feature: Sepsis Engine Refactor: Remove SIRS, Rewire qSOFA + Bundle
Frontend: GCS Entry, SOFA Display, Sepsis UI Refactor
This commit is contained in:
voltsrage
@@ -0,0 +1,19 @@
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using FluentAssertions;
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public class AlertCreationGuardTests
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{
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[Fact]
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public void CannotCreateNewSepsisWarning()
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{
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var act = () => AlertCreationGuard.EnsureAllowed(AlertType.SepsisWarning);
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act.Should().Throw<InvalidOperationException>()
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.WithMessage("*deprecated*");
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}
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[Fact]
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public void AllowsSofaSepsis()
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{
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var act = () => AlertCreationGuard.EnsureAllowed(AlertType.SofaSepsis);
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act.Should().NotThrow();
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}
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}
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@@ -15,7 +15,7 @@ public class ObservabilityPhase8Tests
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"alerts_unacknowledged_gauge",
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"kafka_consumer_lag",
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"outbox_pending_events",
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"sirs_detections_total",
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"qsofa_detections_total",
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"escalations_total",
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};
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@@ -80,12 +80,12 @@ public class QsofaDetectorTests : IAsyncLifetime
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r2.Outcome.Should().Be(QsofaOutcome.AlertCreated);
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var alert = await db.ClinicalAlerts.SingleAsync();
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alert.AlertType.Should().Be(AlertType.QsofaWarning);
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alert.Severity.Should().Be(AlertSeverity.Critical);
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alert.AlertType.Should().Be(AlertType.QsofaScreen);
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alert.Severity.Should().Be(AlertSeverity.Warning);
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alert.Status.Should().Be(AlertStatus.Open);
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alert.EncounterId.Should().Be(_encounterId);
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alert.PatientId.Should().Be(_patientId);
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alert.Details.Should().Contain("qSOFA score 2/3");
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alert.Details.Should().Contain("order SOFA labs");
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var outbox = await db.OutboxEvents.SingleAsync(e => e.Topic == "alert.generated");
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outbox.PartitionKey.Should().Be(_encounterId.ToString());
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@@ -138,7 +138,7 @@ public class QsofaDetectorTests : IAsyncLifetime
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r3.Outcome.Should().Be(QsofaOutcome.AlertAlreadyOpen);
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var alertCount = await db.ClinicalAlerts.CountAsync();
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alertCount.Should().Be(1, "WHERE NOT EXISTS prevents duplicate QSOFA_WARNING while one is open");
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alertCount.Should().Be(1, "WHERE NOT EXISTS prevents duplicate QSOFA_SCREEN while one is open");
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var outboxCount = await db.OutboxEvents.CountAsync(e => e.Topic == "alert.generated");
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outboxCount.Should().Be(1, "outbox event must be written exactly once");
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@@ -43,28 +43,47 @@ public class SepsisBundleTests : IAsyncLifetime
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var cache = redis.GetDatabase();
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foreach (var key in QsofaCalculator.AllCriterionKeys(_encounterId))
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await cache.KeyDeleteAsync(key);
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foreach (var key in SirsEvaluator.AllCriterionKeys(_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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[Fact]
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public async Task QsofaAlert_CreatesBundleWithFourOrders()
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private async Task CreateSofaSepsisBundleAsync(IServiceScope scope)
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{
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using var scope = _fixture.Services.CreateScope();
