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feature: Sepsis Engine Refactor: Remove SIRS, Rewire qSOFA + Bundle

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Frontend: GCS Entry, SOFA Display, Sepsis UI Refactor
This commit is contained in:
voltsrage
2026-06-21 03:56:27 +08:00
parent 93ea473d2b
commit bf46e6554a
48 changed files with 2686 additions and 714 deletions
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VigilCareClinicalAPI.Tests/AlertCreationGuardTests.cs
+19
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@@ -0,0 +1,19 @@
using FluentAssertions;
public class AlertCreationGuardTests
{
[Fact]
public void CannotCreateNewSepsisWarning()
{
var act = () => AlertCreationGuard.EnsureAllowed(AlertType.SepsisWarning);
act.Should().Throw<InvalidOperationException>()
.WithMessage("*deprecated*");
}
[Fact]
public void AllowsSofaSepsis()
{
var act = () => AlertCreationGuard.EnsureAllowed(AlertType.SofaSepsis);
act.Should().NotThrow();
}
}
VigilCareClinicalAPI.Tests/ObservabilityPhase8Tests.cs
+1 -1
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@@ -15,7 +15,7 @@ public class ObservabilityPhase8Tests
"alerts_unacknowledged_gauge",
"kafka_consumer_lag",
"outbox_pending_events",
"sirs_detections_total",
"qsofa_detections_total",
"escalations_total",
};
VigilCareClinicalAPI.Tests/QsofaDetectorTests.cs
+4 -4
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@@ -80,12 +80,12 @@ public class QsofaDetectorTests : IAsyncLifetime
r2.Outcome.Should().Be(QsofaOutcome.AlertCreated);
var alert = await db.ClinicalAlerts.SingleAsync();
alert.AlertType.Should().Be(AlertType.QsofaWarning);
alert.Severity.Should().Be(AlertSeverity.Critical);
alert.AlertType.Should().Be(AlertType.QsofaScreen);
alert.Severity.Should().Be(AlertSeverity.Warning);
alert.Status.Should().Be(AlertStatus.Open);
alert.EncounterId.Should().Be(_encounterId);
alert.PatientId.Should().Be(_patientId);
alert.Details.Should().Contain("qSOFA score 2/3");
alert.Details.Should().Contain("order SOFA labs");
var outbox = await db.OutboxEvents.SingleAsync(e => e.Topic == "alert.generated");
outbox.PartitionKey.Should().Be(_encounterId.ToString());
@@ -138,7 +138,7 @@ public class QsofaDetectorTests : IAsyncLifetime
r3.Outcome.Should().Be(QsofaOutcome.AlertAlreadyOpen);
var alertCount = await db.ClinicalAlerts.CountAsync();
alertCount.Should().Be(1, "WHERE NOT EXISTS prevents duplicate QSOFA_WARNING while one is open");
alertCount.Should().Be(1, "WHERE NOT EXISTS prevents duplicate QSOFA_SCREEN while one is open");
var outboxCount = await db.OutboxEvents.CountAsync(e => e.Topic == "alert.generated");
outboxCount.Should().Be(1, "outbox event must be written exactly once");
VigilCareClinicalAPI.Tests/SepsisBundleTests.cs
+54 -38
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@@ -43,28 +43,47 @@ public class SepsisBundleTests : IAsyncLifetime
var cache = redis.GetDatabase();
foreach (var key in QsofaCalculator.AllCriterionKeys(_encounterId))
await cache.KeyDeleteAsync(key);
foreach (var key in SirsEvaluator.AllCriterionKeys(_encounterId))
await cache.KeyDeleteAsync(key);
}
public Task DisposeAsync() => Task.CompletedTask;
[Fact]
public async Task QsofaAlert_CreatesBundleWithFourOrders()
private async Task CreateSofaSepsisBundleAsync(IServiceScope scope)
{
using var scope = _fixture.Services.CreateScope();
var detector = scope.ServiceProvider.GetRequiredService<QsofaDetector>();
var handler = scope.ServiceProvider.GetRequiredService<SepsisAlertHandler>();
var db = scope.ServiceProvider.GetRequiredService<AppDbContext>();
await detector.ProcessObservationAsync(_encounterId, _patientId, "RESP_RATE", 24m);
await detector.ProcessObservationAsync(_encounterId, _patientId, "SYSTOLIC_BP", 95m);
var alertId = Guid.NewGuid();
db.ClinicalAlerts.Add(new ClinicalAlert
{
Id = alertId,
EncounterId = _encounterId,
PatientId = _patientId,
AlertType = AlertType.SofaSepsis,
Severity = AlertSeverity.Critical,
Details = "SOFA delta +2",
Status = AlertStatus.Open,
TriggeredAt = DateTimeOffset.UtcNow
});
await db.SaveChangesAsync();
await handler.OnSepsisAlertCreatedAsync(
_encounterId, alertId, AlertType.SofaSepsis, CancellationToken.None);
}
[Fact]
public async Task SofaSepsisAlert_CreatesBundleWithFourOrders()
{
using var scope = _fixture.Services.CreateScope();
var db = scope.ServiceProvider.GetRequiredService<AppDbContext>();
await CreateSofaSepsisBundleAsync(scope);
var bundle = await db.SepsisBundles
.Include(b => b.Elements)
.SingleAsync(b => b.EncounterId == _encounterId);
bundle.ComplianceStatus.Should().Be(SepsisBundleComplianceStatus.InProgress);
bundle.TriggeringAlertType.Should().Be("QSOFA_WARNING");
bundle.TriggeringAlertType.Should().Be("SOFA_SEPSIS");
bundle.DeadlineAt.Should().BeCloseTo(bundle.RecognizedAt.AddHours(1), TimeSpan.FromSeconds(5));
bundle.Elements.Should().HaveCount(4);
@@ -86,40 +105,45 @@ public class SepsisBundleTests : IAsyncLifetime
}
[Fact]
public async Task SirsAlert_CreatesBundle()
public async Task QsofaScreen_DoesNotTriggerBundle()
{
using var scope = _fixture.Services.CreateScope();
var detector = scope.ServiceProvider.GetRequiredService<SirsDetector>();
var detector = scope.ServiceProvider.GetRequiredService<QsofaDetector>();
var db = scope.ServiceProvider.GetRequiredService<AppDbContext>();
await detector.ProcessObservationAsync(_encounterId, _patientId, "HEART_RATE", 95m);
await detector.ProcessObservationAsync(_encounterId, _patientId, "TEMP_C", 38.5m);
await detector.ProcessObservationAsync(_encounterId, _patientId, "RESP_RATE", 24m);
await detector.ProcessObservationAsync(_encounterId, _patientId, "SYSTOLIC_BP", 95m);
var bundle = await db.SepsisBundles
.Include(b => b.Elements)
.SingleAsync(b => b.EncounterId == _encounterId);
bundle.TriggeringAlertType.Should().Be("SEPSIS_WARNING");
bundle.ComplianceStatus.Should().Be(SepsisBundleComplianceStatus.InProgress);
bundle.Elements.Should().HaveCount(4);
(await db.SepsisBundles.CountAsync()).Should().Be(0);
}
[Fact]
public async Task SecondAlert_IdempotentBundle()
