feature: Explainable Alerts
This commit is contained in:
voltsrage
@@ -0,0 +1,31 @@
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public static class News2ContributorBuilder
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{
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private static readonly Dictionary<string, (string Label, string NormalRange)> Labels = new()
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{
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["RESP_RATE"] = ("Respiratory Rate", "12-20 breaths/min"),
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["SPO2"] = ("SpO2", "96-100%"),
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["SYSTOLIC_BP"] = ("Systolic BP", "101-219 mmHg"),
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["HEART_RATE"] = ("Heart Rate", "51-90 bpm"),
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["AVPU"] = ("Consciousness", "Alert"),
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["TEMP_C"] = ("Temperature", "36.1-38.0 °C"),
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["SUPPLEMENTAL_O2"] = ("Supplemental O2", "Room air"),
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};
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public static List<ScoreContributor> Build(int[] paramScores, string?[]? rawValues = null)
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{
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var contributors = new List<ScoreContributor>();
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for (int i = 0; i < News2Calculator.ParameterCodes.Count; i++)
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{
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var code = News2Calculator.ParameterCodes[i];
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var (label, range) = Labels[code];
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contributors.Add(new ScoreContributor
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{
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Parameter = label,
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Points = paramScores[i],
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RawValue = rawValues?[i],
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NormalRange = range
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});
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}
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return contributors;
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}
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}
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@@ -69,11 +69,14 @@ public class News2Detector
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var allValues = await cache.StringGetAsync(allKeys);
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var scores = new int?[7];
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var rawValues = new string?[7];
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for (int i = 0; i < 7; i++)
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{
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if (i == 4) // consciousness — GCS-first, AVPU-fallback
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{
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scores[4] = await ResolveConsciousnessScoreAsync(encounterId);
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rawValues[4] = await ResolveConsciousnessRawValueAsync(encounterId);
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if (scores[4] is null)
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{
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var present = allValues.Count(v => v.HasValue) + 0;
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@@ -96,9 +99,11 @@ public class News2Detector
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var cached = JsonSerializer.Deserialize<News2CachedParam>(allValues[i]!, CachedParamJsonOptions);
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scores[i] = cached?.Score;
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rawValues[i] = cached?.Value.ToString();
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}
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var paramScores = scores.Select(s => s!.Value).ToArray();
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var contributors = News2ContributorBuilder.Build(paramScores, rawValues);
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var totalScore = paramScores.Sum();
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var hasSingleParamThree = paramScores.Any(s => s == 3);
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var riskLevel = News2Calculator.DetermineRiskLevel(totalScore, hasSingleParamThree);
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@@ -123,17 +128,17 @@ public class News2Detector
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{
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alertCreated = await TryCreateAlertAsync(
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encounterId, patientId, AlertType.News2Emergency, AlertSeverity.Critical,
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totalScore, riskLevel, paramScores, ct);
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totalScore, riskLevel, paramScores, contributors, ct);
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}
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else if (riskLevel == "MEDIUM" || riskLevel == "LOW_MEDIUM")
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{
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alertCreated = await TryCreateAlertAsync(
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encounterId, patientId, AlertType.News2Warning, AlertSeverity.Warning,
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totalScore, riskLevel, paramScores, ct);
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totalScore, riskLevel, paramScores, contributors, ct);
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}
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return new News2Result(
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News2Outcome.ScoreComputed, totalScore, riskLevel, alertCreated, 7, hasSingleParamThree);
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News2Outcome.ScoreComputed, totalScore, riskLevel, alertCreated, 7, hasSingleParamThree, contributors);
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}
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private async Task<int?> ResolveConsciousnessScoreAsync(Guid encounterId)
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@@ -159,6 +164,28 @@ public class News2Detector
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return cached?.Score;
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}
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private async Task<string?> ResolveConsciousnessRawValueAsync(Guid encounterId)
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{
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var cache = _redis.GetDatabase();
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var gcsValues = await cache.StringGetAsync(GcsCalculator.AllComponentKeys(encounterId));
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if (gcsValues.All(v => v.HasValue))
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{
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var eye = decimal.Parse(gcsValues[0]!);
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var verbal = decimal.Parse(gcsValues[1]!);
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var motor = decimal.Parse(gcsValues[2]!);
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return GcsCalculator.ComputeTotal(eye, verbal, motor)!.Value.ToString();
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}
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var avpuVal = await cache.StringGetAsync(
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News2Calculator.ParameterKey(encounterId, "AVPU"));
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if (!avpuVal.HasValue)
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return null;
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var cached = JsonSerializer.Deserialize<News2CachedParam>(avpuVal!, CachedParamJsonOptions);
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return cached?.Value.ToString();
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}
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private async Task<Guid> PersistScoreAsync(
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Guid encounterId, Guid patientId,
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int totalScore, string riskLevel,
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@@ -198,6 +225,7 @@ public class News2Detector
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Guid encounterId, Guid patientId,
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AlertType alertType, AlertSeverity severity,
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int totalScore, string riskLevel, int[] paramScores,
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List<ScoreContributor> contributors,
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CancellationToken ct)
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{
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if (alertType == AlertType.News2Warning)
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@@ -222,31 +250,26 @@ public class News2Detector
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var details = BuildDetails(totalScore, riskLevel, paramScores);
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var correlation = scope.ServiceProvider.GetRequiredService<MedicationCorrelationHelper>();
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var annotatedParts = new List<string>();
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foreach (var code in News2Calculator.ParameterCodes)
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MedicationContext? medication = null;
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foreach (var (code, score) in News2Calculator.ParameterCodes.Zip(paramScores))
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{
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var part = await correlation.TryAnnotateDetailsAsync(
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encounterId, code, "", ct);
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if (part.StartsWith(" — note:"))
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annotatedParts.Add(part.TrimStart(' ', '—').Trim());
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if (score <= 0)
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continue;
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medication = await correlation.TryGetContextAsync(encounterId, code, ct);
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if (medication is not null)
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break;
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}
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if (annotatedParts.Count > 0)
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details += " — " + string.Join("; ", annotatedParts.Distinct());
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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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{alertType.ToDbString()}, {severity.ToDbString()}, {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 = {alertType.ToDbString()}
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AND status IN ('OPEN', 'ESCALATED')
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)
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""", ct);
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var explanation = AlertExplanationBuilder.Build(
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"NEWS2", totalScore, contributors, medication: medication);
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if (affected == 0)
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var inserted = await ClinicalAlertFactory.TryInsertAsync(
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db, alertId, encounterId, patientId,
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alertType, severity, details, explanation,
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observationCode: null, triggeredAt, ct);
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if (!inserted)
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{
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await tx.RollbackAsync(ct);
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return false;
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@@ -256,16 +279,18 @@ public class News2Detector
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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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Payload = ClinicalAlertFactory.SerializeOutboxPayload(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.ToDbString(),
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severity = severity.ToDbString(),
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details,
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triggeredAt,
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news2Score = totalScore,
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news2RiskLevel = riskLevel,
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explanation,
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partitionKey = encounterId.ToString()
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}),
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PartitionKey = encounterId.ToString(),
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