fix:

No SOFA trend chart or organ-system timeline No GCS trend chart or component history No qSOFA history view
2026-06-23 18:00:43 +08:00
parent 729c19830c
commit 7751d6df06
30 changed files with 3866 additions and 41 deletions
@@ -283,7 +283,7 @@ public class GapAnalysisFixTests : IAsyncLifetime
    // -------------------------------------------------------------------------

    [Fact]
-    public async Task QsofaHistory_ReturnsAlertRecords()
+    public async Task QsofaHistory_ReturnsEvaluationRecords()
    {
        using var scope = _fixture.Services.CreateScope();
        var db = scope.ServiceProvider.GetRequiredService<AppDbContext>();
@@ -304,20 +304,28 @@ public class GapAnalysisFixTests : IAsyncLifetime
        db.Patients.Add(patient);
        db.Encounters.Add(encounter);

-        db.ClinicalAlerts.Add(new ClinicalAlert
+        var now = DateTimeOffset.UtcNow;
+        db.QsofaEvaluations.Add(new QsofaEvaluation
        {
-            Id = Guid.NewGuid(), EncounterId = encounter.Id, PatientId = patient.Id,
-            AlertType = AlertType.QsofaScreen, Severity = AlertSeverity.Warning,
-            Details = "qSOFA >= 2", Status = AlertStatus.Open,
-            TriggeredAt = DateTimeOffset.UtcNow.AddMinutes(-30)
+            Id = Guid.NewGuid(),
+            EncounterId = encounter.Id,
+            PatientId = patient.Id,
+            ActiveCriteria = 1,
+            RespRate = 24m,
+            EvaluatedAt = now.AddMinutes(-30),
+            CreatedAt = now,
        });
-        db.ClinicalAlerts.Add(new ClinicalAlert
+        db.QsofaEvaluations.Add(new QsofaEvaluation
        {
-            Id = Guid.NewGuid(), EncounterId = encounter.Id, PatientId = patient.Id,
-            AlertType = AlertType.QsofaScreen, Severity = AlertSeverity.Warning,
-            Details = "qSOFA >= 2", Status = AlertStatus.Resolved,
-            TriggeredAt = DateTimeOffset.UtcNow.AddMinutes(-10),
-            ResolvedAt = DateTimeOffset.UtcNow
+            Id = Guid.NewGuid(),
+            EncounterId = encounter.Id,
+            PatientId = patient.Id,
+            ActiveCriteria = 2,
+            RespRate = 24m,
+            SystolicBp = 95m,
+            ScreenAlertFired = true,
+            EvaluatedAt = now.AddMinutes(-10),
+            CreatedAt = now,
        });
        await db.SaveChangesAsync();

@@ -325,7 +333,12 @@ public class GapAnalysisFixTests : IAsyncLifetime
            $"/api/v1/encounters/{encounter.Id}/qsofa/history?limit=10");

        var data = resp.GetProperty("data");
-        data.GetProperty("items").GetArrayLength().Should().Be(2);
+        var items = data.GetProperty("items");
+        items.GetArrayLength().Should().Be(2);
+
+        var latest = items[0];
+        latest.GetProperty("activeCriteria").GetInt32().Should().Be(2);
+        latest.GetProperty("screenAlertFired").GetBoolean().Should().BeTrue();
    }

    // -------------------------------------------------------------------------
@@ -2,15 +2,23 @@ using FluentAssertions;
 using Microsoft.EntityFrameworkCore;
 using Microsoft.Extensions.DependencyInjection;
 using StackExchange.Redis;
+using System.Net;
+using System.Net.Http.Json;
+using System.Text.Json;

 [Collection("Integration")]
 public class GcsScoringTests : IAsyncLifetime
 {
    private readonly ApiFixture _fixture;
+    private readonly HttpClient _client;
    private Guid _encounterId;
    private Guid _patientId;

-    public GcsScoringTests(ApiFixture fixture) => _fixture = fixture;
+    public GcsScoringTests(ApiFixture fixture)
+    {
+        _fixture = fixture;
+        _client = fixture.CreateClient();
+    }

    public async Task InitializeAsync()
    {
@@ -194,4 +202,58 @@ public class GcsScoringTests : IAsyncLifetime
        var score = await db.News2Scores.SingleAsync();
        score.ConsciousnessScore.Should().Be(0);
    }
+
+    [Fact]
+    public async Task GcsHistory_ReturnsPaginatedScores()
+    {
+        using var scope = _fixture.Services.CreateScope();
+        var db = scope.ServiceProvider.GetRequiredService<AppDbContext>();
+        var now = DateTimeOffset.UtcNow;
+
+        db.GcsScores.AddRange(
+            new GcsScore
+            {
+                Id = Guid.NewGuid(),
+                EncounterId = _encounterId,
+                PatientId = _patientId,
+                EyeScore = 4,
+                VerbalScore = 5,
+                MotorScore = 6,
+                TotalScore = 15,
+                Classification = "MILD",
+                CalculatedAt = now.AddHours(-2),
+                CreatedAt = now,
+            },
+            new GcsScore
+            {
+                Id = Guid.NewGuid(),
+                EncounterId = _encounterId,
+                PatientId = _patientId,
+                EyeScore = 2,
+                VerbalScore = 3,
+                MotorScore = 3,
+                TotalScore = 8,
+                Classification = "SEVERE",
+                CalculatedAt = now,
+                CreatedAt = now,
+            });
+        await db.SaveChangesAsync();
+
+        var resp = await _client.GetAsync(
+            $"/api/v1/encounters/{_encounterId}/gcs/history?limit=10");
+        resp.StatusCode.Should().Be(HttpStatusCode.OK);
+
+        var body = await resp.Content.ReadFromJsonAsync<JsonElement>();
+        var items = body.GetProperty("data").GetProperty("items");
+        items.GetArrayLength().Should().Be(2);
+
+        var latest = items[0];
+        latest.GetProperty("totalScore").GetInt32().Should().Be(8);
+        latest.GetProperty("eyeScore").GetInt32().Should().Be(2);
+        latest.GetProperty("verbalScore").GetInt32().Should().Be(3);
+        latest.GetProperty("motorScore").GetInt32().Should().Be(3);
+
+        var earliest = items[1];
+        earliest.GetProperty("totalScore").GetInt32().Should().Be(15);
+    }
 }
@@ -25,6 +25,7 @@ public static class DbResetHelper
                    DELETE FROM clinical_alerts;
                    DELETE FROM gcs_scores;
                    DELETE FROM sofa_scores;
+                    DELETE FROM qsofa_evaluations;
                    DELETE FROM news2_scores;
                    DELETE FROM observations;
                    DELETE FROM external_resource_identifiers;
@@ -162,4 +162,25 @@ public class QsofaDetectorTests : IAsyncLifetime
            exists.Should().BeFalse("non-qSOFA codes must not create Redis state");
        }
    }
+
+    [Fact]
+    public async Task CriteriaChange_PersistsEvaluationHistory()
+    {
+        using var scope = _fixture.Services.CreateScope();
+        var detector = scope.ServiceProvider.GetRequiredService<QsofaDetector>();
+        var db = scope.ServiceProvider.GetRequiredService<AppDbContext>();
+
+        await detector.ProcessObservationAsync(_encounterId, _patientId, "RESP_RATE", 24m);
+        await detector.ProcessObservationAsync(_encounterId, _patientId, "SYSTOLIC_BP", 95m);
+
+        var evaluations = await db.QsofaEvaluations
+            .Where(e => e.EncounterId == _encounterId)
+            .OrderBy(e => e.EvaluatedAt)
+            .ToListAsync();
+
+        evaluations.Should().HaveCount(2);
+        evaluations[0].ActiveCriteria.Should().Be(1);
+        evaluations[1].ActiveCriteria.Should().Be(2);
+        evaluations[1].ScreenAlertFired.Should().BeTrue();
+    }
 }
@@ -27,8 +27,33 @@ public class GcsController : ControllerBase
        if (score is null)
            return Ok(ApiResponse<GcsScoreResponse?>.Ok(null));