{
using var scope = _fixture.Services.CreateScope();
var qsofaDetector = scope.ServiceProvider.GetRequiredService<QsofaDetector>();
var sirsDetector = scope.ServiceProvider.GetRequiredService<SirsDetector>();
var handler = scope.ServiceProvider.GetRequiredService<SepsisAlertHandler>();
var db = scope.ServiceProvider.GetRequiredService<AppDbContext>();
await qsofaDetector.ProcessObservationAsync(_encounterId, _patientId, "RESP_RATE", 24m);
await qsofaDetector.ProcessObservationAsync(_encounterId, _patientId, "SYSTOLIC_BP", 95m);
await CreateSofaSepsisBundleAsync(scope);
var bundleCountAfterFirst = await db.SepsisBundles.CountAsync(b => b.EncounterId == _encounterId);
bundleCountAfterFirst.Should().Be(1);
await sirsDetector.ProcessObservationAsync(_encounterId, _patientId, "HEART_RATE", 95m);
await sirsDetector.ProcessObservationAsync(_encounterId, _patientId, "TEMP_C", 38.5m);
var secondAlertId = Guid.NewGuid();
db.ClinicalAlerts.Add(new ClinicalAlert
{
Id = secondAlertId,
EncounterId = _encounterId,
PatientId = _patientId,
AlertType = AlertType.SofaSepsis,
Severity = AlertSeverity.Critical,
Details = "SOFA delta +3",
Status = AlertStatus.Open,
TriggeredAt = DateTimeOffset.UtcNow
});
await db.SaveChangesAsync();
await handler.OnSepsisAlertCreatedAsync(
_encounterId, secondAlertId, AlertType.SofaSepsis, CancellationToken.None);
var bundleCount = await db.SepsisBundles.CountAsync(b => b.EncounterId == _encounterId);
bundleCount.Should().Be(1, "a second bundle must not be created while one is IN_PROGRESS");
@@ -132,12 +156,10 @@ public class SepsisBundleTests : IAsyncLifetime
public async Task OrderResulted_CompletesElement()
{
using var scope = _fixture.Services.CreateScope();
var detector = scope.ServiceProvider.GetRequiredService<QsofaDetector>();
var bundleService = scope.ServiceProvider.GetRequiredService<ISepsisBundleService>();
var db = scope.ServiceProvider.GetRequiredService<AppDbContext>();
await detector.ProcessObservationAsync(_encounterId, _patientId, "RESP_RATE", 24m);
await detector.ProcessObservationAsync(_encounterId, _patientId, "SYSTOLIC_BP", 95m);
await CreateSofaSepsisBundleAsync(scope);
var lactateElement = await db.SepsisBundleElements
.Include(e => e.Order)
@@ -161,12 +183,10 @@ public class SepsisBundleTests : IAsyncLifetime
public async Task AllElementsResulted_BundleCompliant()
{
using var scope = _fixture.Services.CreateScope();
var detector = scope.ServiceProvider.GetRequiredService<QsofaDetector>();
var bundleService = scope.ServiceProvider.GetRequiredService<ISepsisBundleService>();
var db = scope.ServiceProvider.GetRequiredService<AppDbContext>();
await detector.ProcessObservationAsync(_encounterId, _patientId, "RESP_RATE", 24m);
await detector.ProcessObservationAsync(_encounterId, _patientId, "SYSTOLIC_BP", 95m);
await CreateSofaSepsisBundleAsync(scope);
var elements = await db.SepsisBundleElements.ToListAsync();
foreach (var element in elements)
@@ -188,12 +208,10 @@ public class SepsisBundleTests : IAsyncLifetime
public async Task DeadlinePassed_CompletionMarksNonCompliant()
{
using var scope = _fixture.Services.CreateScope();
var detector = scope.ServiceProvider.GetRequiredService<QsofaDetector>();
var bundleService = scope.ServiceProvider.GetRequiredService<ISepsisBundleService>();
var db = scope.ServiceProvider.GetRequiredService<AppDbContext>();
await detector.ProcessObservationAsync(_encounterId, _patientId, "RESP_RATE", 24m);
await detector.ProcessObservationAsync(_encounterId, _patientId, "SYSTOLIC_BP", 95m);
await CreateSofaSepsisBundleAsync(scope);
var bundle = await db.SepsisBundles.SingleAsync();
bundle.DeadlineAt = DateTimeOffset.UtcNow.AddHours(-1);
@@ -212,11 +230,9 @@ public class SepsisBundleTests : IAsyncLifetime
public async Task DeadlinePassed_MonitorMarksNonCompliant()
{
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);
await CreateSofaSepsisBundleAsync(scope);
var bundle = await db.SepsisBundles.SingleAsync();
bundle.DeadlineAt = DateTimeOffset.UtcNow.AddHours(-1);
VigilCareClinicalAPI.Tests/SepsisRefactorTests.cs
+191
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@@ -0,0 +1,191 @@
using FluentAssertions;
using Microsoft.EntityFrameworkCore;
using Microsoft.Extensions.DependencyInjection;
using Microsoft.Extensions.Logging;
[Collection("Integration")]
public class SepsisRefactorTests : IAsyncLifetime
{
private readonly ApiFixture _fixture;
private Guid _encounterId;
private Guid _patientId;
public SepsisRefactorTests(ApiFixture fixture) => _fixture = fixture;
public async Task InitializeAsync()
{
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-REFACTOR-001", FirstName = "Refactor", 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. Refactor", AdmittedAt = DateTimeOffset.UtcNow,
CreatedAt = DateTimeOffset.UtcNow
};
db.Patients.Add(patient);
db.Encounters.Add(encounter);
await db.SaveChangesAsync();
_patientId = patient.Id;
_encounterId = encounter.Id;
}
public Task DisposeAsync() => Task.CompletedTask;
[Fact]
public async Task SirsObservations_NoSepsisWarningAlert()
{
using var scope = _fixture.Services.CreateScope();
var qsofa = scope.ServiceProvider.GetRequiredService<QsofaDetector>();
var db = scope.ServiceProvider.GetRequiredService<AppDbContext>();
await qsofa.ProcessObservationAsync(_encounterId, _patientId, "TEMP_C", 39m);
await qsofa.ProcessObservationAsync(_encounterId, _patientId, "HEART_RATE", 110m);
await qsofa.ProcessObservationAsync(_encounterId, _patientId, "RESP_RATE", 22m);
await qsofa.ProcessObservationAsync(_encounterId, _patientId, "WBC_K_UL", 15m);
(await db.ClinicalAlerts.CountAsync(a => a.AlertType == AlertType.SepsisWarning))
.Should().Be(0);
}
[Fact]
public async Task SofaDelta2_TriggersSepsisBundleCreation()
{
using var scope = _fixture.Services.CreateScope();
var handler = scope.ServiceProvider.GetRequiredService<SepsisAlertHandler>();
var db = scope.ServiceProvider.GetRequiredService<AppDbContext>();
var alertId = Guid.NewGuid();
db.ClinicalAlerts.Add(new ClinicalAlert
{
