feature:
Full SOFA Score: Data Layer + Scoring Engine Glasgow Coma Scale: Data Layer + Scoring Engine
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voltsrage
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using FluentAssertions;
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using Microsoft.EntityFrameworkCore;
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using Microsoft.Extensions.DependencyInjection;
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using StackExchange.Redis;
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[Collection("Integration")]
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public class GcsScoringTests : IAsyncLifetime
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{
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private readonly ApiFixture _fixture;
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private Guid _encounterId;
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private Guid _patientId;
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public GcsScoringTests(ApiFixture fixture) => _fixture = fixture;
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public async Task InitializeAsync()
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{
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using var scope = _fixture.Services.CreateScope();
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var db = scope.ServiceProvider.GetRequiredService<AppDbContext>();
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await DbResetHelper.ResetAsync(db);
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var patient = new Patient
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{
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Id = Guid.NewGuid(), Mrn = "MRN-GCS-001", FirstName = "GCS", LastName = "Test",
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DateOfBirth = new DateOnly(1960, 1, 1), Gender = "M",
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CreatedAt = DateTimeOffset.UtcNow
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};
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var encounter = new Encounter
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{
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Id = Guid.NewGuid(), PatientId = patient.Id, EncounterType = EncounterType.Inpatient,
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Status = EncounterStatus.Active, Department = Department.Icu,
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AttendingPhysician = "Dr. GCS", AdmittedAt = DateTimeOffset.UtcNow,
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CreatedAt = DateTimeOffset.UtcNow
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};
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db.Patients.Add(patient);
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db.Encounters.Add(encounter);
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await db.SaveChangesAsync();
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_patientId = patient.Id;
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_encounterId = encounter.Id;
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var redis = scope.ServiceProvider.GetRequiredService<IConnectionMultiplexer>();
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var cache = redis.GetDatabase();
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foreach (var key in GcsCalculator.AllComponentKeys(_encounterId))
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await cache.KeyDeleteAsync(key);
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}
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public Task DisposeAsync() => Task.CompletedTask;
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private async Task<GcsResult> ScoreAsync(string code, decimal value)
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{
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using var scope = _fixture.Services.CreateScope();
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var detector = scope.ServiceProvider.GetRequiredService<GcsDetector>();
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return await detector.ProcessObservationAsync(_encounterId, _patientId, code, value);
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}
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[Fact]
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public async Task IngestThreeComponents_ComputesTotal()
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{
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await ScoreAsync("GCS_EYE", 4m);
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await ScoreAsync("GCS_VERBAL", 5m);
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var result = await ScoreAsync("GCS_MOTOR", 6m);
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result.Outcome.Should().Be(GcsOutcome.ScoreComputed);
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result.TotalScore.Should().Be(15);
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result.Classification.Should().Be("MILD");
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using var scope = _fixture.Services.CreateScope();
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var db = scope.ServiceProvider.GetRequiredService<AppDbContext>();
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var score = await db.GcsScores.SingleAsync();
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score.TotalScore.Should().Be(15);
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}
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[Fact]
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public async Task GcsTotal8_CreatesCriticalAlert()
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{
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await ScoreAsync("GCS_EYE", 2m);
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await ScoreAsync("GCS_VERBAL", 3m);
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var result = await ScoreAsync("GCS_MOTOR", 3m);
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result.TotalScore.Should().Be(8);
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result.AlertCreated.Should().BeTrue();
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using var scope = _fixture.Services.CreateScope();
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var db = scope.ServiceProvider.GetRequiredService<AppDbContext>();
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var alert = await db.ClinicalAlerts.SingleAsync();
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alert.AlertType.Should().Be(AlertType.GcsCritical);
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alert.Severity.Should().Be(AlertSeverity.Critical);
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alert.AlertType.IsSuppressible().Should().BeFalse();
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}
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[Fact]
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public async Task GcsTotal12_CreatesWarningAlert()
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{
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await ScoreAsync("GCS_EYE", 3m);
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await ScoreAsync("GCS_VERBAL", 4m);
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var result = await ScoreAsync("GCS_MOTOR", 5m);
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result.TotalScore.Should().Be(12);
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result.AlertCreated.Should().BeTrue();
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using var scope = _fixture.Services.CreateScope();
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var db = scope.ServiceProvider.GetRequiredService<AppDbContext>();