-        return Ok(ApiResponse<GcsScoreResponse>.Ok(new GcsScoreResponse(
-            score.EyeScore, score.VerbalScore, score.MotorScore,
-            score.TotalScore, score.Classification, score.CalculatedAt)));
+        return Ok(ApiResponse<GcsScoreResponse>.Ok(MapResponse(score)));
    }
+
+    /// <summary>
+    /// Returns cursor-paginated GCS score history for an encounter.
+    /// </summary>
+    /// <param name="encounterId">Encounter id.</param>
+    /// <param name="limit">Maximum items per page.</param>
+    /// <param name="cursor">Opaque cursor from a previous page.</param>
+    /// <returns>A page of GCS scores with an optional next cursor.</returns>
+    [HttpGet("history")]
+    [ProducesResponseType(typeof(ApiResponse<object>), StatusCodes.Status200OK)]
+    public async Task<IActionResult> History(
+        Guid encounterId,
+        [FromQuery] int limit = 20,
+        [FromQuery] string? cursor = null)
+    {
+        var page = await _gcs.GetHistoryAsync(encounterId, limit, cursor);
+        return Ok(ApiResponse<object>.Ok(new
+        {
+            items = page.Items.Select(MapResponse),
+            nextCursor = page.NextCursor,
+            hasMore = page.HasMore
+        }));
+    }
+
+    private static GcsScoreResponse MapResponse(GcsScore score) =>
+        new(score.EyeScore, score.VerbalScore, score.MotorScore,
+            score.TotalScore, score.Classification, score.CalculatedAt);
 }
@@ -39,7 +39,11 @@ public class QsofaController : ControllerBase
        var page = await _qsofa.GetHistoryAsync(encounterId, limit, cursor);
        return Ok(ApiResponse<object>.Ok(new
        {
-            items = page.Items,
+            items = page.Items.Select(e => new QsofaHistoryResponse(
+                e.ActiveCriteria,
+                QsofaCalculator.ParseCriteriaState(e),
+                e.ScreenAlertFired,
+                e.EvaluatedAt)),
            nextCursor = page.NextCursor,
            hasMore = page.HasMore
        }));
@@ -25,6 +25,7 @@ public class AppDbContext : DbContext
    public DbSet<MedicationAdministration> MedicationAdministrations => Set<MedicationAdministration>();
    public DbSet<GcsScore> GcsScores => Set<GcsScore>();
    public DbSet<SofaScore> SofaScores => Set<SofaScore>();
+    public DbSet<QsofaEvaluation> QsofaEvaluations => Set<QsofaEvaluation>();
    public DbSet<ExternalResourceIdentifier> ExternalResourceIdentifiers => Set<ExternalResourceIdentifier>();
    public DbSet<ClinicalUser> ClinicalUsers => Set<ClinicalUser>();
    public DbSet<ClinicalAuditLog> ClinicalAuditLogs => Set<ClinicalAuditLog>();
@@ -0,0 +1,32 @@
+using Microsoft.EntityFrameworkCore;
+using Microsoft.EntityFrameworkCore.Metadata.Builders;
+
+public class QsofaEvaluationConfiguration : IEntityTypeConfiguration<QsofaEvaluation>
+{
+    public void Configure(EntityTypeBuilder<QsofaEvaluation> builder)
+    {
+        builder.ToTable("qsofa_evaluations", t =>
+        {
+            t.HasCheckConstraint("chk_qsofa_evaluations_active_criteria",
+                "active_criteria >= 0 AND active_criteria <= 3");
+        });
+        builder.HasKey(e => e.Id);
+        builder.Property(e => e.Id).HasColumnName("id").HasDefaultValueSql("gen_random_uuid()");
+        builder.Property(e => e.EncounterId).HasColumnName("encounter_id").IsRequired();
+        builder.Property(e => e.PatientId).HasColumnName("patient_id").IsRequired();
+        builder.Property(e => e.ActiveCriteria).HasColumnName("active_criteria").IsRequired();
+        builder.Property(e => e.RespRate).HasColumnName("resp_rate");
+        builder.Property(e => e.SystolicBp).HasColumnName("systolic_bp");
+        builder.Property(e => e.Avpu).HasColumnName("avpu");
+        builder.Property(e => e.ScreenAlertFired).HasColumnName("screen_alert_fired").IsRequired();
+        builder.Property(e => e.EvaluatedAt).HasColumnName("evaluated_at").IsRequired();
+        builder.Property(e => e.CreatedAt).HasColumnName("created_at").IsRequired();
+
+        builder.HasOne(e => e.Encounter)
+            .WithMany()
+            .HasForeignKey(e => e.EncounterId)
+            .OnDelete(DeleteBehavior.Restrict);
+
+        builder.HasIndex(e => new { e.EncounterId, e.EvaluatedAt });
+    }
+}
@@ -0,0 +1,15 @@
+public class QsofaEvaluation
+{
+    public Guid Id { get; set; }
+    public Guid EncounterId { get; set; }
+    public Guid PatientId { get; set; }
+    public int ActiveCriteria { get; set; }
+    public decimal? RespRate { get; set; }
+    public decimal? SystolicBp { get; set; }
+    public decimal? Avpu { get; set; }
+    public bool ScreenAlertFired { get; set; }
+    public DateTimeOffset EvaluatedAt { get; set; }
+    public DateTimeOffset CreatedAt { get; set; }
+
+    public Encounter Encounter { get; set; } = null!;
+}
@@ -0,0 +1,54 @@
+using System;
+using Microsoft.EntityFrameworkCore.Migrations;
+
+#nullable disable
+
+namespace VigilCareClinicalAPI.Migrations
+{
+    /// <inheritdoc />
+    public partial class AddQsofaEvaluations : Migration
+    {
+        /// <inheritdoc />
+        protected override void Up(MigrationBuilder migrationBuilder)
+        {
+            migrationBuilder.CreateTable(
+                name: "qsofa_evaluations",
+                columns: table => new
+                {
+                    id = table.Column<Guid>(type: "uuid", nullable: false, defaultValueSql: "gen_random_uuid()"),
+                    encounter_id = table.Column<Guid>(type: "uuid", nullable: false),
+                    patient_id = table.Column<Guid>(type: "uuid", nullable: false),
+                    active_criteria = table.Column<int>(type: "integer", nullable: false),
+                    resp_rate = table.Column<decimal>(type: "numeric", nullable: true),
+                    systolic_bp = table.Column<decimal>(type: "numeric", nullable: true),
+                    avpu = table.Column<decimal>(type: "numeric", nullable: true),
+                    screen_alert_fired = table.Column<bool>(type: "boolean", nullable: false),
+                    evaluated_at = table.Column<DateTimeOffset>(type: "timestamp with time zone", nullable: false),
+                    created_at = table.Column<DateTimeOffset>(type: "timestamp with time zone", nullable: false)
+                },
+                constraints: table =>
+                {
+                    table.PrimaryKey("PK_qsofa_evaluations", x => x.id);
+                    table.CheckConstraint("chk_qsofa_evaluations_active_criteria", "active_criteria >= 0 AND active_criteria <= 3");
+                    table.ForeignKey(
+                        name: "FK_qsofa_evaluations_encounters_encounter_id",
+                        column: x => x.encounter_id,
+                        principalTable: "encounters",
+                        principalColumn: "id",
+                        onDelete: ReferentialAction.Restrict);
+                });
+
+            migrationBuilder.CreateIndex(
+                name: "IX_qsofa_evaluations_encounter_id_evaluated_at",
+                table: "qsofa_evaluations",
+                columns: new[] { "encounter_id", "evaluated_at" });
+        }
+
+        /// <inheritdoc />
+        protected override void Down(MigrationBuilder migrationBuilder)
+        {
+            migrationBuilder.DropTable(
+                name: "qsofa_evaluations");
+        }
+    }
+}
@@ -1122,6 +1122,60 @@ namespace VigilCareClinicalAPI.Migrations
                    b.ToTable("phi_access_logs", (string)null);
                });