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var detector = scope.ServiceProvider.GetRequiredService<QsofaDetector>();
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var handler = scope.ServiceProvider.GetRequiredService<SepsisAlertHandler>();
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var db = scope.ServiceProvider.GetRequiredService<AppDbContext>();
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await detector.ProcessObservationAsync(_encounterId, _patientId, "RESP_RATE", 24m);
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await detector.ProcessObservationAsync(_encounterId, _patientId, "SYSTOLIC_BP", 95m);
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var alertId = Guid.NewGuid();
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db.ClinicalAlerts.Add(new ClinicalAlert
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{
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Id = alertId,
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EncounterId = _encounterId,
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PatientId = _patientId,
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AlertType = AlertType.SofaSepsis,
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Severity = AlertSeverity.Critical,
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Details = "SOFA delta +2",
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Status = AlertStatus.Open,
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TriggeredAt = DateTimeOffset.UtcNow
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});
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await db.SaveChangesAsync();
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await handler.OnSepsisAlertCreatedAsync(
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_encounterId, alertId, AlertType.SofaSepsis, CancellationToken.None);
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}
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[Fact]
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public async Task SofaSepsisAlert_CreatesBundleWithFourOrders()
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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 CreateSofaSepsisBundleAsync(scope);
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var bundle = await db.SepsisBundles
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.Include(b => b.Elements)
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.SingleAsync(b => b.EncounterId == _encounterId);
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bundle.ComplianceStatus.Should().Be(SepsisBundleComplianceStatus.InProgress);
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bundle.TriggeringAlertType.Should().Be("QSOFA_WARNING");
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bundle.TriggeringAlertType.Should().Be("SOFA_SEPSIS");
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bundle.DeadlineAt.Should().BeCloseTo(bundle.RecognizedAt.AddHours(1), TimeSpan.FromSeconds(5));
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bundle.Elements.Should().HaveCount(4);
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@@ -86,40 +105,45 @@ public class SepsisBundleTests : IAsyncLifetime
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}
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[Fact]
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public async Task SirsAlert_CreatesBundle()
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public async Task QsofaScreen_DoesNotTriggerBundle()
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{
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using var scope = _fixture.Services.CreateScope();
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var detector = scope.ServiceProvider.GetRequiredService<SirsDetector>();
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var detector = scope.ServiceProvider.GetRequiredService<QsofaDetector>();
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var db = scope.ServiceProvider.GetRequiredService<AppDbContext>();
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await detector.ProcessObservationAsync(_encounterId, _patientId, "HEART_RATE", 95m);
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await detector.ProcessObservationAsync(_encounterId, _patientId, "TEMP_C", 38.5m);
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await detector.ProcessObservationAsync(_encounterId, _patientId, "RESP_RATE", 24m);
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await detector.ProcessObservationAsync(_encounterId, _patientId, "SYSTOLIC_BP", 95m);
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var bundle = await db.SepsisBundles
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.Include(b => b.Elements)
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.SingleAsync(b => b.EncounterId == _encounterId);
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bundle.TriggeringAlertType.Should().Be("SEPSIS_WARNING");
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bundle.ComplianceStatus.Should().Be(SepsisBundleComplianceStatus.InProgress);
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bundle.Elements.Should().HaveCount(4);
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(await db.SepsisBundles.CountAsync()).Should().Be(0);
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}
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[Fact]
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public async Task SecondAlert_IdempotentBundle()
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{
