feature:
Full SOFA Score: Data Layer + Scoring Engine Glasgow Coma Scale: Data Layer + Scoring Engine
This commit is contained in:
voltsrage
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using StackExchange.Redis;
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public static class GcsCalculator
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{
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public static readonly IReadOnlyList<string> ComponentCodes = new[]
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{
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"GCS_EYE", "GCS_VERBAL", "GCS_MOTOR"
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};
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public static readonly IReadOnlySet<string> ComponentCodeSet =
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new HashSet<string>(ComponentCodes);
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public static bool IsGcsCode(string observationCode) =>
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ComponentCodeSet.Contains(observationCode);
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public static RedisKey[] AllComponentKeys(Guid encounterId) =>
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ComponentCodes
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.Select(code => (RedisKey)$"gcs:{encounterId}:{code}")
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.ToArray();
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public static string ComponentKey(Guid encounterId, string code) =>
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$"gcs:{encounterId}:{code}";
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// Compute total from three components. Returns null if any component missing.
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public static int? ComputeTotal(decimal? eye, decimal? verbal, decimal? motor)
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{
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if (eye is null || verbal is null || motor is null)
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return null;
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return (int)(eye.Value + verbal.Value + motor.Value);
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}
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// GCS severity classification
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public static string ClassifyGcs(int total) => total switch
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{
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<= 8 => "SEVERE", // Coma
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<= 12 => "MODERATE",
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_ => "MILD" // 13-15
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};
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// Map GCS total to NEWS2 consciousness score (replaces AVPU mapping)
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public static int ToNews2ConsciousnessScore(int gcsTotal) => gcsTotal switch
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{
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15 => 0, // Fully alert — equivalent to AVPU=Alert
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_ => 3 // Any deficit — equivalent to AVPU=Voice/Pain/Unresponsive
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};
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// Map GCS total to qSOFA altered mentation criterion
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public static bool MeetsQsofaAlteredMentation(int gcsTotal) =>
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gcsTotal < 15;
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// Map GCS total to SOFA CNS score (used in Phase 26)
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public static int ToSofaCnsScore(int gcsTotal) => gcsTotal switch
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{
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15 => 0,
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>= 13 => 1, // 13-14
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>= 10 => 2, // 10-12
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>= 6 => 3, // 6-9
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_ => 4 // < 6
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};
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}
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@@ -0,0 +1,235 @@
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using System.Globalization;
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using System.Text.Json;
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using Microsoft.EntityFrameworkCore;
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using StackExchange.Redis;
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public class GcsDetector
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{
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private const int GcsTtlSeconds = 14400; // 4 hours — same as NEWS2
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private readonly IConnectionMultiplexer _redis;
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private readonly IServiceProvider _services;
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private readonly ClinicalMetrics _metrics;
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private readonly ILogger<GcsDetector> _logger;
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public GcsDetector(
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IConnectionMultiplexer redis,
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IServiceProvider services,
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ClinicalMetrics metrics,
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ILogger<GcsDetector> logger)
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{
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_redis = redis;
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_services = services;
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_metrics = metrics;
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_logger = logger;
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}
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public async Task<GcsResult> 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 (!GcsCalculator.IsGcsCode(observationCode))
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return GcsResult.NotGcsCode;
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var cache = _redis.GetDatabase();
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await cache.StringSetAsync(
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GcsCalculator.ComponentKey(encounterId, observationCode),
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value.ToString(CultureInfo.InvariantCulture),
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TimeSpan.FromSeconds(GcsTtlSeconds));
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var allKeys = GcsCalculator.AllComponentKeys(encounterId);
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var allValues = await cache.StringGetAsync(allKeys);
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if (allValues.Any(v => !v.HasValue))
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{
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var present = allValues.Count(v => v.HasValue);
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_logger.LogDebug(
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"GCS incomplete for encounter {Id}: {Present}/3 components present",
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encounterId, present);
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return GcsResult.IncompleteComponents(present);
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}
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var eye = decimal.Parse(allValues[0]!, CultureInfo.InvariantCulture);
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var verbal = decimal.Parse(allValues[1]!, CultureInfo.InvariantCulture);
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var motor = decimal.Parse(allValues[2]!, CultureInfo.InvariantCulture);
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var total = GcsCalculator.ComputeTotal(eye, verbal, motor)!.Value;
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var classification = GcsCalculator.ClassifyGcs(total);
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var calculatedAt = DateTimeOffset.UtcNow;
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await PersistScoreAsync(
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encounterId, patientId, (int)eye, (int)verbal, (int)motor,
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total, classification, calculatedAt, ct);