+            modelBuilder.Entity("QsofaEvaluation", b =>
+                {
+                    b.Property<Guid>("Id")
+                        .ValueGeneratedOnAdd()
+                        .HasColumnType("uuid")
+                        .HasColumnName("id")
+                        .HasDefaultValueSql("gen_random_uuid()");
+
+                    b.Property<int>("ActiveCriteria")
+                        .HasColumnType("integer")
+                        .HasColumnName("active_criteria");
+
+                    b.Property<decimal?>("Avpu")
+                        .HasColumnType("numeric")
+                        .HasColumnName("avpu");
+
+                    b.Property<DateTimeOffset>("CreatedAt")
+                        .HasColumnType("timestamp with time zone")
+                        .HasColumnName("created_at");
+
+                    b.Property<Guid>("EncounterId")
+                        .HasColumnType("uuid")
+                        .HasColumnName("encounter_id");
+
+                    b.Property<DateTimeOffset>("EvaluatedAt")
+                        .HasColumnType("timestamp with time zone")
+                        .HasColumnName("evaluated_at");
+
+                    b.Property<Guid>("PatientId")
+                        .HasColumnType("uuid")
+                        .HasColumnName("patient_id");
+
+                    b.Property<decimal?>("RespRate")
+                        .HasColumnType("numeric")
+                        .HasColumnName("resp_rate");
+
+                    b.Property<bool>("ScreenAlertFired")
+                        .HasColumnType("boolean")
+                        .HasColumnName("screen_alert_fired");
+
+                    b.Property<decimal?>("SystolicBp")
+                        .HasColumnType("numeric")
+                        .HasColumnName("systolic_bp");
+
+                    b.HasKey("Id");
+
+                    b.HasIndex("EncounterId", "EvaluatedAt");
+
+                    b.ToTable("qsofa_evaluations", null, t =>
+                        {
+                            t.HasCheckConstraint("chk_qsofa_evaluations_active_criteria", "active_criteria >= 0 AND active_criteria <= 3");
+                        });
+                });
+
            modelBuilder.Entity("ReconciliationAlert", b =>
                {
                    b.Property<Guid>("Id")
@@ -1527,6 +1581,17 @@ namespace VigilCareClinicalAPI.Migrations
                    b.Navigation("Encounter");
                });

