fix:

No SOFA trend chart or organ-system timeline
No GCS trend chart or component history
No qSOFA history view

VigilCareClinicalAPI/Sepsis/QsofaCalculator.cs

@@ -34,4 +34,16 @@ public static class QsofaCalculator
 
     public static int CountActiveCriteria(RedisValue[] values) =>
         values.Count(v => v.HasValue);
+
+    public static QsofaCriteriaState ParseCriteriaState(RedisValue[] values) =>
+        new(
+            ParseOptionalDecimal(values.ElementAtOrDefault(0)),
+            ParseOptionalDecimal(values.ElementAtOrDefault(1)),
+            ParseOptionalDecimal(values.ElementAtOrDefault(2)));
+
+    public static QsofaCriteriaState ParseCriteriaState(QsofaEvaluation evaluation) =>
+        new(evaluation.RespRate, evaluation.SystolicBp, evaluation.Avpu);
+
+    private static decimal? ParseOptionalDecimal(RedisValue value) =>
+        value.HasValue ? decimal.Parse(value.ToString()!) : null;
 }

VigilCareClinicalAPI/Sepsis/QsofaDetector.cs

@@ -83,13 +83,64 @@ public class QsofaDetector
         var values = await cache.StringGetAsync(allKeys);
         var activeCount = QsofaCalculator.CountActiveCriteria(values);
 
+        var created = activeCount >= 2
+            && await TryCreateScreenAlertAsync(encounterId, patientId, activeCount, values, ct);
+
+        await PersistEvaluationIfChangedAsync(
+            encounterId, patientId, activeCount, values, created, ct);
+
         if (activeCount < 2)
             return QsofaResult.InsufficientCriteria(activeCount);
 
-        var created = await TryCreateScreenAlertAsync(encounterId, patientId, activeCount, values, ct);
         return created ? QsofaResult.AlertCreated : QsofaResult.AlertAlreadyOpen;
     }
 
+    private async Task PersistEvaluationIfChangedAsync(
+        Guid encounterId,
+        Guid patientId,
+        int activeCount,
+        RedisValue[] values,
+        bool screenAlertFired,
+        CancellationToken ct)
+    {
+        using var scope = _services.CreateScope();
+        var db = scope.ServiceProvider.GetRequiredService<AppDbContext>();
+
+        var last = await db.QsofaEvaluations
+            .AsNoTracking()
+            .Where(e => e.EncounterId == encounterId)
+            .OrderByDescending(e => e.EvaluatedAt)
+            .ThenByDescending(e => e.Id)
+            .Select(e => new { e.ActiveCriteria, e.ScreenAlertFired })
+            .FirstOrDefaultAsync(ct);
+
+        if (last is not null
+            && last.ActiveCriteria == activeCount
+            && !screenAlertFired)
+        {
+            return;
+        }
+
+        var criteria = QsofaCalculator.ParseCriteriaState(values);
+        var evaluatedAt = DateTimeOffset.UtcNow;
+
+        db.QsofaEvaluations.Add(new QsofaEvaluation
+        {
+            Id = Guid.NewGuid(),
+            EncounterId = encounterId,
+            PatientId = patientId,
+            ActiveCriteria = activeCount,
+            RespRate = criteria.RespRate,
+            SystolicBp = criteria.SystolicBp,
+            Avpu = criteria.Avpu,
+            ScreenAlertFired = screenAlertFired,
+            EvaluatedAt = evaluatedAt,
+            CreatedAt = evaluatedAt,
+        });
+
+        await db.SaveChangesAsync(ct);
+    }
+
     private async Task<bool> TryCreateScreenAlertAsync(
         Guid encounterId,
         Guid patientId,