Id = alertId, EncounterId = _encounterId, PatientId = _patientId,
AlertType = AlertType.SofaSepsis, Severity = AlertSeverity.Critical,
Details = "SOFA delta +2", Status = AlertStatus.Open,
TriggeredAt = DateTimeOffset.UtcNow
});
await db.SaveChangesAsync();
await handler.OnSepsisAlertCreatedAsync(
_encounterId, alertId, AlertType.SofaSepsis, CancellationToken.None);
(await db.SepsisBundles.CountAsync()).Should().Be(1);
}
[Fact]
public async Task QsofaScreen_DoesNotTriggerBundle()
{
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);
(await db.SepsisBundles.CountAsync()).Should().Be(0);
}
[Fact]
public async Task QsofaScreen_IsWarningNotCritical()
{
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.AlertType.Should().Be(AlertType.QsofaScreen);
alert.Severity.Should().Be(AlertSeverity.Warning);
}
[Fact]
public void QsofaScreen_IsSuppressible()
{
AlertType.QsofaScreen.IsSuppressible().Should().BeTrue();
}
[Fact]
public async Task LegacySepsisWarning_StillQueryable()
{
using var scope = _fixture.Services.CreateScope();
var db = scope.ServiceProvider.GetRequiredService<AppDbContext>();
var alertService = scope.ServiceProvider.GetRequiredService<IAlertService>();
db.ClinicalAlerts.Add(new ClinicalAlert
{
Id = Guid.NewGuid(), EncounterId = _encounterId, PatientId = _patientId,
AlertType = AlertType.SepsisWarning, Severity = AlertSeverity.Critical,
Details = "Legacy SIRS alert", Status = AlertStatus.Resolved,
TriggeredAt = DateTimeOffset.UtcNow.AddDays(-1)
});
await db.SaveChangesAsync();
var page = await alertService.ListByEncounterAsync(_encounterId, null, 1, 10);
page.Items.Should().ContainSingle(a => a.AlertType == AlertType.SepsisWarning);
}
[Fact]
public void CannotCreateNewSepsisWarning()
{
var act = () => AlertCreationGuard.EnsureAllowed(AlertType.SepsisWarning);
act.Should().Throw<InvalidOperationException>()
.WithMessage("*deprecated*");
}
[Fact]
public async Task SepsisBundleCompliance_StillTracked()
{
using var scope = _fixture.Services.CreateScope();
var handler = scope.ServiceProvider.GetRequiredService<SepsisAlertHandler>();
var db = scope.ServiceProvider.GetRequiredService<AppDbContext>();
var alertId = Guid.NewGuid();
db.ClinicalAlerts.Add(new ClinicalAlert
{
Id = alertId, EncounterId = _encounterId, PatientId = _patientId,
AlertType = AlertType.SofaSepsis, Severity = AlertSeverity.Critical,
Details = "SOFA delta +2", Status = AlertStatus.Open,
TriggeredAt = DateTimeOffset.UtcNow
});
await db.SaveChangesAsync();
await handler.OnSepsisAlertCreatedAsync(
_encounterId, alertId, AlertType.SofaSepsis, CancellationToken.None);
var bundle = await db.SepsisBundles.SingleAsync();
bundle.DeadlineAt = DateTimeOffset.UtcNow.AddHours(-1);
await db.SaveChangesAsync();
var monitor = new SepsisBundleMonitorService(
_fixture.Services,
_fixture.Services.GetRequiredService<ClinicalMetrics>(),
_fixture.Services.GetRequiredService<ILogger<SepsisBundleMonitorService>>());
await monitor.ScanOverdueBundlesAsync(CancellationToken.None);
var updated = await db.SepsisBundles.AsNoTracking().SingleAsync();
updated.ComplianceStatus.Should().Be(SepsisBundleComplianceStatus.NonCompliant);
}
[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");
}
}
VigilCareClinicalAPI.Tests/SirsDetectorTests.cs
-213
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@@ -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();
}
}
VigilCareClinicalAPI.Tests/SirsEvaluatorTests.cs
-30
View File
@@ -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();
}
}
VigilCareClinicalAPI/BackgroundServices/SepsisEngineService.cs
+4 -26
View File
@@ -34,13 +34,10 @@ public class SepsisEngineService : BackgroundService
};
using var consumer = new ConsumerBuilder<string, string>(config).Build();
// Subscribes to observation.recorded only.
// The es-indexer consumes all three topics; the sepsis engine only needs one.
// Subscribing to a superset of needed topics would waste CPU deserializing
// alert and encounter events that this engine discards immediately.
consumer.Subscribe(_kafkaOptions.Topics.ObservationRecorded);
_logger.LogInformation("SepsisEngineService started — consumer group: sepsis-engine");
_logger.LogInformation(
"SepsisEngineService started — consumer group: sepsis-engine (qSOFA screening only)");
try
{
@@ -54,19 +51,9 @@ public class SepsisEngineService : BackgroundService
var evt = JsonSerializer.Deserialize<SepsisObservationEvent>(
result.Message.Value, EventJsonOptions)!;
// Create a scope per message — both detectors are scoped and
// each owns a fresh DbContext when creating alerts.
using var scope = _services.CreateScope();
var sirsDetector = scope.ServiceProvider.GetRequiredService<SirsDetector>();
var qsofaDetector = scope.ServiceProvider.GetRequiredService<QsofaDetector>();
var sirsOutcome = await sirsDetector.ProcessObservationAsync(
evt.EncounterId,
evt.PatientId,
evt.ObservationCode,
evt.Value,
stoppingToken);
var qsofaOutcome = await qsofaDetector.ProcessObservationAsync(
evt.EncounterId,
evt.PatientId,
@@ -74,19 +61,12 @@ public class SepsisEngineService : BackgroundService
evt.Value,
stoppingToken);
if (sirsOutcome.Outcome == SirsOutcome.AlertCreated)
_logger.LogWarning(
"SEPSIS_WARNING created via SepsisEngine " +
"— encounter={EncounterId} code={Code} value={Value}",
evt.EncounterId, evt.ObservationCode, evt.Value);
if (qsofaOutcome.Outcome == QsofaOutcome.AlertCreated)
_logger.LogWarning(
"QSOFA_WARNING created via SepsisEngine " +
_logger.LogInformation(
"QSOFA_SCREEN created via SepsisEngine " +
"— encounter={EncounterId} code={Code} value={Value}",
evt.EncounterId, evt.ObservationCode, evt.Value);
// Commit only after successful processing.
consumer.Commit(result);
}
catch (OperationCanceledException)
@@ -98,8 +78,6 @@ public class SepsisEngineService : BackgroundService
_logger.LogError(ex,
"SepsisEngine failed on topic={Topic} offset={Offset} — not committing",
result?.Topic, result?.Offset.Value);
// Back off before retrying so a persistent failure (e.g., Redis down)
// does not spin the loop at maximum throughput.