+            modelBuilder.Entity("QsofaEvaluation", b =>
+                {
+                    b.HasOne("Encounter", "Encounter")
+                        .WithMany()
+                        .HasForeignKey("EncounterId")
+                        .OnDelete(DeleteBehavior.Restrict)
+                        .IsRequired();
+
+                    b.Navigation("Encounter");
+                });
+
            modelBuilder.Entity("ReconciliationAlert", b =>
                {
                    b.HasOne("Encounter", "Encounter")
@@ -0,0 +1,22 @@
+using System.Text;
+using System.Text.Json;
+
+public record GcsScoreCursor(DateTimeOffset CalculatedAt, Guid Id)
+{
+    public string Encode()
+    {
+        var json = JsonSerializer.Serialize(this);
+        return Convert.ToBase64String(Encoding.UTF8.GetBytes(json));
+    }
+
+    public static GcsScoreCursor? Decode(string? encoded)
+    {
+        if (string.IsNullOrEmpty(encoded)) return null;
+        try
+        {
+            var json = Encoding.UTF8.GetString(Convert.FromBase64String(encoded));
+            return JsonSerializer.Deserialize<GcsScoreCursor>(json);
+        }
+        catch { return null; }
+    }
+}
@@ -0,0 +1,22 @@
+using System.Text;
+using System.Text.Json;
+
+public record QsofaEvaluationCursor(DateTimeOffset EvaluatedAt, Guid Id)
+{
+    public string Encode()
+    {
+        var json = JsonSerializer.Serialize(this);
+        return Convert.ToBase64String(Encoding.UTF8.GetBytes(json));
+    }
+
+    public static QsofaEvaluationCursor? Decode(string? encoded)
+    {
+        if (string.IsNullOrEmpty(encoded)) return null;
+        try
+        {
+            var json = Encoding.UTF8.GetString(Convert.FromBase64String(encoded));
+            return JsonSerializer.Deserialize<QsofaEvaluationCursor>(json);
+        }
+        catch { return null; }
+    }
+}
@@ -0,0 +1,5 @@
+public record QsofaHistoryResponse(
+    int ActiveCriteria,
+    QsofaCriteriaState Criteria,
+    bool ScreenAlertFired,
+    DateTimeOffset EvaluatedAt);
@@ -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;
 }
@@ -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,
@@ -14,4 +14,37 @@ public class GcsService : IGcsService
            .OrderByDescending(s => s.CalculatedAt)
            .FirstOrDefaultAsync();
    }
+
+    public async Task<CursorPage<GcsScore>> GetHistoryAsync(
+        Guid encounterId, int limit, string? cursorToken)
+    {
+        limit = Math.Clamp(limit, 1, 100);
+        var cursor = GcsScoreCursor.Decode(cursorToken);
+
+        var query = _db.GcsScores
+            .AsNoTracking()
+            .Where(s => s.EncounterId == encounterId);
+
+        if (cursor is not null)
+        {
+            query = query.Where(s =>
+                s.CalculatedAt < cursor.CalculatedAt ||
+                (s.CalculatedAt == cursor.CalculatedAt && s.Id.CompareTo(cursor.Id) < 0));
+        }
+
+        var items = await query
+            .OrderByDescending(s => s.CalculatedAt)
+            .ThenByDescending(s => s.Id)
+            .Take(limit + 1)
+            .ToListAsync();
+
+        var hasMore = items.Count > limit;
+        if (hasMore) items.RemoveAt(limit);
+
+        var nextCursor = hasMore
+            ? new GcsScoreCursor(items[^1].CalculatedAt, items[^1].Id).Encode()
+            : null;
+
+        return new CursorPage<GcsScore>(items, nextCursor, hasMore);
+    }
 }
@@ -1,4 +1,5 @@
 public interface IGcsService
 {
    Task<GcsScore?> GetCurrentAsync(Guid encounterId);
+    Task<CursorPage<GcsScore>> GetHistoryAsync(Guid encounterId, int limit, string? cursorToken);
 }
@@ -2,5 +2,5 @@ public interface IQsofaService
 {
    Task<QsofaCurrentResponse> GetCurrentAsync(Guid encounterId);
    Task<int> GetActiveCriteriaCountAsync(Guid encounterId);
-    Task<CursorPage<ClinicalAlert>> GetHistoryAsync(Guid encounterId, int limit, string? cursor);
+    Task<CursorPage<QsofaEvaluation>> GetHistoryAsync(Guid encounterId, int limit, string? cursor);
 }
@@ -26,28 +26,37 @@ public class QsofaService : IQsofaService
        return QsofaCalculator.CountActiveCriteria(values);
    }

-    public async Task<CursorPage<ClinicalAlert>> GetHistoryAsync(
-        Guid encounterId, int limit, string? cursor)
+    public async Task<CursorPage<QsofaEvaluation>> GetHistoryAsync(
+        Guid encounterId, int limit, string? cursorToken)
    {
        limit = Math.Clamp(limit, 1, 100);
+        var cursor = QsofaEvaluationCursor.Decode(cursorToken);

-        var query = _db.ClinicalAlerts
+        var query = _db.QsofaEvaluations
            .AsNoTracking()
-            .Where(a => a.EncounterId == encounterId
-#pragma warning disable CS0618 // Include legacy QSOFA_WARNING rows in history
-                && (a.AlertType == AlertType.QsofaScreen || a.AlertType == AlertType.QsofaWarning));
-#pragma warning restore CS0618
+            .Where(e => e.EncounterId == encounterId);
+
+        if (cursor is not null)
+        {
+            query = query.Where(e =>
+                e.EvaluatedAt < cursor.EvaluatedAt ||
+                (e.EvaluatedAt == cursor.EvaluatedAt && e.Id.CompareTo(cursor.Id) < 0));
+        }

        var items = await query
-            .OrderByDescending(a => a.TriggeredAt)
-            .ThenByDescending(a => a.Id)
+            .OrderByDescending(e => e.EvaluatedAt)
+            .ThenByDescending(e => e.Id)
            .Take(limit + 1)
            .ToListAsync();

        var hasMore = items.Count > limit;
        if (hasMore) items.RemoveAt(limit);

-        return new CursorPage<ClinicalAlert>(items, null, hasMore);
+        var nextCursor = hasMore
+            ? new QsofaEvaluationCursor(items[^1].EvaluatedAt, items[^1].Id).Encode()
+            : null;
+
+        return new CursorPage<QsofaEvaluation>(items, nextCursor, hasMore);
    }

