feature:

Full SOFA Score: Data Layer + Scoring Engine Glasgow Coma Scale: Data Layer + Scoring Engine
2026-06-21 01:09:50 +08:00
parent 78c043e4d3
commit 93ea473d2b
62 changed files with 7133 additions and 72 deletions
@@ -0,0 +1,160 @@
+public static class SofaCalculator
+{
+    public static readonly IReadOnlyList<string> SofaObservationCodes = new[]
+    {
+        "PAO2_MMHG", "FIO2_PCT", "PLATELET_K_UL", "BILIRUBIN_MG_DL",
+        "CREATININE_MG_DL", "URINE_OUTPUT_ML_H",
+        "SYSTOLIC_BP", "DIASTOLIC_BP", "SPO2", "SUPPLEMENTAL_O2"
+    };
+
+    public static readonly IReadOnlySet<string> SofaCodeSet =
+        new HashSet<string>(SofaObservationCodes);
+
+    public static bool IsSofaCode(string observationCode) =>
+        SofaCodeSet.Contains(observationCode);
+
+    // GCS components and gcs.scored also trigger SOFA re-score (CNS organ system)
+    public static bool TriggersRescore(string observationCode) =>
+        IsSofaCode(observationCode) || GcsCalculator.IsGcsCode(observationCode);
+
+    public static string CacheKey(Guid encounterId, string code) =>
+        $"sofa:{encounterId}:{code}";
+
+    // --- 1. Respiratory: PaO2/FiO2 ratio ---
+    public static int ScoreRespiratory(decimal? pao2, decimal? fio2, bool onMechanicalVent)
+    {
+        if (pao2 is null || fio2 is null || fio2 == 0) return 0;
+        var ratio = pao2.Value / (fio2.Value / 100m);
+        return ratio switch
+        {
+            >= 400 when onMechanicalVent     => 0,
+            >= 400                           => 0,
+            >= 300                           => 1,
+            >= 200                           => 2,
+            >= 100 when onMechanicalVent     => 3,
+            >= 100                           => 2,
+            _ when onMechanicalVent          => 4,
+            _                                => 3
+        };
+    }
+
+    // SpO2/FiO2 proxy when PaO2 unavailable (Rice et al. 2007)
+    public static int ScoreRespiratoryFromSpo2(decimal? spo2, decimal? fio2, bool onMechanicalVent)
+    {
+        if (spo2 is null || fio2 is null || fio2 == 0) return 0;
+        var sfRatio = spo2.Value / (fio2.Value / 100m);
+        return sfRatio switch
+        {
+            >= 315                           => 0,
+            >= 235                           => 1,
+            >= 150                           => 2,
+            >= 67 when onMechanicalVent      => 3,
+            >= 67                            => 2,
+            _ when onMechanicalVent          => 4,
+            _                                => 3
+        };
+    }
+
+    // --- 2. Coagulation: Platelet count (k/µL) ---
+    public static int ScoreCoagulation(decimal? platelets)
+    {
+        if (platelets is null) return 0;
+        return platelets.Value switch
+        {
+            >= 150 => 0,
+            >= 100 => 1,
+            >= 50  => 2,
+            >= 20  => 3,
+            _      => 4
+        };
+    }
+
+    // --- 3. Liver: Bilirubin (mg/dL) ---
+    public static int ScoreLiver(decimal? bilirubin)
+    {
+        if (bilirubin is null) return 0;
+        return bilirubin.Value switch
+        {
+            < 1.2m  => 0,
+            < 2.0m  => 1,
+            < 6.0m  => 2,
+            < 12.0m => 3,
+            _       => 4
+        };
+    }
+
+    // --- 4. Cardiovascular: MAP and vasopressor dose ---
+    public static int ScoreCardiovascular(decimal? map, VasopressorInfo? vasopressor)
+    {
+        if (vasopressor is not null)
+        {
+            return vasopressor.DrugName.ToUpperInvariant() switch
+            {
+                "DOPAMINE" when vasopressor.DoseUgKgMin > 15m  => 4,
+                "EPINEPHRINE" when vasopressor.DoseUgKgMin > 0.1m => 4,
+                "NOREPINEPHRINE" when vasopressor.DoseUgKgMin > 0.1m => 4,
+                "DOPAMINE" when vasopressor.DoseUgKgMin > 5m   => 3,
+                "EPINEPHRINE"                                  => 3,
+                "NOREPINEPHRINE"                               => 3,
+                "DOPAMINE"                                     => 2,
+                "DOBUTAMINE"                                   => 2,
+                _                                              => 1
+            };
+        }
+
+        if (map is null) return 0;
+        return map.Value < 70m ? 1 : 0;
+    }
+
+    // --- 5. CNS: Glasgow Coma Scale (from Phase 25) ---
+    public static int ScoreCns(int? gcsTotal) =>
+        GcsCalculator.ToSofaCnsScore(gcsTotal ?? 15);
+
+    // --- 6. Renal: Creatinine (mg/dL) or urine output (mL/day) ---
+    public static int ScoreRenal(decimal? creatinine, decimal? urineOutputMlPerDay)
+    {
+        var creatScore = creatinine switch
+        {
+            null     => 0,
+            < 1.2m   => 0,
+            < 2.0m   => 1,
+            < 3.5m   => 2,
+            < 5.0m   => 3,
+            _        => 4
+        };
+
+        var urineScore = urineOutputMlPerDay switch
+        {
+            null    => 0,
+            < 200m  => 4,
+            < 500m  => 3,
+            _       => 0
+        };
+
+        return Math.Max(creatScore, urineScore);
+    }
+
+    public static SofaResult ComputeTotal(
+        int respiratory, int coagulation, int liver,
+        int cardiovascular, int cns, int renal) =>
+        new(
+            Total: respiratory + coagulation + liver + cardiovascular + cns + renal,
+            Respiratory: respiratory,
+            Coagulation: coagulation,
+            Liver: liver,
+            Cardiovascular: cardiovascular,
+            Cns: cns,
+            Renal: renal);
+
+    // Count organ systems with component data for baseline eligibility
+    public static int CountPopulatedOrganSystems(
+        bool hasRespiratory,
+        bool hasCoagulation,
+        bool hasLiver,
+        bool hasCardiovascular,
+        bool hasCns,
+        bool hasRenal) =>
+        new[] { hasRespiratory, hasCoagulation, hasLiver,
+                hasCardiovascular, hasCns, hasRenal }
+            .Count(hasData => hasData);
+}