await Task.Delay(2000, stoppingToken);
}
}
VigilCareClinicalAPI/Data/Configurations/ClinicalAlertConfiguration.cs
+7 -2
View File
@@ -18,13 +18,18 @@ public class ClinicalAlertConfiguration : IEntityTypeConfiguration<ClinicalAlert
"'CRITICAL_SPO2', 'CRITICAL_RESP_RATE', 'CRITICAL_WBC_K_UL', " +
"'CRITICAL_SYSTOLIC_BP', 'CRITICAL_DIASTOLIC_BP', 'CRITICAL_LACTATE_MMOL_L', " +
"'CRITICAL_AVPU', 'CRITICAL_GLUCOSE_MG_DL', " +
"'CRITICAL_PAO2_MMHG', 'CRITICAL_PLATELET_K_UL', " +
"'CRITICAL_BILIRUBIN_MG_DL', 'CRITICAL_CREATININE_MG_DL', " +
"'WARNING_HEART_RATE', 'WARNING_TEMP_C', 'WARNING_POTASSIUM_MEQ_L', " +
"'WARNING_SPO2', 'WARNING_RESP_RATE', 'WARNING_WBC_K_UL', " +
"'WARNING_SYSTOLIC_BP', 'WARNING_DIASTOLIC_BP', 'WARNING_LACTATE_MMOL_L', " +
"'WARNING_GLUCOSE_MG_DL', " +
"'WARNING_PAO2_MMHG', 'WARNING_PLATELET_K_UL', " +
"'WARNING_BILIRUBIN_MG_DL', 'WARNING_CREATININE_MG_DL', " +
"'NEWS2_WARNING', 'NEWS2_EMERGENCY', " +
"'RAPID_DETERIORATION', 'QSOFA_WARNING', " +
"'GCS_CRITICAL', 'GCS_WARNING')");
"'RAPID_DETERIORATION', 'QSOFA_WARNING', 'QSOFA_SCREEN', " +
"'GCS_CRITICAL', 'GCS_WARNING', " +
"'SOFA_SEPSIS', 'SOFA_WARNING')");
});
builder.HasKey(a => a.Id);
builder.Property(a => a.Id).HasColumnName("id").HasDefaultValueSql("gen_random_uuid()");
VigilCareClinicalAPI/Domains/Enums/AlertType.cs
+7 -1
View File
@@ -1,5 +1,6 @@
public enum AlertType
{
[Obsolete("Legacy — replaced by SOFA_SEPSIS in Phase 27. Retained for historical alert queries.")]
SepsisWarning,
CriticalHeartRate,
CriticalTempC,
@@ -30,8 +31,11 @@ public enum AlertType
RapidDeterioration,
[Obsolete("Legacy — replaced by QSOFA_SCREEN in Phase 27. Retained for historical alert queries.")]
QsofaWarning,
QsofaScreen,
GcsCritical,
GcsWarning,
@@ -90,6 +94,7 @@ public static class AlertTypeExtensions
AlertType.WarningCreatinineMgDl => "WARNING_CREATININE_MG_DL",
AlertType.SofaSepsis => "SOFA_SEPSIS",
AlertType.SofaWarning => "SOFA_WARNING",
AlertType.QsofaScreen => "QSOFA_SCREEN",
_ => throw new ArgumentOutOfRangeException(nameof(t))
};
@@ -121,6 +126,7 @@ public static class AlertTypeExtensions
"NEWS2_EMERGENCY" => AlertType.News2Emergency,
"RAPID_DETERIORATION" => AlertType.RapidDeterioration,
"QSOFA_WARNING" => AlertType.QsofaWarning,
"QSOFA_SCREEN" => AlertType.QsofaScreen,
"GCS_CRITICAL" => AlertType.GcsCritical,
"GCS_WARNING" => AlertType.GcsWarning,
"CRITICAL_PAO2_MMHG" => AlertType.CriticalPao2MmHg,
@@ -189,7 +195,7 @@ public static class AlertTypeExtensions
AlertType.RapidDeterioration => false,
AlertType.GcsCritical => false, // trajectory alerts are never suppressed
AlertType.SofaSepsis => false,
_ => true // all Warning* types, News2Warning, and QsofaWarning
_ => true // all Warning* types, News2Warning, QsofaScreen, SofaWarning, GcsWarning
};
public static string? ObservationCodeForWarning(this AlertType t) => t switch
VigilCareClinicalAPI/Gcs/GcsDetector.cs
+2
View File
@@ -141,6 +141,8 @@ public class GcsDetector
}
}
AlertCreationGuard.EnsureAllowed(alertType);
using var scope = _services.CreateScope();
var db = scope.ServiceProvider.GetRequiredService<AppDbContext>();
VigilCareClinicalAPI/Migrations/20260620191432_AddQsofaScreenAlertType.cs.Designer.cs
Generated
+1085
View File
File diff suppressed because it is too large Load Diff
VigilCareClinicalAPI/Migrations/20260620191432_AddQsofaScreenAlertType.cs.cs
+44
View File
@@ -0,0 +1,44 @@
using Microsoft.EntityFrameworkCore.Migrations;
#nullable disable
namespace VigilCareClinicalAPI.Migrations
{
/// <inheritdoc />
public partial class AddQsofaScreenAlertTypecs : Migration
{
/// <inheritdoc />
protected override void Up(MigrationBuilder migrationBuilder)
{
migrationBuilder.Sql("""
ALTER TABLE clinical_alerts DROP CONSTRAINT chk_clinical_alerts_alert_type;
ALTER TABLE clinical_alerts ADD CONSTRAINT chk_clinical_alerts_alert_type
CHECK (alert_type IN (
'SEPSIS_WARNING',
'CRITICAL_HEART_RATE', 'CRITICAL_TEMP_C', 'CRITICAL_POTASSIUM_MEQ_L',
'CRITICAL_SPO2', 'CRITICAL_RESP_RATE', 'CRITICAL_WBC_K_UL',
'CRITICAL_SYSTOLIC_BP', 'CRITICAL_DIASTOLIC_BP', 'CRITICAL_LACTATE_MMOL_L',
'CRITICAL_AVPU', 'CRITICAL_GLUCOSE_MG_DL',
'CRITICAL_PAO2_MMHG', 'CRITICAL_PLATELET_K_UL',
'CRITICAL_BILIRUBIN_MG_DL', 'CRITICAL_CREATININE_MG_DL',
'WARNING_HEART_RATE', 'WARNING_TEMP_C', 'WARNING_POTASSIUM_MEQ_L',
'WARNING_SPO2', 'WARNING_RESP_RATE', 'WARNING_WBC_K_UL',
'WARNING_SYSTOLIC_BP', 'WARNING_DIASTOLIC_BP', 'WARNING_LACTATE_MMOL_L',
'WARNING_GLUCOSE_MG_DL',
'WARNING_PAO2_MMHG', 'WARNING_PLATELET_K_UL',
'WARNING_BILIRUBIN_MG_DL', 'WARNING_CREATININE_MG_DL',
'NEWS2_WARNING', 'NEWS2_EMERGENCY',
'RAPID_DETERIORATION', 'QSOFA_WARNING', 'QSOFA_SCREEN',
'GCS_CRITICAL', 'GCS_WARNING',
'SOFA_SEPSIS', 'SOFA_WARNING'
));
""");
}
/// <inheritdoc />
protected override void Down(MigrationBuilder migrationBuilder)
{
}
}
}
VigilCareClinicalAPI/Migrations/AppDbContextModelSnapshot.cs
+1 -1
View File
@@ -156,7 +156,7 @@ namespace VigilCareClinicalAPI.Migrations
b.ToTable("clinical_alerts", null, t =>
{
t.HasCheckConstraint("chk_clinical_alerts_alert_type", "alert_type IN ('SEPSIS_WARNING', 'CRITICAL_HEART_RATE', 'CRITICAL_TEMP_C', 'CRITICAL_POTASSIUM_MEQ_L', 'CRITICAL_SPO2', 'CRITICAL_RESP_RATE', 'CRITICAL_WBC_K_UL', 'CRITICAL_SYSTOLIC_BP', 'CRITICAL_DIASTOLIC_BP', 'CRITICAL_LACTATE_MMOL_L', 'CRITICAL_AVPU', 'CRITICAL_GLUCOSE_MG_DL', 'WARNING_HEART_RATE', 'WARNING_TEMP_C', 'WARNING_POTASSIUM_MEQ_L', 'WARNING_SPO2', 'WARNING_RESP_RATE', 'WARNING_WBC_K_UL', 'WARNING_SYSTOLIC_BP', 'WARNING_DIASTOLIC_BP', 'WARNING_LACTATE_MMOL_L', 'WARNING_GLUCOSE_MG_DL', 'NEWS2_WARNING', 'NEWS2_EMERGENCY', 'RAPID_DETERIORATION', 'QSOFA_WARNING', 'GCS_CRITICAL', 'GCS_WARNING')");