    private async Task EnsureEncounterExistsAsync(Guid encounterId)
@@ -67,12 +76,6 @@ public class QsofaService : IQsofaService
    {
        return new QsofaCurrentResponse(
            QsofaCalculator.CountActiveCriteria(values),
-            new QsofaCriteriaState(
-                ParseOptionalDecimal(values[0]),
-                ParseOptionalDecimal(values[1]),
-                ParseOptionalDecimal(values[2])));
+            QsofaCalculator.ParseCriteriaState(values));
    }
-
-    private static decimal? ParseOptionalDecimal(RedisValue value) =>
-        value.HasValue ? decimal.Parse(value.ToString()) : null;
 }
@@ -0,0 +1,59 @@
+import { describe, it, expect, vi, beforeEach } from 'vitest'
+import { mount } from '@vue/test-utils'
+import GcsHistory from '@/components/charts/GcsHistory.vue'
+
+vi.mock('vue-chartjs', () => ({
+  Line: {
+    name: 'Line',
+    template: '<div class="mock-chart" />',
+    props: ['data', 'options'],
+  },
+}))
+
+describe('GcsHistory', () => {
+  beforeEach(() => {
+    window.matchMedia = vi.fn().mockReturnValue({ matches: false })
+  })
+
+  const history = [
+    {
+      eyeScore: 4,
+      verbalScore: 5,
+      motorScore: 6,
+      totalScore: 15,
+      classification: 'MILD',
+      calculatedAt: '2026-06-23T10:00:00Z',
+    },
+    {
+      eyeScore: 2,
+      verbalScore: 3,
+      motorScore: 3,
+      totalScore: 8,
+      classification: 'SEVERE',
+      calculatedAt: '2026-06-23T14:00:00Z',
+    },
+  ]
+
+  it('rendersTitleAndChart', () => {
+    const wrapper = mount(GcsHistory, { props: { history } })
+    expect(wrapper.text()).toContain('GCS Over Time')
+    expect(wrapper.find('.mock-chart').exists()).toBe(true)
+  })
+
+  it('sortsHistoryChronologically', () => {
+    const wrapper = mount(GcsHistory, { props: { history: [...history].reverse() } })
+    const chart = wrapper.findComponent({ name: 'Line' })
+    const totals = chart.props('data').datasets.find(d => d.label === 'GCS Total').data
+    expect(totals).toEqual([15, 8])
+  })
+
+  it('includesComponentDatasets', () => {
+    const wrapper = mount(GcsHistory, { props: { history } })
+    const chart = wrapper.findComponent({ name: 'Line' })
+    const labels = chart.props('data').datasets.map(d => d.label)
+    expect(labels).toContain('Eye')
+    expect(labels).toContain('Verbal')
+    expect(labels).toContain('Motor')
+    expect(labels).toContain('GCS Total')
+  })
+})
@@ -0,0 +1,52 @@
+import { describe, it, expect, vi, beforeEach } from 'vitest'
+import { mount } from '@vue/test-utils'
+import QsofaHistory from '@/components/charts/QsofaHistory.vue'
+
+vi.mock('vue-chartjs', () => ({
+  Line: {
+    name: 'Line',
+    template: '<div class="mock-chart" />',
+    props: ['data', 'options'],
+  },
+}))
+
+describe('QsofaHistory', () => {
+  beforeEach(() => {
+    window.matchMedia = vi.fn().mockReturnValue({ matches: false })
+  })
+
+  const history = [
+    {
+      activeCriteria: 1,
+      criteria: { respRate: 24, systolicBp: null, avpu: null },
+      screenAlertFired: false,
+      evaluatedAt: '2026-06-23T10:00:00Z',
+    },
+    {
+      activeCriteria: 2,
+      criteria: { respRate: 24, systolicBp: 95, avpu: null },
+      screenAlertFired: true,
+      evaluatedAt: '2026-06-23T14:00:00Z',
+    },
+  ]
+
+  it('rendersTitleAndChart', () => {
+    const wrapper = mount(QsofaHistory, { props: { history } })
+    expect(wrapper.text()).toContain('qSOFA Screen Over Time')
+    expect(wrapper.find('.mock-chart').exists()).toBe(true)
+  })
+
+  it('sortsHistoryChronologically', () => {
+    const wrapper = mount(QsofaHistory, { props: { history: [...history].reverse() } })
+    const chart = wrapper.findComponent({ name: 'Line' })
+    const counts = chart.props('data').datasets.find(d => d.label === 'Active criteria').data
+    expect(counts).toEqual([1, 2])
+  })
+
+  it('marksAlertFiredPoints', () => {
+    const wrapper = mount(QsofaHistory, { props: { history } })
+    const chart = wrapper.findComponent({ name: 'Line' })
+    const total = chart.props('data').datasets.find(d => d.label === 'Active criteria')
+    expect(total.pointStyle).toEqual(['circle', 'star'])
+  })
+})
@@ -0,0 +1,61 @@
+import { describe, it, expect, vi, beforeEach } from 'vitest'
+import { mount } from '@vue/test-utils'
+import SofaHistory from '@/components/charts/SofaHistory.vue'
+
+vi.mock('vue-chartjs', () => ({
+  Chart: {
+    name: 'Chart',
+    template: '<div class="mock-chart" />',
+    props: ['type', 'data', 'options'],
+  },
+}))
+
+describe('SofaHistory', () => {
+  beforeEach(() => {
+    window.matchMedia = vi.fn().mockReturnValue({ matches: false })
+  })
+  const history = [
+    {
+      totalScore: 4,
+      respiratoryScore: 1,
+      coagulationScore: 1,
+      liverScore: 0,
+      cardiovascularScore: 1,
+      cnsScore: 1,
+      renalScore: 0,
+      calculatedAt: '2026-06-23T10:00:00Z',
+    },
+    {
+      totalScore: 8,
+      respiratoryScore: 2,
+      coagulationScore: 1,
+      liverScore: 1,
+      cardiovascularScore: 2,
+      cnsScore: 1,
+      renalScore: 1,
+      calculatedAt: '2026-06-23T14:00:00Z',
+    },
+  ]
+
+  it('rendersTitleAndChart', () => {
+    const wrapper = mount(SofaHistory, { props: { history } })
+    expect(wrapper.text()).toContain('SOFA Score Over Time')
+    expect(wrapper.find('.mock-chart').exists()).toBe(true)
+  })
+
+  it('sortsHistoryChronologically', () => {
+    const wrapper = mount(SofaHistory, { props: { history: [...history].reverse() } })
+    const chart = wrapper.findComponent({ name: 'Chart' })
+    const totals = chart.props('data').datasets.find(d => d.label === 'SOFA Total').data
+    expect(totals).toEqual([4, 8])
+  })
+
+  it('includesOrganSystemDatasets', () => {
+    const wrapper = mount(SofaHistory, { props: { history } })
+    const chart = wrapper.findComponent({ name: 'Chart' })
+    const labels = chart.props('data').datasets.map(d => d.label)
+    expect(labels).toContain('Respiratory')
+    expect(labels).toContain('Renal')
+    expect(labels).toContain('SOFA Total')
+  })
+})
@@ -66,6 +66,45 @@ export async function fetchNews2History(encounterId, { limit = 100 } = {}) {
  return all
 }

