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 SofaScoringTests : 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 SofaScoringTests(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-SOFA-001", FirstName = "SOFA", 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. SOFA", 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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}
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public Task DisposeAsync() => Task.CompletedTask;
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private async Task<SofaScoringResult> ScoreObsAsync(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<SofaDetector>();
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return await detector.ProcessObservationAsync(
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_encounterId, _patientId, code, value, DateTimeOffset.UtcNow);
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}
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[Fact]
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public async Task RespiratoryScore_PaO2FiO2Ratio()
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{
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await ScoreObsAsync("FIO2_PCT", 40m);
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var result = await ScoreObsAsync("PAO2_MMHG", 80m);
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result.Score!.Respiratory.Should().Be(2);
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}
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[Fact]
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public async Task RespiratoryScore_SpO2Fallback()
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{
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await ScoreObsAsync("FIO2_PCT", 40m);
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await ScoreObsAsync("SPO2", 94m);
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var result = await ScoreObsAsync("PLATELET_K_UL", 180m);
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result.Score!.Respiratory.Should().Be(1);
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}
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[Fact]
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public async Task CoagulationScore_LowPlatelets()
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{
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var result = await ScoreObsAsync("PLATELET_K_UL", 45m);
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result.Score!.Coagulation.Should().Be(3);
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}
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[Fact]
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public async Task LiverScore_ElevatedBilirubin()
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{
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var result = await ScoreObsAsync("BILIRUBIN_MG_DL", 3.5m);
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result.Score!.Liver.Should().Be(2);
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}
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[Fact]
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public async Task CardiovascularScore_LowMAP()
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{
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await ScoreObsAsync("SYSTOLIC_BP", 85m);
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var result = await ScoreObsAsync("DIASTOLIC_BP", 50m);
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result.Score!.Cardiovascular.Should().Be(1);
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}
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[Fact]
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public async Task CardiovascularScore_Vasopressor()
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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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var resolver = scope.ServiceProvider.GetRequiredService<SofaVasopressorResolver>();
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var detector = scope.ServiceProvider.GetRequiredService<SofaDetector>();
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var med = new MedicationAdministration
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{
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Id = Guid.NewGuid(),
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EncounterId = _encounterId,
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DrugName = "NOREPINEPHRINE",
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Dose = 0.05m,
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DoseUnit = "mcg/kg/min",
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Route = "IV",
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AdministeredAt = DateTimeOffset.UtcNow,
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AdministeredBy = "RN Test"
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};
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db.MedicationAdministrations.Add(med);
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await db.SaveChangesAsync();
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await resolver.CacheFromAdministrationAsync(med, CancellationToken.None);
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var result = await detector.ProcessObservationAsync(
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_encounterId, _patientId, "SYSTOLIC_BP", 120m, DateTimeOffset.UtcNow);
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result.Score!.Cardiovascular.Should().BeGreaterThanOrEqualTo(2);
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}
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[Fact]
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public async Task CnsScore_FromGcs()
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{
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using var scope = _fixture.Services.CreateScope();
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var gcs = scope.ServiceProvider.GetRequiredService<GcsDetector>();
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await gcs.ProcessObservationAsync(_encounterId, _patientId, "GCS_EYE", 2m);
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await gcs.ProcessObservationAsync(_encounterId, _patientId, "GCS_VERBAL", 3m);
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await gcs.ProcessObservationAsync(_encounterId, _patientId, "GCS_MOTOR", 4m);
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var sofa = scope.ServiceProvider.GetRequiredService<SofaDetector>();
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var result = await sofa.ProcessGcsScoredAsync(_encounterId, _patientId);
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result.Score!.Cns.Should().Be(3);
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}
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[Fact]
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public async Task RenalScore_ElevatedCreatinine()
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{
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var result = await ScoreObsAsync("CREATININE_MG_DL", 4.0m);
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result.Score!.Renal.Should().Be(3);
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}
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[Fact]
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public async Task BaselineEstablished_OnFirstCompleteScore()
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{
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await SeedBaselineInputsAsync();
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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 baseline = await db.SofaScores.FirstAsync(s => s.IsBaseline);
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baseline.IsBaseline.Should().BeTrue();
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}
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[Fact]
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public async Task DeltaTwo_CreatesSofaSepsisAlert()
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{
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await SeedBaselineInputsAsync(totalOffset: 0);
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await ScoreObsAsync("PLATELET_K_UL", 20m);
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await ScoreObsAsync("CREATININE_MG_DL", 4.5m);
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using var scope = _fixture.Services.CreateScope();
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var db = scope.ServiceProvider.GetRequiredService<AppDbContext>();
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var alert = await db.ClinicalAlerts.SingleAsync(a => a.AlertType == AlertType.SofaSepsis);
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alert.Severity.Should().Be(AlertSeverity.Critical);
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}
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[Fact]
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public async Task DeltaOne_CreatesWarning()
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{
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await SeedBaselineInputsAsync(totalOffset: 0);
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await ScoreObsAsync("PLATELET_K_UL", 120m);
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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(a => a.AlertType == AlertType.SofaWarning);
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alert.Severity.Should().Be(AlertSeverity.Warning);
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}
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[Fact]
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public async Task NoDelta_NoAlert()
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{
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await SeedBaselineInputsAsync();
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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 CarryForward_WithinWindow()
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{
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using var scope = _fixture.Services.CreateScope();
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var cache = scope.ServiceProvider.GetRequiredService<SofaLabCache>();
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await cache.StoreAsync(_encounterId, "PLATELET_K_UL", 180m,
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DateTimeOffset.UtcNow.AddHours(-8));
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var result = await ScoreObsAsync("FIO2_PCT", 40m);
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result.Score!.Coagulation.Should().Be(0);
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}
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private async Task SeedBaselineInputsAsync(int totalOffset = 0)
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{
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await ScoreObsAsync("PAO2_MMHG", 100m);
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await ScoreObsAsync("FIO2_PCT", 40m);
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await ScoreObsAsync("PLATELET_K_UL", 180m - totalOffset);
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await ScoreObsAsync("BILIRUBIN_MG_DL", 1.0m);
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await ScoreObsAsync("SYSTOLIC_BP", 120m);
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await ScoreObsAsync("DIASTOLIC_BP", 80m);
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await ScoreObsAsync("CREATININE_MG_DL", 1.0m);
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await ScoreObsAsync("URINE_OUTPUT_ML_H", 50m);
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}
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}
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