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var alertCreated = false;
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if (total <= 8)
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{
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alertCreated = await TryCreateAlertAsync(
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encounterId, patientId, AlertType.GcsCritical, AlertSeverity.Critical,
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eye, verbal, motor, total, classification, ct);
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}
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else if (total <= 12)
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{
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alertCreated = await TryCreateAlertAsync(
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encounterId, patientId, AlertType.GcsWarning, AlertSeverity.Warning,
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eye, verbal, motor, total, classification, ct);
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}
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await PublishScoredEventAsync(
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encounterId, patientId, eye, verbal, motor, total, classification, calculatedAt, ct);
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// Re-evaluate qSOFA altered mentation from the computed GCS total (Step 6)
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using (var scope = _services.CreateScope())
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{
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var qsofa = scope.ServiceProvider.GetRequiredService<QsofaDetector>();
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await qsofa.SyncAlteredMentationAsync(encounterId, patientId, ct);
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}
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_metrics.GcsScoresTotal.WithLabels(classification).Inc();
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_logger.LogInformation(
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"GCS score {Total} ({Classification}) for encounter {Id} — E={Eye} V={Verbal} M={Motor}",
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total, classification, encounterId, eye, verbal, motor);
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return new GcsResult(GcsOutcome.ScoreComputed, total, classification, alertCreated, 3);
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}
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private async Task PersistScoreAsync(
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Guid encounterId, Guid patientId,
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int eye, int verbal, int motor,
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int total, string classification,
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DateTimeOffset calculatedAt,
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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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db.GcsScores.Add(new GcsScore
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{
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Id = Guid.NewGuid(),
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EncounterId = encounterId,
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PatientId = patientId,
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EyeScore = eye,
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VerbalScore = verbal,
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MotorScore = motor,
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TotalScore = total,
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Classification = classification,
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CalculatedAt = calculatedAt,
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CreatedAt = DateTimeOffset.UtcNow
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});
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await db.SaveChangesAsync(ct);
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}
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private async Task<bool> TryCreateAlertAsync(
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Guid encounterId, Guid patientId,
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AlertType alertType, AlertSeverity severity,
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decimal eye, decimal verbal, decimal motor,
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int total, string classification,
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CancellationToken ct)
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{
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if (alertType == AlertType.GcsWarning)
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{
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var suppression = _services.GetRequiredService<IAlertSuppressionService>();
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if (await suppression.IsSuppressedAsync(encounterId, alertType, ct))
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{
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_logger.LogDebug("GCS_WARNING suppressed for encounter {Id}", encounterId);
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return false;
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}
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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 =
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$"GCS total {total} ({classification}): E={eye}, V={verbal}, M={motor}.";
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var affected = await db.Database.ExecuteSqlInterpolatedAsync($"""
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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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if (affected == 0)
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{
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await tx.RollbackAsync(ct);
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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.ToDbString(),
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severity = severity.ToDbString(),
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details,
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triggeredAt,
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gcsTotal = total,
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gcsClassification = classification,
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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.ClinicalAlertsTotal
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.WithLabels(alertType.ToDbString(), severity.ToDbString()).Inc();
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return true;
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}
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private async Task PublishScoredEventAsync(
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Guid encounterId, Guid patientId,
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decimal eye, decimal verbal, decimal motor,
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int total, string classification,
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DateTimeOffset calculatedAt,
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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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db.OutboxEvents.Add(new OutboxEvent
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{
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Id = Guid.NewGuid(),
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Topic = "gcs.scored",
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Payload = JsonSerializer.Serialize(new
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{
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encounterId,
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patientId,
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eyeScore = (int)eye,
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verbalScore = (int)verbal,
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motorScore = (int)motor,
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totalScore = total,
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classification,
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calculatedAt,
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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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}
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}
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