+export async function fetchGcsHistory(encounterId, { limit = 100 } = {}) {
+  const all = []
+  let cursor = null
+  do {
+    const params = new URLSearchParams({ limit: String(limit) })
+    if (cursor) params.set('cursor', cursor)
+    const page = await api.get(`/api/v1/encounters/${encounterId}/gcs/history?${params}`)
+    all.push(...(page.items ?? []))
+    cursor = page.hasMore ? page.nextCursor : null
+  } while (cursor)
+  return all
+}
+
+export async function fetchQsofaHistory(encounterId, { limit = 100 } = {}) {
+  const all = []
+  let cursor = null
+  do {
+    const params = new URLSearchParams({ limit: String(limit) })
+    if (cursor) params.set('cursor', cursor)
+    const page = await api.get(`/api/v1/encounters/${encounterId}/qsofa/history?${params}`)
+    all.push(...(page.items ?? []))
+    cursor = page.hasMore ? page.nextCursor : null
+  } while (cursor)
+  return all
+}
+
+export async function fetchSofaHistory(encounterId, { limit = 100 } = {}) {
+  const all = []
+  let cursor = null
+  do {
+    const params = new URLSearchParams({ limit: String(limit) })
+    if (cursor) params.set('cursor', cursor)
+    const page = await api.get(`/api/v1/encounters/${encounterId}/sofa/history?${params}`)
+    all.push(...(page.items ?? []))
+    cursor = page.hasMore ? page.nextCursor : null
+  } while (cursor)
+  return all
+}
+
 export async function fetchMedications(encounterId, { pageSize = 50, since } = {}) {
  const all = []
  let page = 1
@@ -0,0 +1,120 @@
+<script setup>
+import { computed, shallowRef, markRaw } from 'vue'
+import { Line } from 'vue-chartjs'
+import { Chart as ChartJS, registerables } from 'chart.js'
+import { formatTime } from '@/composables/chartFormat'
+
+ChartJS.register(...registerables)
+
+const props = defineProps({ history: { type: Array, required: true } })
+
+const COMPONENT_DATASETS = [
+  { label: 'Eye', key: 'eyeScore', color: '#3b82f6' },
+  { label: 'Verbal', key: 'verbalScore', color: '#8b5cf6' },
+  { label: 'Motor', key: 'motorScore', color: '#06b6d4' },
+]
+
+function gcsRiskBorder(score) {
+  if (score <= 8) return '#dc2626'
+  if (score <= 12) return '#f59e0b'
+  return '#22c55e'
+}
+
+function gcsSeverityLabel(score) {
+  if (score <= 8) return 'Severe (3–8)'
+  if (score <= 12) return 'Moderate (9–12)'
+  return 'Mild (13–15)'
+}
+
+const sortedHistory = computed(() =>
+  [...props.history].sort((a, b) => new Date(a.calculatedAt) - new Date(b.calculatedAt)),
+)
+
+const chartData = computed(() => {
+  const sorted = sortedHistory.value
+  const labels = sorted.map(h => formatTime(h.calculatedAt))
+
+  const componentDatasets = COMPONENT_DATASETS.map(({ label, key, color }) => ({
+    label,
+    data: sorted.map(h => h[key] ?? 0),
+    borderColor: color,
+    backgroundColor: 'transparent',
+    borderWidth: 1.5,
+    borderDash: [4, 3],
+    pointRadius: 2,
+    tension: 0.2,
+    order: 2,
+  }))
+
+  return {
+    labels,
+    datasets: [
+      {
+        label: 'GCS Total',
+        data: sorted.map(h => h.totalScore),
+        borderColor: '#111827',
+        backgroundColor: sorted.map(h => {
+          if (h.totalScore <= 8) return 'rgba(220, 38, 38, 0.15)'
+          if (h.totalScore <= 12) return 'rgba(245, 158, 11, 0.15)'
+          return 'rgba(34, 197, 94, 0.15)'
+        }),
+        pointBackgroundColor: sorted.map(h => gcsRiskBorder(h.totalScore)),
+        pointBorderColor: sorted.map(h => gcsRiskBorder(h.totalScore)),
+        pointRadius: 4,
+        borderWidth: 2,
+        fill: true,
+        tension: 0.3,
+        order: 1,
+      },
+      ...componentDatasets,
+    ],
+  }
+})
+
+const chartOptions = shallowRef(markRaw({
+  responsive: true,
+  maintainAspectRatio: true,
+  animation: {
+    duration: window.matchMedia('(prefers-reduced-motion: reduce)').matches ? 0 : 400,
+  },
+  interaction: { mode: 'index', intersect: false },
+  scales: {
+    y: {
+      min: 3,
+      max: 15,
+      title: { display: true, text: 'GCS Score' },
+    },
+  },
+  plugins: {
+    legend: {
+      display: true,
+      position: 'bottom',
+      labels: { boxWidth: 12, font: { size: 11 } },
+    },
+    tooltip: {
+      callbacks: {
+        footer(items) {
+          const total = items.find(i => i.dataset.label === 'GCS Total')
+          if (!total) return ''
+          return gcsSeverityLabel(total.parsed.y)
+        },
+      },
+    },
+  },
+}))
+</script>
+
+<template>
+  <div class="w-full min-w-0 rounded-lg border border-gray-200 bg-white p-4 dark:border-gray-700 dark:bg-gray-900">
+    <h3 class="mb-1 text-sm font-medium text-gray-700 dark:text-gray-300">GCS Over Time</h3>
+    <p class="mb-4 text-xs text-gray-500 dark:text-gray-400">
+      Total score with Eye, Verbal, and Motor components.
+      <span class="text-green-600 dark:text-green-400">Mild 13–15</span>,
+      <span class="text-amber-600 dark:text-amber-400">Moderate 9–12</span>,
+      <span class="text-red-600 dark:text-red-400">Severe 3–8</span>.
+    </p>
+    <div class="aspect-video w-full min-h-0 overflow-hidden">
+      <Line :data="chartData" :options="chartOptions" />
+    </div>
+  </div>
+</template>
@@ -0,0 +1,141 @@
+<script setup>
+import { computed, shallowRef, markRaw } from 'vue'
+import { Line } from 'vue-chartjs'
+import { Chart as ChartJS, registerables } from 'chart.js'
+import { formatTime } from '@/composables/chartFormat'
+
+ChartJS.register(...registerables)
+
+const props = defineProps({ history: { type: Array, required: true } })
+
+const CRITERION_LABELS = [
+  { label: 'Resp rate', key: 'respRate', color: '#3b82f6' },
+  { label: 'Systolic BP', key: 'systolicBp', color: '#8b5cf6' },
+  { label: 'Altered mentation', key: 'avpu', color: '#ec4899' },
+]
+
+function criteriaColor(count) {
+  if (count >= 2) return '#dc2626'
+  if (count === 1) return '#f59e0b'
+  return '#22c55e'
+}
+
+function criteriaLabel(count) {
+  if (count >= 2) return 'Screen positive (≥2) — consider SOFA labs'
+  if (count === 1) return '1 criterion met'
+  return 'Screen negative'
+}
+
+function criterionMet(value) {
+  return value != null ? 1 : 0
+}
+
+const sortedHistory = computed(() =>
+  [...props.history].sort((a, b) => new Date(a.evaluatedAt) - new Date(b.evaluatedAt)),
+)
+
+const chartData = computed(() => {
+  const sorted = sortedHistory.value
+  const labels = sorted.map(h => formatTime(h.evaluatedAt))
+
+  const criterionDatasets = CRITERION_LABELS.map(({ label, key, color }) => ({
+    label,
+    data: sorted.map(h => criterionMet(h.criteria?.[key])),
+    borderColor: color,
+    backgroundColor: `${color}33`,
+    borderWidth: 1,
+    borderDash: [3, 3],
+    pointRadius: 0,
+    stepped: true,
+    yAxisID: 'criteria',
+    order: 2,
+  }))
+
+  return {
+    labels,
+    datasets: [
+      {
+        label: 'Active criteria',
+        data: sorted.map(h => h.activeCriteria),
+        borderColor: '#111827',
+        backgroundColor: sorted.map(h => {
+          if (h.activeCriteria >= 2) return 'rgba(220, 38, 38, 0.2)'
+          if (h.activeCriteria === 1) return 'rgba(245, 158, 11, 0.2)'
+          return 'rgba(34, 197, 94, 0.15)'
+        }),
+        pointBackgroundColor: sorted.map(h => criteriaColor(h.activeCriteria)),
+        pointBorderColor: sorted.map(h => criteriaColor(h.activeCriteria)),
+        pointRadius: sorted.map(h => (h.screenAlertFired ? 7 : 4)),
+        pointStyle: sorted.map(h => (h.screenAlertFired ? 'star' : 'circle')),
+        borderWidth: 2,
+        fill: true,
+        tension: 0.2,
+        yAxisID: 'count',
+        order: 1,
+      },
+      ...criterionDatasets,
+    ],
+  }
+})
+
+const chartOptions = shallowRef(markRaw({
+  responsive: true,
+  maintainAspectRatio: true,
+  animation: {
+    duration: window.matchMedia('(prefers-reduced-motion: reduce)').matches ? 0 : 400,
+  },
+  interaction: { mode: 'index', intersect: false },
+  scales: {
+    count: {
+      type: 'linear',
+      position: 'left',
+      min: 0,
+      max: 3,
+      ticks: { stepSize: 1 },
+      title: { display: true, text: 'Criteria count' },
+    },
+    criteria: {
+      type: 'linear',
+      position: 'right',
+      min: 0,
+      max: 1,
+      display: false,
+    },
+  },
+  plugins: {
+    legend: {
+      display: true,
+      position: 'bottom',
+      labels: { boxWidth: 12, font: { size: 11 } },
+    },
+    tooltip: {
+      callbacks: {
+        footer(items) {
+          const total = items.find(i => i.dataset.label === 'Active criteria')
+          if (!total) return ''
+          const idx = total.dataIndex
+          const entry = sortedHistory.value[idx]
+          const lines = [criteriaLabel(total.parsed.y)]
+          if (entry?.screenAlertFired) lines.push('qSOFA screen alert fired')
+          return lines.join(' · ')
+        },
+      },
+    },
+  },
+}))
+</script>
+
+<template>
+  <div class="w-full min-w-0 rounded-lg border border-gray-200 bg-white p-4 dark:border-gray-700 dark:bg-gray-900">
+    <h3 class="mb-1 text-sm font-medium text-gray-700 dark:text-gray-300">qSOFA Screen Over Time</h3>
+    <p class="mb-4 text-xs text-gray-500 dark:text-gray-400">
+      Criteria count (0–3); star markers indicate when a screen alert fired.
+      <span class="text-green-600 dark:text-green-400">0</span>,
+      <span class="text-amber-600 dark:text-amber-400">1</span>,
+      <span class="text-red-600 dark:text-red-400">≥2</span>.
+    </p>
+    <div class="aspect-video w-full min-h-0 overflow-hidden">
+      <Line :data="chartData" :options="chartOptions" />
+    </div>
+  </div>
+</template>
@@ -0,0 +1,121 @@
+<script setup>
+import { computed, shallowRef, markRaw } from 'vue'
+import { Chart } from 'vue-chartjs'
+import { Chart as ChartJS, registerables } from 'chart.js'
+import { formatTime } from '@/composables/chartFormat'
+
+ChartJS.register(...registerables)
+
+const props = defineProps({ history: { type: Array, required: true } })
+
+const ORGAN_DATASETS = [
+  { label: 'Respiratory', key: 'respiratoryScore', color: '#3b82f6' },
+  { label: 'Coagulation', key: 'coagulationScore', color: '#8b5cf6' },
+  { label: 'Liver', key: 'liverScore', color: '#f59e0b' },
+  { label: 'Cardiovascular', key: 'cardiovascularScore', color: '#ef4444' },
+  { label: 'CNS', key: 'cnsScore', color: '#ec4899' },
+  { label: 'Renal', key: 'renalScore', color: '#06b6d4' },
+]
+
+function sofaRiskBorder(score) {
+  if (score >= 10) return '#dc2626'
+  if (score >= 6) return '#f59e0b'
+  return '#22c55e'
+}
+
+const sortedHistory = computed(() =>
+  [...props.history].sort((a, b) => new Date(a.calculatedAt) - new Date(b.calculatedAt)),
+)
+
+const chartData = computed(() => {
+  const sorted = sortedHistory.value
+  const labels = sorted.map(h => formatTime(h.calculatedAt))
+
+  const organDatasets = ORGAN_DATASETS.map(({ label, key, color }) => ({
+    type: 'line',
+    label,
+    data: sorted.map(h => h[key] ?? 0),
+    backgroundColor: `${color}66`,
+    borderColor: color,
+    borderWidth: 1,
+    fill: true,
+    stack: 'organs',
+    pointRadius: 0,
+    tension: 0.2,
+    order: 2,
+  }))
+
+  return {
+    labels,
+    datasets: [
+      ...organDatasets,
+      {
+        type: 'line',
+        label: 'SOFA Total',
+        data: sorted.map(h => h.totalScore),
+        borderColor: '#111827',
+        backgroundColor: 'transparent',
+        pointBackgroundColor: sorted.map(h => sofaRiskBorder(h.totalScore)),
+        pointBorderColor: sorted.map(h => sofaRiskBorder(h.totalScore)),
+        pointRadius: 4,
+        borderWidth: 2,
+        fill: false,
+        tension: 0.3,
+        order: 1,
+      },
+    ],
+  }
+})
+
+const chartOptions = shallowRef(markRaw({
+  responsive: true,
+  maintainAspectRatio: true,
+  animation: {
+    duration: window.matchMedia('(prefers-reduced-motion: reduce)').matches ? 0 : 400,
+  },
+  interaction: { mode: 'index', intersect: false },
+  scales: {
+    x: { stacked: true },
+    y: {
+      stacked: true,
+      min: 0,
+      max: 24,
+      title: { display: true, text: 'SOFA Score' },
+    },
+  },
+  plugins: {
+    legend: {
+      display: true,
+      position: 'bottom',
+      labels: { boxWidth: 12, font: { size: 11 } },
+    },
+    tooltip: {
+      callbacks: {
+        footer(items) {
+          const total = items.find(i => i.dataset.label === 'SOFA Total')
+          if (!total) return ''
+          const score = total.parsed.y
+          if (score >= 10) return 'Risk: High (≥10)'
+          if (score >= 6) return 'Risk: Moderate (6–9)'
+          return 'Risk: Low (0–5)'
+        },
+      },
+    },
+  },
+}))
+</script>
+
+<template>
+  <div class="w-full min-w-0 rounded-lg border border-gray-200 bg-white p-4 dark:border-gray-700 dark:bg-gray-900">
+    <h3 class="mb-1 text-sm font-medium text-gray-700 dark:text-gray-300">SOFA Score Over Time</h3>
+    <p class="mb-4 text-xs text-gray-500 dark:text-gray-400">
+      Stacked areas show per-organ contributions; line shows total score.
+      <span class="text-green-600 dark:text-green-400">0–5</span>,
+      <span class="text-amber-600 dark:text-amber-400">6–9</span>,
+      <span class="text-red-600 dark:text-red-400">10+</span>.
+    </p>
+    <div class="aspect-video w-full min-h-0 overflow-hidden">
+      <Chart type="line" :data="chartData" :options="chartOptions" />
+    </div>
+  </div>
+</template>
@@ -16,6 +16,9 @@ import OrdersPanel from '@/components/patient/OrdersPanel.vue'
 import SepsisBundlePanel from '@/components/patient/SepsisBundlePanel.vue'
 import TrendsGrid from '@/components/charts/TrendsGrid.vue'
 import News2History from '@/components/charts/News2History.vue'
+import GcsHistory from '@/components/charts/GcsHistory.vue'
+import QsofaHistory from '@/components/charts/QsofaHistory.vue'
+import SofaHistory from '@/components/charts/SofaHistory.vue'
 import ReplayControls from '@/components/replay/ReplayControls.vue'
 import AlertReasoning from '@/components/alerts/AlertReasoning.vue'
 import Skeleton from '@/components/ui/Skeleton.vue'
@@ -47,6 +50,9 @@ const encounter = ref(null)
 const loading = ref(true)
 const observations = ref([])
 const news2History = ref([])
+const gcsHistory = ref([])
+const qsofaHistory = ref([])
+const sofaHistory = ref([])
 const medications = ref([])
 const sepsisBundle = ref(null)
 const orders = ref([])
@@ -65,10 +71,25 @@ const replayNews2History = computed(() =>
  news2History.value.filter(h => isAtOrBefore(h.calculatedAt)),
 )