t.HasCheckConstraint("chk_clinical_alerts_alert_type", "alert_type IN ('SEPSIS_WARNING', 'CRITICAL_HEART_RATE', 'CRITICAL_TEMP_C', 'CRITICAL_POTASSIUM_MEQ_L', 'CRITICAL_SPO2', 'CRITICAL_RESP_RATE', 'CRITICAL_WBC_K_UL', 'CRITICAL_SYSTOLIC_BP', 'CRITICAL_DIASTOLIC_BP', 'CRITICAL_LACTATE_MMOL_L', 'CRITICAL_AVPU', 'CRITICAL_GLUCOSE_MG_DL', 'CRITICAL_PAO2_MMHG', 'CRITICAL_PLATELET_K_UL', 'CRITICAL_BILIRUBIN_MG_DL', 'CRITICAL_CREATININE_MG_DL', 'WARNING_HEART_RATE', 'WARNING_TEMP_C', 'WARNING_POTASSIUM_MEQ_L', 'WARNING_SPO2', 'WARNING_RESP_RATE', 'WARNING_WBC_K_UL', 'WARNING_SYSTOLIC_BP', 'WARNING_DIASTOLIC_BP', 'WARNING_LACTATE_MMOL_L', 'WARNING_GLUCOSE_MG_DL', 'WARNING_PAO2_MMHG', 'WARNING_PLATELET_K_UL', 'WARNING_BILIRUBIN_MG_DL', 'WARNING_CREATININE_MG_DL', 'NEWS2_WARNING', 'NEWS2_EMERGENCY', 'RAPID_DETERIORATION', 'QSOFA_WARNING', 'QSOFA_SCREEN', 'GCS_CRITICAL', 'GCS_WARNING', 'SOFA_SEPSIS', 'SOFA_WARNING')");
t.HasCheckConstraint("chk_clinical_alerts_severity", "severity IN ('WARNING', 'CRITICAL')");
VigilCareClinicalAPI/Models/Records/Sepsis/SirsOutcome.cs
-7
View File
@@ -1,7 +0,0 @@
public enum SirsOutcome
{
NotSirsCode,
InsufficientCriteria,
AlertCreated,
AlertAlreadyOpen
}
VigilCareClinicalAPI/Models/Records/Sepsis/SirsResult.cs
-11
View File
@@ -1,11 +0,0 @@
// Discriminated result — allows tests and callers to assert the exact outcome
// without inspecting PostgreSQL or Redis directly.
public record SirsResult(SirsOutcome Outcome, int ActiveCount = 0)
{
public static readonly SirsResult NotSirsCode = new(SirsOutcome.NotSirsCode);
public static readonly SirsResult AlertCreated = new(SirsOutcome.AlertCreated);
public static readonly SirsResult AlertAlreadyOpen = new(SirsOutcome.AlertAlreadyOpen);
public static SirsResult InsufficientCriteria(int count) =>
new(SirsOutcome.InsufficientCriteria, count);
}
VigilCareClinicalAPI/News2/News2Detector.cs
+2
View File
@@ -199,6 +199,8 @@ public class News2Detector
}
}
AlertCreationGuard.EnsureAllowed(alertType);
using var scope = _services.CreateScope();
var db = scope.ServiceProvider.GetRequiredService<AppDbContext>();
VigilCareClinicalAPI/Observability/Metrics/ClinicalMetrics.cs
+2 -9
View File
@@ -11,19 +11,12 @@ public sealed class ClinicalMetrics
"Total observations ingested, labeled by observation code and source.",
labelNames: new[] { "observation_code", "source" });
// Labeled by alert_type (THRESHOLD_BREACH, SEPSIS_WARNING, QSOFA_WARNING) and severity
// (Critical, Warning) so the dashboard can show Critical vs Warning rates separately.
// Labeled by alert_type and severity (e.g. QSOFA_SCREEN/WARNING, SOFA_SEPSIS/CRITICAL).
public readonly Counter ClinicalAlertsTotal = Metrics.CreateCounter(
"clinical_alerts_total",
"Total clinical alerts generated, labeled by type and severity.",
labelNames: new[] { "alert_type", "severity" });
// Incremented only when INSERT WHERE NOT EXISTS succeeds — duplicate-suppressed
// SIRS detections do not count. This is the true detection rate, not the evaluation rate.
public readonly Counter SirsDetectionsTotal = Metrics.CreateCounter(
"sirs_detections_total",
"Total SEPSIS_WARNING alerts generated by the sepsis detection engine.");
public readonly Counter News2ScoresTotal = Metrics.CreateCounter(
"news2_scores_total",
"Total NEWS2 scores computed, labeled by risk level.",
@@ -48,7 +41,7 @@ public sealed class ClinicalMetrics
public readonly Counter QsofaDetectionsTotal = Metrics.CreateCounter(
"qsofa_detections_total",
"Total QSOFA_WARNING alerts generated by the qSOFA scoring engine.");
"Total QSOFA_SCREEN alerts generated by the qSOFA screening engine.");
public readonly Counter SepsisBundleComplianceTotal = Metrics.CreateCounter(
"sepsis_bundle_compliance_total",
VigilCareClinicalAPI/Program.cs
-1
View File
@@ -105,7 +105,6 @@ try
builder.Services.AddScoped<IQsofaService, QsofaService>();
builder.Services.AddScoped<ISepsisBundleService, SepsisBundleService>();
builder.Services.AddScoped<SepsisAlertHandler>();
builder.Services.AddScoped<SirsDetector>();
builder.Services.AddScoped<QsofaDetector>();
builder.Services.AddScoped<UnacknowledgedAlertsCheck>();
builder.Services.AddScoped<PendingOrdersCheck>();
VigilCareClinicalAPI/Sepsis/AlertCreationGuard.cs
+9
View File
@@ -0,0 +1,9 @@
public static class AlertCreationGuard
{
public static void EnsureAllowed(AlertType alertType)
{
if (alertType == AlertType.SepsisWarning)
throw new InvalidOperationException(
"SEPSIS_WARNING is deprecated. Use SOFA_SEPSIS for sepsis detection.");
}
}
VigilCareClinicalAPI/Sepsis/QsofaCalculator.cs
+4
View File
@@ -1,5 +1,9 @@
using StackExchange.Redis;
// qSOFA criteria (Sepsis-3 bedside screen):
// - Respiratory rate ≥ 22 breaths/min
// - Systolic blood pressure ≤ 100 mmHg
// - Altered mentation: AVPU ≥ 1 or GCS total < 15 (via SyncAlteredMentationAsync)
public static class QsofaCalculator
{
public static readonly IReadOnlyList<string> QsofaCodes = new[]
VigilCareClinicalAPI/Sepsis/QsofaDetector.cs
+27 -42
View File
@@ -5,7 +5,6 @@ using StackExchange.Redis;
public class QsofaDetector
{
// 30 minutes in seconds — same sliding window as SIRS.