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var alert = await db.ClinicalAlerts.SingleAsync();
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alert.AlertType.Should().Be(AlertType.GcsWarning);
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alert.Severity.Should().Be(AlertSeverity.Warning);
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alert.AlertType.IsSuppressible().Should().BeTrue();
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}
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[Fact]
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public async Task GcsTotal15_NoAlert()
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{
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await ScoreAsync("GCS_EYE", 4m);
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await ScoreAsync("GCS_VERBAL", 5m);
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await ScoreAsync("GCS_MOTOR", 6m);
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using var scope = _fixture.Services.CreateScope();
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var db = scope.ServiceProvider.GetRequiredService<AppDbContext>();
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(await db.ClinicalAlerts.CountAsync()).Should().Be(0);
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}
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[Fact]
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public async Task PartialComponents_NoScore()
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{
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await ScoreAsync("GCS_EYE", 4m);
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await ScoreAsync("GCS_VERBAL", 5m);
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using var scope = _fixture.Services.CreateScope();
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var db = scope.ServiceProvider.GetRequiredService<AppDbContext>();
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(await db.GcsScores.CountAsync()).Should().Be(0);
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}
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[Fact]
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public async Task GcsTriggersNews2Rescore()
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{
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using var scope = _fixture.Services.CreateScope();
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var news2 = scope.ServiceProvider.GetRequiredService<News2Detector>();
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await news2.ProcessObservationAsync(_encounterId, _patientId, "RESP_RATE", 16m);
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await news2.ProcessObservationAsync(_encounterId, _patientId, "SPO2", 98m);
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await news2.ProcessObservationAsync(_encounterId, _patientId, "SYSTOLIC_BP", 120m);
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await news2.ProcessObservationAsync(_encounterId, _patientId, "HEART_RATE", 72m);
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await news2.ProcessObservationAsync(_encounterId, _patientId, "TEMP_C", 36.8m);
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await news2.ProcessObservationAsync(_encounterId, _patientId, "SUPPLEMENTAL_O2", 0m);
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await ScoreAsync("GCS_EYE", 2m);
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await ScoreAsync("GCS_VERBAL", 3m);
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await ScoreAsync("GCS_MOTOR", 4m);
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var result = await news2.ProcessObservationAsync(_encounterId, _patientId, "GCS_MOTOR", 4m);
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result.Outcome.Should().Be(News2Outcome.ScoreComputed);
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var db = scope.ServiceProvider.GetRequiredService<AppDbContext>();
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var score = await db.News2Scores.OrderByDescending(s => s.CalculatedAt).FirstAsync();
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score.ConsciousnessScore.Should().Be(3);
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}
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[Fact]
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public async Task GcsTriggersQsofaReeval()
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{
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using var scope = _fixture.Services.CreateScope();
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var qsofa = scope.ServiceProvider.GetRequiredService<QsofaDetector>();
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await qsofa.ProcessObservationAsync(_encounterId, _patientId, "RESP_RATE", 24m);
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await ScoreAsync("GCS_EYE", 2m);
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await ScoreAsync("GCS_VERBAL", 3m);
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await ScoreAsync("GCS_MOTOR", 4m);
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var redis = scope.ServiceProvider.GetRequiredService<IConnectionMultiplexer>();
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var avpuKey = QsofaCalculator.CriterionKey(_encounterId, "AVPU");
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var exists = await redis.GetDatabase().KeyExistsAsync(avpuKey);
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exists.Should().BeTrue("GCS total 9 should set altered mentation criterion");
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}
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[Fact]
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public async Task AvpuFallback_WhenNoGcs()
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{
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using var scope = _fixture.Services.CreateScope();
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var news2 = scope.ServiceProvider.GetRequiredService<News2Detector>();
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await news2.ProcessObservationAsync(_encounterId, _patientId, "RESP_RATE", 16m);
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await news2.ProcessObservationAsync(_encounterId, _patientId, "SPO2", 98m);
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await news2.ProcessObservationAsync(_encounterId, _patientId, "SYSTOLIC_BP", 120m);
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await news2.ProcessObservationAsync(_encounterId, _patientId, "HEART_RATE", 72m);
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await news2.ProcessObservationAsync(_encounterId, _patientId, "AVPU", 0m);
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await news2.ProcessObservationAsync(_encounterId, _patientId, "TEMP_C", 36.8m);
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var result = await news2.ProcessObservationAsync(
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_encounterId, _patientId, "SUPPLEMENTAL_O2", 0m);
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result.Outcome.Should().Be(News2Outcome.ScoreComputed);
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result.TotalScore.Should().Be(0);
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var db = scope.ServiceProvider.GetRequiredService<AppDbContext>();
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var score = await db.News2Scores.SingleAsync();
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score.ConsciousnessScore.Should().Be(0);
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}
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}
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