+const replayGcsHistory = computed(() =>
+  gcsHistory.value.filter(h => isAtOrBefore(h.calculatedAt)),
+)
+
+const replayQsofaHistory = computed(() =>
+  qsofaHistory.value.filter(h => isAtOrBefore(h.evaluatedAt)),
+)
+
+const replaySofaHistory = computed(() =>
+  sofaHistory.value.filter(h => isAtOrBefore(h.calculatedAt)),
+)
+
 function collectScenarioTimes() {
  return [
    ...observations.value.map(o => new Date(o.recordedAt).getTime()),
    ...news2History.value.map(h => new Date(h.calculatedAt).getTime()),
+    ...gcsHistory.value.map(h => new Date(h.calculatedAt).getTime()),
+    ...qsofaHistory.value.map(h => new Date(h.evaluatedAt).getTime()),
+    ...sofaHistory.value.map(h => new Date(h.calculatedAt).getTime()),
    ...alerts.value.map(a => new Date(a.triggeredAt).getTime()),
  ].filter(Number.isFinite)
 }
@@ -88,10 +109,13 @@ async function loadAll() {
  const id = route.params.encounterId
  loading.value = true
  try {
-    const [enc, obs, history, meds, bundle, ord] = await Promise.all([
+    const [enc, obs, history, gcsHist, qsofaHist, sofaHist, meds, bundle, ord] = await Promise.all([
      encountersApi.fetchEncounter(id),
      encountersApi.fetchObservations(id),
      clinicalApi.fetchNews2History(id).catch(() => []),
+      clinicalApi.fetchGcsHistory(id).catch(() => []),
+      clinicalApi.fetchQsofaHistory(id).catch(() => []),
+      clinicalApi.fetchSofaHistory(id).catch(() => []),
      clinicalApi.fetchMedications(id).catch(() => []),
      clinicalApi.fetchSepsisBundle(id),
      clinicalApi.fetchOrders(id).catch(() => ({ items: [] })),
@@ -100,6 +124,9 @@ async function loadAll() {
    encounter.value = enc
    observations.value = obs
    news2History.value = history
+    gcsHistory.value = gcsHist
+    qsofaHistory.value = qsofaHist
+    sofaHistory.value = sofaHist
    medications.value = meds
    sepsisBundle.value = bundle
    orders.value = ord.items ?? ord
@@ -147,7 +174,7 @@ watch(openAlerts, (list) => {
  }
 })