private const int QsofaTtlSeconds = 1800;
private readonly IConnectionMultiplexer _redis;
@@ -42,30 +41,13 @@ public class QsofaDetector
{
await cache.StringSetAsync(
key, value.ToString(), TimeSpan.FromSeconds(QsofaTtlSeconds));
_logger.LogDebug("qSOFA criterion set: {Key}={Value} (TTL={Ttl}s)",
key, value, QsofaTtlSeconds);
}
else
{
await cache.KeyDeleteAsync(key);
_logger.LogDebug("qSOFA criterion cleared: {Key}", key);
}
var allKeys = QsofaCalculator.AllCriterionKeys(encounterId);
var values = await cache.StringGetAsync(allKeys);
var activeCount = QsofaCalculator.CountActiveCriteria(values);
_logger.LogDebug(
"qSOFA state for encounter {Id}: {Active}/3 criteria active after {Code}={Value}",
encounterId, activeCount, observationCode, value);
if (activeCount < 2)
return QsofaResult.InsufficientCriteria(activeCount);
var created = await TryCreateAlertAsync(encounterId, patientId, activeCount, values, ct);
return created ? QsofaResult.AlertCreated : QsofaResult.AlertAlreadyOpen;
return await EvaluateAndMaybeAlertAsync(encounterId, patientId, ct);
}
public async Task<QsofaResult> SyncAlteredMentationAsync(
@@ -85,16 +67,18 @@ public class QsofaDetector
var total = GcsCalculator.ComputeTotal(eye, verbal, motor)!.Value;
if (QsofaCalculator.MeetsGcsAlteredMentation(total))
{
await cache.StringSetAsync(
avpuKey, "1", TimeSpan.FromSeconds(QsofaTtlSeconds));
}
await cache.StringSetAsync(avpuKey, "1", TimeSpan.FromSeconds(QsofaTtlSeconds));
else
{
await cache.KeyDeleteAsync(avpuKey);
}
}
return await EvaluateAndMaybeAlertAsync(encounterId, patientId, ct);
}
private async Task<QsofaResult> EvaluateAndMaybeAlertAsync(
Guid encounterId, Guid patientId, CancellationToken ct)
{
var cache = _redis.GetDatabase();
var allKeys = QsofaCalculator.AllCriterionKeys(encounterId);
var values = await cache.StringGetAsync(allKeys);
var activeCount = QsofaCalculator.CountActiveCriteria(values);
@@ -102,17 +86,19 @@ public class QsofaDetector
if (activeCount < 2)
return QsofaResult.InsufficientCriteria(activeCount);
var created = await TryCreateAlertAsync(encounterId, patientId, activeCount, values, ct);
var created = await TryCreateScreenAlertAsync(encounterId, patientId, activeCount, values, ct);
return created ? QsofaResult.AlertCreated : QsofaResult.AlertAlreadyOpen;
}
private async Task<bool> TryCreateAlertAsync(
private async Task<bool> TryCreateScreenAlertAsync(
Guid encounterId,
Guid patientId,
int activeCount,
RedisValue[] criterionValues,
CancellationToken ct)
{
AlertCreationGuard.EnsureAllowed(AlertType.QsofaScreen);
using var scope = _services.CreateScope();
var db = scope.ServiceProvider.GetRequiredService<AppDbContext>();
@@ -120,17 +106,21 @@ public class QsofaDetector
var alertId = Guid.NewGuid();
var triggeredAt = DateTimeOffset.UtcNow;
var details = BuildDetails(activeCount, criterionValues);
var activeCriteria = BuildActiveCriteriaList(criterionValues);
var details =
$"qSOFA score ≥ 2 (criteria: {activeCriteria}). " +
"Recommend: order SOFA labs (PaO2/FiO2, platelets, bilirubin, creatinine) " +
"to evaluate for organ dysfunction.";
var affected = await db.Database.ExecuteSqlInterpolatedAsync($"""
INSERT INTO clinical_alerts
(id, encounter_id, patient_id, alert_type, severity, details, status, triggered_at)
SELECT {alertId}, {encounterId}, {patientId},
'QSOFA_WARNING', 'CRITICAL', {details}, 'OPEN', {triggeredAt}
'QSOFA_SCREEN', 'WARNING', {details}, 'OPEN', {triggeredAt}
WHERE NOT EXISTS (
SELECT 1 FROM clinical_alerts
WHERE encounter_id = {encounterId}
AND alert_type = 'QSOFA_WARNING'
AND alert_type = 'QSOFA_SCREEN'
AND status IN ('OPEN', 'ESCALATED')
)
""", ct);
@@ -138,8 +128,6 @@ public class QsofaDetector
if (affected == 0)
{
await tx.RollbackAsync(ct);
_logger.LogDebug(
"QSOFA_WARNING already open for encounter {Id} — no new alert", encounterId);
return false;
}
@@ -152,8 +140,8 @@ public class QsofaDetector
alertId,
encounterId,
patientId,
alertType = AlertType.QsofaWarning.ToDbString(),
severity = "Critical",
alertType = AlertType.QsofaScreen.ToDbString(),
severity = AlertSeverity.Warning.ToDbString(),
details,
triggeredAt,
partitionKey = encounterId.ToString()
@@ -167,24 +155,22 @@ public class QsofaDetector
_metrics.QsofaDetectionsTotal.Inc();
_metrics.ClinicalAlertsTotal
.WithLabels(AlertType.QsofaWarning.ToDbString(), AlertSeverity.Critical.ToDbString())
.WithLabels(AlertType.QsofaScreen.ToDbString(), AlertSeverity.Warning.ToDbString())
.Inc();
using (LogContext.PushProperty("EncounterId", encounterId))
using (LogContext.PushProperty("PatientId", patientId))
{
_logger.LogWarning(
"QSOFA_WARNING created. ActiveCriteriaCount={Count} AlertId={AlertId}",
"QSOFA_SCREEN created. ActiveCriteriaCount={Count} AlertId={AlertId}",
activeCount, alertId);
}
var handler = scope.ServiceProvider.GetRequiredService<SepsisAlertHandler>();
await handler.OnSepsisAlertCreatedAsync(encounterId, alertId, AlertType.QsofaWarning, ct);
// Screening alert — does NOT trigger sepsis bundle (Phase 27 Step 4)
return true;
}
private static string BuildDetails(int activeCount, RedisValue[] values)
private static string BuildActiveCriteriaList(RedisValue[] values)
{
var activeParts = new List<string>();
for (var i = 0; i < QsofaCalculator.QsofaCodes.Count; i++)
@@ -192,7 +178,6 @@ public class QsofaDetector
if (values[i].HasValue)
activeParts.Add($"{QsofaCalculator.QsofaCodes[i]}={values[i]}");
}
return $"qSOFA score {activeCount}/3: {string.Join(", ", activeParts)}";
return string.Join(", ", activeParts);
}
}
VigilCareClinicalAPI/Sepsis/SepsisAlertHandler.cs
+8
View File
@@ -12,6 +12,14 @@ public class SepsisAlertHandler
public async Task OnSepsisAlertCreatedAsync(
Guid encounterId, Guid alertId, AlertType alertType, CancellationToken ct)
{
if (alertType != AlertType.SofaSepsis)
{
_logger.LogDebug(
"Alert type {AlertType} does not trigger sepsis bundle — skipping",
alertType.ToDbString());
return;
}
var bundle = await _bundleService.TryCreateBundleAsync(encounterId, alertId, alertType, ct);
if (bundle is not null)
VigilCareClinicalAPI/Sepsis/SirsDetector.cs
-177
View File
@@ -1,177 +0,0 @@
using System.Text.Json;
using Microsoft.EntityFrameworkCore;
using Serilog.Context;
using StackExchange.Redis;
public class SirsDetector
{
// 30 minutes in seconds. This is a clinical parameter: SIRS criteria evaluated
// outside a 30-minute window are clinically stale. The TTL enforces the window
// automatically — no cleanup job required.