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using var scope = _fixture.Services.CreateScope();
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var qsofaDetector = scope.ServiceProvider.GetRequiredService<QsofaDetector>();
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var sirsDetector = scope.ServiceProvider.GetRequiredService<SirsDetector>();
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var handler = scope.ServiceProvider.GetRequiredService<SepsisAlertHandler>();
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var db = scope.ServiceProvider.GetRequiredService<AppDbContext>();
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await qsofaDetector.ProcessObservationAsync(_encounterId, _patientId, "RESP_RATE", 24m);
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await qsofaDetector.ProcessObservationAsync(_encounterId, _patientId, "SYSTOLIC_BP", 95m);
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await CreateSofaSepsisBundleAsync(scope);
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var bundleCountAfterFirst = await db.SepsisBundles.CountAsync(b => b.EncounterId == _encounterId);
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bundleCountAfterFirst.Should().Be(1);
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await sirsDetector.ProcessObservationAsync(_encounterId, _patientId, "HEART_RATE", 95m);
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await sirsDetector.ProcessObservationAsync(_encounterId, _patientId, "TEMP_C", 38.5m);
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var secondAlertId = Guid.NewGuid();
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db.ClinicalAlerts.Add(new ClinicalAlert
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{
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Id = secondAlertId,
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EncounterId = _encounterId,
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PatientId = _patientId,
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AlertType = AlertType.SofaSepsis,
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Severity = AlertSeverity.Critical,
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Details = "SOFA delta +3",
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Status = AlertStatus.Open,
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TriggeredAt = DateTimeOffset.UtcNow
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});
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await db.SaveChangesAsync();
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await handler.OnSepsisAlertCreatedAsync(
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_encounterId, secondAlertId, AlertType.SofaSepsis, CancellationToken.None);
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var bundleCount = await db.SepsisBundles.CountAsync(b => b.EncounterId == _encounterId);
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bundleCount.Should().Be(1, "a second bundle must not be created while one is IN_PROGRESS");
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@@ -132,12 +156,10 @@ public class SepsisBundleTests : IAsyncLifetime
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public async Task OrderResulted_CompletesElement()
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{
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using var scope = _fixture.Services.CreateScope();
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var detector = scope.ServiceProvider.GetRequiredService<QsofaDetector>();
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var bundleService = scope.ServiceProvider.GetRequiredService<ISepsisBundleService>();
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var db = scope.ServiceProvider.GetRequiredService<AppDbContext>();
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await detector.ProcessObservationAsync(_encounterId, _patientId, "RESP_RATE", 24m);
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await detector.ProcessObservationAsync(_encounterId, _patientId, "SYSTOLIC_BP", 95m);
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await CreateSofaSepsisBundleAsync(scope);
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var lactateElement = await db.SepsisBundleElements
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.Include(e => e.Order)
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@@ -161,12 +183,10 @@ public class SepsisBundleTests : IAsyncLifetime
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public async Task AllElementsResulted_BundleCompliant()
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{
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using var scope = _fixture.Services.CreateScope();
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var detector = scope.ServiceProvider.GetRequiredService<QsofaDetector>();
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var bundleService = scope.ServiceProvider.GetRequiredService<ISepsisBundleService>();
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var db = scope.ServiceProvider.GetRequiredService<AppDbContext>();
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await detector.ProcessObservationAsync(_encounterId, _patientId, "RESP_RATE", 24m);
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await detector.ProcessObservationAsync(_encounterId, _patientId, "SYSTOLIC_BP", 95m);
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await CreateSofaSepsisBundleAsync(scope);
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var elements = await db.SepsisBundleElements.ToListAsync();