-watch([observations, news2History, alerts], syncReplayBounds, { deep: true })
+watch([observations, news2History, gcsHistory, qsofaHistory, sofaHistory, alerts], syncReplayBounds, { deep: true })

 onBeforeUnmount(() => {
  stopPlayback()
@@ -168,7 +195,10 @@ onBeforeUnmount(() => {
    </div>

    <div class="grid min-w-0 gap-4 sm:grid-cols-2 lg:grid-cols-3">
-      <ScoresPanel />
+      <div class="space-y-4">
+        <ScoresPanel />
+        <GcsHistory v-if="replayGcsHistory.length" :history="replayGcsHistory" />
+      </div>
      <VitalsPanel :observations="replayObservations" />
      <AlertsList
        :encounter-id="route.params.encounterId"
@@ -184,7 +214,10 @@ onBeforeUnmount(() => {
    />

    <div class="grid min-w-0 gap-4 lg:grid-cols-2">
-      <SofaScorePanel :encounter-id="route.params.encounterId" />
+      <div class="space-y-4">
+        <SofaScorePanel :encounter-id="route.params.encounterId" />
+        <SofaHistory v-if="replaySofaHistory.length" :history="replaySofaHistory" />
+      </div>
      <OrdersPanel :orders="orders" />
    </div>

@@ -197,6 +230,7 @@ onBeforeUnmount(() => {
    <div id="clinical-review" class="w-full min-w-0 space-y-8">
      <TrendsGrid :observations="replayObservations" />
      <News2History v-if="replayNews2History.length" :history="replayNews2History" />
+      <QsofaHistory v-if="replayQsofaHistory.length" :history="replayQsofaHistory" />
      <ReplayControls
        :alerts="openAlerts"
        :is-paused="isPaused"