private const int SirsTtlSeconds = 1800;
private readonly IConnectionMultiplexer _redis;
private readonly IServiceProvider _services;
private readonly ILogger<SirsDetector> _logger;
private readonly ClinicalMetrics _metrics;
public SirsDetector(
IConnectionMultiplexer redis,
IServiceProvider services,
ILogger<SirsDetector> logger,
ClinicalMetrics metrics)
{
_redis = redis;
_services = services;
_logger = logger;
_metrics = metrics;
}
public async Task<SirsResult> ProcessObservationAsync(
Guid encounterId,
Guid patientId,
string observationCode,
decimal value,
CancellationToken ct = default)
{
// Fast exit for non-SIRS codes. The sepsis engine subscribes to the full
// observation.recorded stream — the majority of messages (SpO2, potassium, glucose)
// are not SIRS-relevant and are discarded here without touching Redis or PostgreSQL.
if (!SirsEvaluator.SirsCodes.Contains(observationCode))
return SirsResult.NotSirsCode;
var cache = _redis.GetDatabase();
var key = SirsEvaluator.CriterionKey(encounterId, observationCode);
if (SirsEvaluator.MeetsCriterion(observationCode, value))
{
// SET with EX refreshes the TTL on every qualifying observation.
// A patient with tachycardia posting a reading every 60 seconds will keep
// sirs:{id}:HEART_RATE alive for 30 minutes after the LAST qualifying reading,
// not the first — the window slides forward with each new abnormal value.
await cache.StringSetAsync(key, "1", TimeSpan.FromSeconds(SirsTtlSeconds));
_logger.LogDebug("SIRS criterion set: {Key} (TTL={Ttl}s)", key, SirsTtlSeconds);
}
else
{
// Criterion no longer met — remove the key immediately rather than waiting
// for TTL expiry. If a patient's temperature normalises at 37.0 °C, the
// fever criterion must stop contributing to the count right away.
// Without this DEL, a recovered criterion could persist for up to 30 minutes
// and falsely sustain a SEPSIS_WARNING count.
await cache.KeyDeleteAsync(key);
_logger.LogDebug("SIRS criterion cleared: {Key}", key);
}
// Count active criteria in one MGET round-trip.
// MGET is O(N) where N = number of keys requested (4 here, always).
// Never use KEYS pattern for this check: KEYS scans the entire keyspace
// and blocks all other Redis operations until the scan completes.
var allKeys = SirsEvaluator.AllCriterionKeys(encounterId);
var values = await cache.StringGetAsync(allKeys);
var activeCount = values.Count(v => v.HasValue);
_logger.LogDebug(
"SIRS state for encounter {Id}: {Active}/4 criteria active after {Code}={Value}",
encounterId, activeCount, observationCode, value);
if (activeCount < 2)
return SirsResult.InsufficientCriteria(activeCount);
// Two or more criteria are active — attempt to create the alert.
var created = await TryCreateAlertAsync(encounterId, patientId, activeCount, ct);
return created ? SirsResult.AlertCreated : SirsResult.AlertAlreadyOpen;
}
// Creates the SEPSIS_WARNING alert and its outbox event in one atomic transaction.
// The INSERT WHERE NOT EXISTS pattern makes this safe under at-least-once delivery:
// if the consumer crashes after the INSERT but before committing the Kafka offset,
// the observation is reprocessed on restart. The second run hits the WHERE NOT EXISTS
// subquery, finds the existing open alert, inserts 0 rows, and returns false — no
// duplicate alert, no duplicate outbox event.
private async Task<bool> TryCreateAlertAsync(
Guid encounterId,
Guid patientId,
int activeCount,
CancellationToken ct)
{
using var scope = _services.CreateScope();
var db = scope.ServiceProvider.GetRequiredService<AppDbContext>();
await using var tx = await db.Database.BeginTransactionAsync(ct);
var alertId = Guid.NewGuid();
var triggeredAt = DateTimeOffset.UtcNow;
var details =
$"SIRS criteria met: {activeCount} of 4 criteria active within the 30-minute window.";
// One SQL round-trip: check + insert atomically.
// status IN ('OPEN', 'ESCALATED') prevents re-creating an alert that has been
// escalated but not yet resolved — the patient is still in danger.
var affected = await db.Database.ExecuteSqlInterpolatedAsync($"""
INSERT INTO clinical_alerts
(id, encounter_id, patient_id, alert_type, severity, details, status, triggered_at)
SELECT {alertId}, {encounterId}, {patientId},
'SEPSIS_WARNING', 'CRITICAL', {details}, 'OPEN', {triggeredAt}
WHERE NOT EXISTS (
SELECT 1 FROM clinical_alerts
WHERE encounter_id = {encounterId}
AND alert_type = 'SEPSIS_WARNING'
AND status IN ('OPEN', 'ESCALATED')
)
""", ct);
if (affected == 0)
{
await tx.RollbackAsync(ct);
_logger.LogDebug(
"SEPSIS_WARNING already open for encounter {Id} — no new alert", encounterId);
return false;
}
// Alert was created — write the outbox event in the same transaction.