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foreach (var element in elements)
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@@ -188,12 +208,10 @@ public class SepsisBundleTests : IAsyncLifetime
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public async Task DeadlinePassed_CompletionMarksNonCompliant()
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{
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using var scope = _fixture.Services.CreateScope();
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var detector = scope.ServiceProvider.GetRequiredService<QsofaDetector>();
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var bundleService = scope.ServiceProvider.GetRequiredService<ISepsisBundleService>();
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var db = scope.ServiceProvider.GetRequiredService<AppDbContext>();
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await detector.ProcessObservationAsync(_encounterId, _patientId, "RESP_RATE", 24m);
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await detector.ProcessObservationAsync(_encounterId, _patientId, "SYSTOLIC_BP", 95m);
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await CreateSofaSepsisBundleAsync(scope);
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var bundle = await db.SepsisBundles.SingleAsync();
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bundle.DeadlineAt = DateTimeOffset.UtcNow.AddHours(-1);
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@@ -212,11 +230,9 @@ public class SepsisBundleTests : IAsyncLifetime
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public async Task DeadlinePassed_MonitorMarksNonCompliant()
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{
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using var scope = _fixture.Services.CreateScope();
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var detector = scope.ServiceProvider.GetRequiredService<QsofaDetector>();
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var db = scope.ServiceProvider.GetRequiredService<AppDbContext>();
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await detector.ProcessObservationAsync(_encounterId, _patientId, "RESP_RATE", 24m);
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await detector.ProcessObservationAsync(_encounterId, _patientId, "SYSTOLIC_BP", 95m);
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await CreateSofaSepsisBundleAsync(scope);
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var bundle = await db.SepsisBundles.SingleAsync();
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bundle.DeadlineAt = DateTimeOffset.UtcNow.AddHours(-1);
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@@ -0,0 +1,191 @@
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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 Microsoft.Extensions.Logging;
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[Collection("Integration")]
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public class SepsisRefactorTests : 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 SepsisRefactorTests(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-REFACTOR-001", FirstName = "Refactor", 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. Refactor", 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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[Fact]
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public async Task SirsObservations_NoSepsisWarningAlert()
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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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var db = scope.ServiceProvider.GetRequiredService<AppDbContext>();
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await qsofa.ProcessObservationAsync(_encounterId, _patientId, "TEMP_C", 39m);
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await qsofa.ProcessObservationAsync(_encounterId, _patientId, "HEART_RATE", 110m);
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await qsofa.ProcessObservationAsync(_encounterId, _patientId, "RESP_RATE", 22m);
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await qsofa.ProcessObservationAsync(_encounterId, _patientId, "WBC_K_UL", 15m);
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(await db.ClinicalAlerts.CountAsync(a => a.AlertType == AlertType.SepsisWarning))
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.Should().Be(0);
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}
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[Fact]
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public async Task SofaDelta2_TriggersSepsisBundleCreation()
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{
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using var scope = _fixture.Services.CreateScope();
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var handler = scope.ServiceProvider.GetRequiredService<SepsisAlertHandler>();
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var db = scope.ServiceProvider.GetRequiredService<AppDbContext>();
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var alertId = Guid.NewGuid();
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db.ClinicalAlerts.Add(new ClinicalAlert
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{
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Id = alertId, EncounterId = _encounterId, PatientId = _patientId,
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AlertType = AlertType.SofaSepsis, Severity = AlertSeverity.Critical,
