.Redis;
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public class QsofaDetector
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{
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// 30 minutes in seconds — same sliding window as SIRS.
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private const int QsofaTtlSeconds = 1800;
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private readonly IConnectionMultiplexer _redis;
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private readonly IServiceProvider _services;
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private readonly ILogger<QsofaDetector> _logger;
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private readonly ClinicalMetrics _metrics;
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public QsofaDetector(
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IConnectionMultiplexer redis,
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IServiceProvider services,
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ILogger<QsofaDetector> logger,
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ClinicalMetrics metrics)
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{
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_redis = redis;
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_services = services;
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_logger = logger;
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_metrics = metrics;
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}
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public async Task<QsofaResult> ProcessObservationAsync(
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Guid encounterId,
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Guid patientId,
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string observationCode,
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decimal value,
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CancellationToken ct = default)
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{
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if (!QsofaCalculator.QsofaCodeSet.Contains(observationCode))
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return QsofaResult.NotQsofaCode;
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var cache = _redis.GetDatabase();
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var key = QsofaCalculator.CriterionKey(encounterId, observationCode);
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if (QsofaCalculator.MeetsCriterion(observationCode, value))
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{
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await cache.StringSetAsync(
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key, value.ToString(), TimeSpan.FromSeconds(QsofaTtlSeconds));
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_logger.LogDebug("qSOFA criterion set: {Key}={Value} (TTL={Ttl}s)",
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key, value, QsofaTtlSeconds);
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}
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else
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{
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await cache.KeyDeleteAsync(key);
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_logger.LogDebug("qSOFA criterion cleared: {Key}", key);
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}
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var allKeys = QsofaCalculator.AllCriterionKeys(encounterId);
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var values = await cache.StringGetAsync(allKeys);
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var activeCount = QsofaCalculator.CountActiveCriteria(values);
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_logger.LogDebug(
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"qSOFA state for encounter {Id}: {Active}/3 criteria active after {Code}={Value}",
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encounterId, activeCount, observationCode, value);
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if (activeCount < 2)
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return QsofaResult.InsufficientCriteria(activeCount);
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var created = await TryCreateAlertAsync(encounterId, patientId, activeCount, values, ct);
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return created ? QsofaResult.AlertCreated : QsofaResult.AlertAlreadyOpen;
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}
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private async Task<bool> TryCreateAlertAsync(
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Guid encounterId,
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Guid patientId,
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int activeCount,
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RedisValue[] criterionValues,
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CancellationToken ct)
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{
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using var scope = _services.CreateScope();
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var db = scope.ServiceProvider.GetRequiredService<AppDbContext>();
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await using var tx = await db.Database.BeginTransactionAsync(ct);
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var alertId = Guid.NewGuid();
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var triggeredAt = DateTimeOffset.UtcNow;
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var details = BuildDetails(activeCount, criterionValues);
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var affected = await db.Database.ExecuteSqlInterpolatedAsync($"""
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INSERT INTO clinical_alerts
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(id, encounter_id, patient_id, alert_type, severity, details, status, triggered_at)
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SELECT {alertId}, {encounterId}, {patientId},
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'QSOFA_WARNING', 'CRITICAL', {details}, 'OPEN', {triggeredAt}
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WHERE NOT EXISTS (
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SELECT 1 FROM clinical_alerts
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WHERE encounter_id = {encounterId}
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AND alert_type = 'QSOFA_WARNING'
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AND status IN ('OPEN', 'ESCALATED')
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)
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""", ct);
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if (affected == 0)
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{
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await tx.RollbackAsync(ct);
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_logger.LogDebug(
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"QSOFA_WARNING already open for encounter {Id} — no new alert", encounterId);
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return false;
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}
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db.OutboxEvents.Add(new OutboxEvent
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{
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Id = Guid.NewGuid(),
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Topic = "alert.generated",
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Payload = JsonSerializer.Serialize(new
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{
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alertId,
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encounterId,
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patientId,
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alertType = AlertType.QsofaWarning.ToDbString(),
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severity = "Critical",
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details,
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triggeredAt,
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partitionKey = encounterId.ToString()
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}),
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PartitionKey = encounterId.ToString(),
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CreatedAt = DateTimeOffset.UtcNow
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});
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await db.SaveChangesAsync(ct);
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await tx.CommitAsync(ct);
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_metrics.QsofaDetectionsTotal.Inc();
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_metrics.ClinicalAlertsTotal
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.WithLabels(AlertType.QsofaWarning.ToDbString(), AlertSeverity.Critical.ToDbString())
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.Inc();
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using (LogContext.PushProperty("EncounterId", encounterId))
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using (LogContext.PushProperty("PatientId", patientId))
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{
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_logger.LogWarning(
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"QSOFA_WARNING created. ActiveCriteriaCount={Count} AlertId={AlertId}",
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activeCount, alertId);
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}
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var handler = scope.ServiceProvider.GetRequiredService<SepsisAlertHandler>();
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await handler.OnSepsisAlertCreatedAsync(encounterId, alertId, AlertType.QsofaWarning, ct);
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return true;
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}
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private static string BuildDetails(int activeCount, RedisValue[] values)
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{
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var activeParts = new List<string>();
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for (var i = 0; i < QsofaCalculator.QsofaCodes.Count; i++)
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{
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if (values[i].HasValue)
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activeParts.Add($"{QsofaCalculator.QsofaCodes[i]}={values[i]}");
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}
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return $"qSOFA score {activeCount}/3: {string.Join(", ", activeParts)}";
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}
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}
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@@ -0,0 +1,22 @@
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public class SepsisAlertHandler
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{
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private readonly ISepsisBundleService _bundleService;
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private readonly ILogger<SepsisAlertHandler> _logger;
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public SepsisAlertHandler(ISepsisBundleService bundleService, ILogger<SepsisAlertHandler> logger)
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{
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_bundleService = bundleService;
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_logger = logger;
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}
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public async Task OnSepsisAlertCreatedAsync(
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Guid encounterId, Guid alertId, AlertType alertType, CancellationToken ct)
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{
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var bundle = await _bundleService.TryCreateBundleAsync(encounterId, alertId, alertType, ct);
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if (bundle is not null)
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_logger.LogInformation(
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"Sepsis bundle {BundleId} created for encounter {EncounterId} (trigger={AlertType})",
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bundle.Id, encounterId, alertType.ToDbString());
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}
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}
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@@ -169,6 +169,9 @@ public class SirsDetector
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activeCount, alertId);
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}
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var handler = scope.ServiceProvider.GetRequiredService<SepsisAlertHandler>();
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await handler.OnSepsisAlertCreatedAsync(encounterId, alertId, AlertType.SepsisWarning, ct);
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return true;
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}
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}
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