feature: Sepsis Engine Refactor: Remove SIRS, Rewire qSOFA + Bundle
Frontend: GCS Entry, SOFA Display, Sepsis UI Refactor
This commit is contained in:
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 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]
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public async Task QsofaScreen_IncludesLabRecommendation()
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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.Details.Should().Contain("order SOFA labs");
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}
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}
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