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Details = "SOFA delta +2", Status = AlertStatus.Open,
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TriggeredAt = DateTimeOffset.UtcNow
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});
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await db.SaveChangesAsync();
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await handler.OnSepsisAlertCreatedAsync(
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_encounterId, alertId, AlertType.SofaSepsis, CancellationToken.None);
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(await db.SepsisBundles.CountAsync()).Should().Be(1);
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}
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[Fact]
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public async Task QsofaScreen_DoesNotTriggerBundle()
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{
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using var scope = _fixture.Services.CreateScope();
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var detector = scope.ServiceProvider.GetRequiredService<QsofaDetector>();
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var db = scope.ServiceProvider.GetRequiredService<AppDbContext>();
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await detector.ProcessObservationAsync(_encounterId, _patientId, "RESP_RATE", 24m);
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await detector.ProcessObservationAsync(_encounterId, _patientId, "SYSTOLIC_BP", 95m);
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(await db.SepsisBundles.CountAsync()).Should().Be(0);
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}
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[Fact]
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public async Task QsofaScreen_IsWarningNotCritical()
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{
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using var scope = _fixture.Services.CreateScope();
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var detector = scope.ServiceProvider.GetRequiredService<QsofaDetector>();
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var db = scope.ServiceProvider.GetRequiredService<AppDbContext>();
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await detector.ProcessObservationAsync(_encounterId, _patientId, "RESP_RATE", 24m);
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await detector.ProcessObservationAsync(_encounterId, _patientId, "SYSTOLIC_BP", 95m);
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var alert = await db.ClinicalAlerts.SingleAsync();
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alert.AlertType.Should().Be(AlertType.QsofaScreen);
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alert.Severity.Should().Be(AlertSeverity.Warning);
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}
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[Fact]
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public void QsofaScreen_IsSuppressible()
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{
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AlertType.QsofaScreen.IsSuppressible().Should().BeTrue();
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}
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[Fact]
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public async Task LegacySepsisWarning_StillQueryable()
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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 alertService = scope.ServiceProvider.GetRequiredService<IAlertService>();
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db.ClinicalAlerts.Add(new ClinicalAlert
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{
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Id = Guid.NewGuid(), EncounterId = _encounterId, PatientId = _patientId,
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AlertType = AlertType.SepsisWarning, Severity = AlertSeverity.Critical,
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Details = "Legacy SIRS alert", Status = AlertStatus.Resolved,
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TriggeredAt = DateTimeOffset.UtcNow.AddDays(-1)
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});
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await db.SaveChangesAsync();
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var page = await alertService.ListByEncounterAsync(_encounterId, null, 1, 10);
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page.Items.Should().ContainSingle(a => a.AlertType == AlertType.SepsisWarning);
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}
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[Fact]
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public void CannotCreateNewSepsisWarning()
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{
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var act = () => AlertCreationGuard.EnsureAllowed(AlertType.SepsisWarning);
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act.Should().Throw<InvalidOperationException>()
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.WithMessage("*deprecated*");
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}
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[Fact]
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public async Task SepsisBundleCompliance_StillTracked()
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{
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using var scope = _fixture.Services.CreateScope();
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var handler = scope.ServiceProvider.GetRequiredService<SepsisAlertHandler>();
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var db = scope.ServiceProvider.GetRequiredService<AppDbContext>();
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var alertId = Guid.NewGuid();
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db.ClinicalAlerts.Add(new ClinicalAlert
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{
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Id = alertId, EncounterId = _encounterId, PatientId = _patientId,
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AlertType = AlertType.SofaSepsis, Severity = AlertSeverity.Critical,
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Details = "SOFA delta +2", Status = AlertStatus.Open,
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TriggeredAt = DateTimeOffset.UtcNow
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});
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await db.SaveChangesAsync();
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await handler.OnSepsisAlertCreatedAsync(
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_encounterId, alertId, AlertType.SofaSepsis, CancellationToken.None);
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var bundle = await db.SepsisBundles.SingleAsync();
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bundle.DeadlineAt = DateTimeOffset.UtcNow.AddHours(-1);
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await db.SaveChangesAsync();
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var monitor = new SepsisBundleMonitorService(
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_fixture.Services,
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_fixture.Services.GetRequiredService<ClinicalMetrics>(),
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_fixture.Services.GetRequiredService<ILogger<SepsisBundleMonitorService>>());
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await monitor.ScanOverdueBundlesAsync(CancellationToken.None);
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var updated = await db.SepsisBundles.AsNoTracking().SingleAsync();
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updated.ComplianceStatus.Should().Be(SepsisBundleComplianceStatus.NonCompliant);
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}
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[Fact]
|
||||
public async Task QsofaScreen_IncludesLabRecommendation()
|
||||
{
|
||||
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 alert = await db.ClinicalAlerts.SingleAsync();
|
||||
alert.Details.Should().Contain("order SOFA labs");
|
||||
}
|
||||
}
|
||||
@@ -1,213 +0,0 @@
|
||||
using FluentAssertions;
|
||||
using Microsoft.EntityFrameworkCore;
|
||||
using Microsoft.Extensions.DependencyInjection;
|
||||
using StackExchange.Redis;
|
||||
|
||||
[Collection("Integration")]
|
||||
public class SirsDetectorTests : IAsyncLifetime
|
||||
{
|
||||
private readonly ApiFixture _fixture;
|
||||
private Guid _encounterId;
|
||||
private Guid _patientId;
|
||||
|
||||
public SirsDetectorTests(ApiFixture fixture) => _fixture = fixture;
|
||||
|
||||
public async Task InitializeAsync()
|
||||
{
|
||||
// Reset PostgreSQL test data
|
||||
using var scope = _fixture.Services.CreateScope();
|
||||
var db = scope.ServiceProvider.GetRequiredService<AppDbContext>();
|
||||
await DbResetHelper.ResetAsync(db);
|
||||
|
||||
var patient = new Patient
|
||||
{
|
||||
Id = Guid.NewGuid(), Mrn = "MRN-SIRS-001", FirstName = "SIRS", LastName = "Test",
|
||||
DateOfBirth = new DateOnly(1960, 1, 1), Gender = "M",
|
||||
CreatedAt = DateTimeOffset.UtcNow
|
||||
};
|
||||
var encounter = new Encounter
|
||||
{
|
||||
Id = Guid.NewGuid(), PatientId = patient.Id, EncounterType = EncounterType.Inpatient,
|
||||
Status = EncounterStatus.Active, Department = Department.Icu,
|
||||
AttendingPhysician = "Dr. SIRS", AdmittedAt = DateTimeOffset.UtcNow,
|
||||
CreatedAt = DateTimeOffset.UtcNow
|
||||
};
|
||||
db.Patients.Add(patient);
|
||||
db.Encounters.Add(encounter);
|
||||
await db.SaveChangesAsync();
|
||||
|
||||
_patientId = patient.Id;
|
||||
_encounterId = encounter.Id;
|
||||
|
||||
// Flush all SIRS keys for this encounter from Redis
|
||||
var redis = scope.ServiceProvider.GetRequiredService<IConnectionMultiplexer>();
|
||||
var cache = redis.GetDatabase();
|
||||
foreach (var key in SirsEvaluator.AllCriterionKeys(_encounterId))
|
||||
await cache.KeyDeleteAsync(key);
|
||||
}
|
||||
|
||||
public Task DisposeAsync() => Task.CompletedTask;
|
||||
|
||||
private SirsDetector CreateDetector()
|
||||
{
|
||||
using var scope = _fixture.Services.CreateScope();
|
||||
return scope.ServiceProvider.GetRequiredService<SirsDetector>();
|
||||
}
|
||||
|
||||
// Test 1: one criterion met — insufficient for alert
|
||||
[Fact]
|
||||
public async Task OneCriterion_NoAlert()
|
||||
{
|
||||
using var scope = _fixture.Services.CreateScope();
|
||||
var detector = scope.ServiceProvider.GetRequiredService<SirsDetector>();
|
||||
|
||||
var result = await detector.ProcessObservationAsync(
|
||||
_encounterId, _patientId, "HEART_RATE", 95m);
|
||||
|
||||
result.Outcome.Should().Be(SirsOutcome.InsufficientCriteria);
|
||||
result.ActiveCount.Should().Be(1);
|
||||
|
||||
// Verify Redis key was set
|
||||
var redis = scope.ServiceProvider.GetRequiredService<IConnectionMultiplexer>();
|
||||
var ttl = await redis.GetDatabase()
|
||||
.KeyTimeToLiveAsync(SirsEvaluator.CriterionKey(_encounterId, "HEART_RATE"));
|
||||
ttl.Should().NotBeNull().And.BeGreaterThan(TimeSpan.Zero);
|
||||
}
|
||||
|
||||
// Test 2: two criteria met — SEPSIS_WARNING alert created
|
||||
[Fact]
|
||||
public async Task TwoCriteriaMet_AlertCreated()
|
||||
{
|
||||
using var scope = _fixture.Services.CreateScope();
|
||||
var detector = scope.ServiceProvider.GetRequiredService<SirsDetector>();
|
||||
var db = scope.ServiceProvider.GetRequiredService<AppDbContext>();
|
||||
|
||||
// Tachycardia
|
||||
var r1 = await detector.ProcessObservationAsync(
|
||||
_encounterId, _patientId, "HEART_RATE", 95m);
|
||||
r1.Outcome.Should().Be(SirsOutcome.InsufficientCriteria);
|
||||
|
||||
// Fever — now count = 2 → alert
|
||||
var r2 = await detector.ProcessObservationAsync(
|
||||
_encounterId, _patientId, "TEMP_C", 38.5m);
|
||||
r2.Outcome.Should().Be(SirsOutcome.AlertCreated);
|
||||
|
||||
// Verify clinical_alert row in PostgreSQL
|
||||
var alert = await db.ClinicalAlerts.SingleAsync();
|
||||
alert.AlertType.Should().Be(AlertType.SepsisWarning);
|
||||
alert.Severity.Should().Be(AlertSeverity.Critical);
|
||||
alert.Status.Should().Be(AlertStatus.Open);
|
||||
alert.EncounterId.Should().Be(_encounterId);
|
||||
alert.PatientId.Should().Be(_patientId);
|
||||
|
||||
// Verify outbox event was written in the same transaction
|
||||
var outbox = await db.OutboxEvents.SingleAsync(e => e.Topic == "alert.generated");
|
||||
outbox.PartitionKey.Should().Be(_encounterId.ToString());
|
||||
}
|
||||
|
||||
// Test 3: third criterion met while alert already open — no second alert
|
||||
[Fact]
|
||||
public async Task ThreeCriteriaMet_NoSecondAlert()
|
||||
{
|
||||
using var scope = _fixture.Services.CreateScope();
|
||||
var detector = scope.ServiceProvider.GetRequiredService<SirsDetector>();
|
||||
var db = scope.ServiceProvider.GetRequiredService<AppDbContext>();
|
||||
|
||||
await detector.ProcessObservationAsync(_encounterId, _patientId, "HEART_RATE", 95m);
|
||||
await detector.ProcessObservationAsync(_encounterId, _patientId, "TEMP_C", 38.5m);
|
||||
// Third criterion (tachypnea) — alert already open
|
||||
var r3 = await detector.ProcessObservationAsync(
|
||||
_encounterId, _patientId, "RESP_RATE", 22m);
|
||||
|
||||
r3.Outcome.Should().Be(SirsOutcome.AlertAlreadyOpen);
|
||||
|
||||
// Still exactly one alert — the WHERE NOT EXISTS prevented a duplicate
|
||||
var alertCount = await db.ClinicalAlerts.CountAsync();
|
||||
alertCount.Should().Be(1, "a second SEPSIS_WARNING must not be created while one is already open");
|
||||
}
|
||||
|
||||
// Test 4: criterion clears — Redis key deleted, alert remains open
|
||||
//
|
||||
// This is the most important test in Phase 5. It verifies:
|
||||
// (a) The DEL path works when a criterion is no longer met.
|
||||
// (b) Clearing a criterion does not resolve the existing alert — the clinical
|
||||
// workflow requires explicit acknowledgment. A patient whose temperature
|
||||
// normalises may still be septic; the alert is for the clinician to evaluate.
|
||||
[Fact]
|
||||
public async Task CriterionClears_KeyDeleted_AlertRemainsOpen()
|
||||
{
|
||||
using var scope = _fixture.Services.CreateScope();
|
||||
var detector = scope.ServiceProvider.GetRequiredService<SirsDetector>();
|
||||
var db = scope.ServiceProvider.GetRequiredService<AppDbContext>();
|
||||
var redis = scope.ServiceProvider.GetRequiredService<IConnectionMultiplexer>();
|
||||
var cache = redis.GetDatabase();
|
||||
|
||||
// Establish two criteria and create the alert
|
||||
await detector.ProcessObservationAsync(_encounterId, _patientId, "HEART_RATE", 95m);
|
||||
await detector.ProcessObservationAsync(_encounterId, _patientId, "TEMP_C", 38.5m);
|
||||
|
||||
// Temperature normalises
|
||||
var result = await detector.ProcessObservationAsync(
|
||||
_encounterId, _patientId, "TEMP_C", 37.0m);
|
||||
|
||||
// TEMP_C key must be gone from Redis
|
||||
var tempKeyExists = await cache.KeyExistsAsync(
|
||||
SirsEvaluator.CriterionKey(_encounterId, "TEMP_C"));
|
||||
tempKeyExists.Should().BeFalse("a cleared criterion must be deleted from Redis immediately");
|
||||
|
||||
// HEART_RATE key must still exist (criterion still met)
|
||||
var hrKeyExists = await cache.KeyExistsAsync(
|
||||
SirsEvaluator.CriterionKey(_encounterId, "HEART_RATE"));
|
||||
hrKeyExists.Should().BeTrue("an active criterion must remain until its own TTL or a clearing observation");
|
||||
|
||||
// Active count is now 1, but alert must stay open
|
||||
result.Outcome.Should().Be(SirsOutcome.InsufficientCriteria);
|
||||
result.ActiveCount.Should().Be(1);
|
||||
|
||||
var alert = await db.ClinicalAlerts.SingleAsync();
|
||||
alert.Status.Should().Be(AlertStatus.Open,
|
||||
"the existing alert is not auto-resolved when criteria drop below 2 — " +
|
||||
"clinical acknowledgment is required");
|
||||
}
|
||||
|
||||
// Test 5: at-least-once redelivery — idempotency under simulated crash
|
||||
[Fact]
|
||||
public async Task DuplicateObservationEvent_AlertCreatedOnce()
|
||||
{
|
||||
using var scope = _fixture.Services.CreateScope();
|
||||
var detector = scope.ServiceProvider.GetRequiredService<SirsDetector>();
|
||||
var db = scope.ServiceProvider.GetRequiredService<AppDbContext>();
|
||||
|
||||
await detector.ProcessObservationAsync(_encounterId, _patientId, "HEART_RATE", 95m);
|
||||
|
||||
// Simulate: the consumer crashes after this call completes but before committing
|
||||
// the Kafka offset. On restart, the same observation is redelivered.
|
||||
await detector.ProcessObservationAsync(_encounterId, _patientId, "TEMP_C", 38.5m);
|
||||
await detector.ProcessObservationAsync(_encounterId, _patientId, "TEMP_C", 38.5m); // duplicate
|
||||
|
||||
var alertCount = await db.ClinicalAlerts.CountAsync();
|
||||
alertCount.Should().Be(1, "WHERE NOT EXISTS prevents duplicate alert on redelivery");
|
||||
|
||||
var outboxCount = await db.OutboxEvents.CountAsync(e => e.Topic == "alert.generated");
|
||||
outboxCount.Should().Be(1, "outbox event must be written exactly once");
|
||||
}
|
||||
|
||||
// Test 6: non-SIRS code — engine ignores it entirely
|
||||
[Fact]
|
||||
public async Task NonSirsCode_NoRedisInteraction()
|
||||
{
|
||||
using var scope = _fixture.Services.CreateScope();
|
||||
var detector = scope.ServiceProvider.GetRequiredService<SirsDetector>();
|
||||
var redis = scope.ServiceProvider.GetRequiredService<IConnectionMultiplexer>();
|
||||
|
||||
var result = await detector.ProcessObservationAsync(
|
||||
_encounterId, _patientId, "POTASSIUM_MEQ_L", 3.2m);
|
||||
|
||||
result.Outcome.Should().Be(SirsOutcome.NotSirsCode);
|
||||
|
||||
// No SIRS keys were created for this encounter
|
||||
var anyKey = await redis.GetDatabase()
|
||||
.KeyExistsAsync(SirsEvaluator.CriterionKey(_encounterId, "POTASSIUM_MEQ_L"));
|
||||
anyKey.Should().BeFalse();
|
||||
}
|
||||
}
|
||||
@@ -1,30 +0,0 @@
|
||||
using FluentAssertions;
|
||||
|
||||
public class SirsEvaluatorTests
|
||||
{
|
||||
[Theory]
|
||||
[InlineData("TEMP_C", 38.4, true)] // fever
|
||||
[InlineData("TEMP_C", 35.9, true)] // hypothermia
|
||||
[InlineData("TEMP_C", 37.0, false)] // normal
|
||||
[InlineData("HEART_RATE", 91, true)]
|
||||
[InlineData("HEART_RATE", 90, false)] // boundary: 90 is NOT tachycardia (> not >=)
|
||||
[InlineData("RESP_RATE", 21, true)]
|
||||
[InlineData("RESP_RATE", 20, false)] // boundary
|
||||
[InlineData("WBC_K_UL", 12.1, true)] // leukocytosis
|
||||
[InlineData("WBC_K_UL", 3.9, true)] // leukopenia
|
||||
[InlineData("WBC_K_UL", 8.0, false)] // normal
|
||||
[InlineData("POTASSIUM_MEQ_L", 4.0, false)] // not a SIRS code
|
||||
public void MeetsCriterion_ReturnsExpected(string code, double value, bool expected)
|
||||
{
|
||||
SirsEvaluator.MeetsCriterion(code, (decimal)value).Should().Be(expected);
|
||||
}
|
||||
|
||||
[Fact]
|
||||
public void AllCriterionKeys_ReturnsFourKeys_AllDistinct()
|
||||
{
|
||||
var id = Guid.NewGuid();
|
||||
var keys = SirsEvaluator.AllCriterionKeys(id);
|
||||
keys.Should().HaveCount(4);
|
||||
keys.Select(k => k.ToString()).Should().OnlyHaveUniqueItems();
|
||||
}
|
||||
}
|
||||
Reference in New Issue
Block a user