// The relay (Phase 3) will publish to alert.generated, which Phase 6's
// notification worker reads to page the attending physician via RabbitMQ.
db.OutboxEvents.Add(new OutboxEvent
{
Id = Guid.NewGuid(),
Topic = "alert.generated",
Payload = JsonSerializer.Serialize(new
{
alertId,
encounterId,
patientId,
alertType = AlertType.SepsisWarning.ToDbString(),
severity = "Critical",
details,
triggeredAt,
partitionKey = encounterId.ToString()
}),
PartitionKey = encounterId.ToString(),
CreatedAt = DateTimeOffset.UtcNow
});
await db.SaveChangesAsync(ct);
await tx.CommitAsync(ct);
_metrics.SirsDetectionsTotal.Inc();
_metrics.ClinicalAlertsTotal
.WithLabels(AlertType.SepsisWarning.ToDbString(), AlertSeverity.Critical.ToDbString())
.Inc();
using (LogContext.PushProperty("EncounterId", encounterId))
using (LogContext.PushProperty("PatientId", patientId))
{
_logger.LogWarning(
"SEPSIS_WARNING created. ActiveCriteriaCount={Count} AlertId={AlertId}",
activeCount, alertId);
}
var handler = scope.ServiceProvider.GetRequiredService<SepsisAlertHandler>();
await handler.OnSepsisAlertCreatedAsync(encounterId, alertId, AlertType.SepsisWarning, ct);
return true;
}
}
VigilCareClinicalAPI/Sepsis/SirsEvaluator.cs
-38
View File
@@ -1,38 +0,0 @@
using StackExchange.Redis;
public static class SirsEvaluator
{
// The four SIRS codes defined by this project's simplified SIRS criteria.
// Observations for any other code are ignored by the sepsis engine entirely —
// they pass through to the outbox and Elasticsearch but do not affect SIRS state.
public static readonly IReadOnlySet<string> SirsCodes =
new HashSet<string> { "TEMP_C", "HEART_RATE", "RESP_RATE", "WBC_K_UL" };
// Returns true if the observation value meets the SIRS criterion for its code.
// These thresholds are clinical parameters, not configuration — changing them
// requires clinical review, not a config file edit. They live here as named constants.
public static bool MeetsCriterion(string observationCode, decimal value) =>
observationCode switch
{
// Fever (> 38.3 °C) or hypothermia (< 36.0 °C)
"TEMP_C" => value > 38.3m || value < 36.0m,
// Tachycardia
"HEART_RATE" => value > 90m,
// Tachypnea
"RESP_RATE" => value > 20m,
// Leukocytosis or leukopenia
"WBC_K_UL" => value > 12.0m || value < 4.0m,
_ => false
};
// Redis key for one SIRS criterion for one encounter.
public static string CriterionKey(Guid encounterId, string code) =>
$"sirs:{encounterId}:{code}";
// All four Redis keys for one encounter — used in MGET to count active criteria.
// The order is stable so the MGET result array always maps to the same codes.
public static RedisKey[] AllCriterionKeys(Guid encounterId) =>
SirsCodes
.Select(code => (RedisKey)CriterionKey(encounterId, code))
.ToArray();
}
VigilCareClinicalAPI/Services/SepsisBundleService.cs
+4
View File
@@ -17,6 +17,10 @@ public class SepsisBundleService : ISepsisBundleService
public async Task<SepsisBundle?> TryCreateBundleAsync(
Guid encounterId, Guid triggeringAlertId, AlertType alertType, CancellationToken ct = default)
{
if (alertType != AlertType.SofaSepsis)
throw new InvalidOperationException(
$"Sepsis bundle can only be triggered by SOFA_SEPSIS, not {alertType.ToDbString()}.");
var exists = await _db.SepsisBundles
.AnyAsync(b => b.EncounterId == encounterId
&& b.ComplianceStatus == SepsisBundleComplianceStatus.InProgress, ct);
VigilCareClinicalAPI/Sofa/SofaDetector.cs
+8
View File
@@ -276,6 +276,8 @@ public class SofaDetector
return false;
}
AlertCreationGuard.EnsureAllowed(alertType);
using var scope = _services.CreateScope();
var db = scope.ServiceProvider.GetRequiredService<AppDbContext>();
@@ -332,6 +334,12 @@ public class SofaDetector
await db.SaveChangesAsync(ct);
await tx.CommitAsync(ct);
if (alertType == AlertType.SofaSepsis)
{
var handler = _services.GetRequiredService<SepsisAlertHandler>();
await handler.OnSepsisAlertCreatedAsync(encounterId, alertId, alertType, ct);
}
_metrics.ClinicalAlertsTotal
.WithLabels(alertType.ToDbString(), severity.ToDbString()).Inc();
docs/decisions/sepsis-engine-design.md
+18 -2
View File
@@ -1,4 +1,3 @@
```markdown
# Sepsis Engine Design Decisions
## Why Redis for SIRS state, not a PostgreSQL time-range query
@@ -50,4 +49,21 @@ and no additional infrastructure. The trade-off: if this system needed to scale
multi-hospital network with 50,000+ concurrent inpatients (~5,000 observations/second),
Flink would become the right choice. The architecture decision is correct at this scale
and defensible at interview with a clear scale inflection point named.
```
## Phase 27 — Migration from SIRS to SOFA
**Rationale:** Sepsis-3 (2016) replaced SIRS with SOFA for organ dysfunction assessment.
SIRS is non-specific (post-exercise tachycardia, mild fever). Doctor feedback aligned with
moving sepsis **confirmation** to SOFA delta ≥ 2 while retaining qSOFA as a **bedside screen**.
**What changed:**
- `SirsDetector` / `SirsEvaluator` deleted — no new `SEPSIS_WARNING` alerts
- qSOFA ≥ 2 → `QSOFA_SCREEN` (WARNING, suppressible) with lab-order recommendation
- Sepsis hour-1 bundle triggers from `SOFA_SEPSIS` only (Phase 26 delta ≥ 2)
- Historical `SEPSIS_WARNING` and `QSOFA_WARNING` rows remain queryable
**Redis key patterns after Phase 27:**
- `qsofa:{encounterId}:{code}` — qSOFA screening (30 min TTL)
- `sofa:{encounterId}:{code}` — SOFA lab carry-forward (Phase 26)
- `gcs:{encounterId}:{code}` — GCS components (Phase 25)
- ~~`sirs:{encounterId}:{code}`~~ — removed (legacy keys expire)
scripts/run-phase27-verification.sh
Executable
+28
View File
@@ -0,0 +1,28 @@
#!/usr/bin/env bash
set -euo pipefail
SCRIPT_DIR="$(cd "$(dirname "${BASH_SOURCE[0]}")" && pwd)"
ROOT_DIR="$(cd "${SCRIPT_DIR}/.." && pwd)"
API_DIR="${ROOT_DIR}/VigilCareClinicalAPI"
echo "=== Phase 27 verification ==="
echo "1. SIRS files removed"
test ! -f "${API_DIR}/Sepsis/SirsDetector.cs"
test ! -f "${API_DIR}/Sepsis/SirsEvaluator.cs"
echo "2. Sepsis refactor integration tests"
dotnet test "${ROOT_DIR}/VigilCareClinicalAPI.Tests" \
--filter "FullyQualifiedName~SepsisRefactor" \
--no-restore
echo "3. Full regression suite"
dotnet test "${ROOT_DIR}/VigilCareClinicalAPI.Tests" --no-restore
echo "4. Manual checks (requires running stack)"
BASE_URL="${BASE_URL:-http://localhost:5270}"
echo " - Replay uti-sepsis-elderly-01 → expect QSOFA_SCREEN, not SEPSIS_WARNING"
echo " - Ingest SOFA labs with delta ≥ 2 → expect SOFA_SEPSIS + bundle"
echo " - GET ${BASE_URL}/api/v1/alerts?alertType=SEPSIS_WARNING → legacy rows still returned"
echo "Phase 27 verification complete."
vigilcare-dashboard/src/__tests__/AlertCard.test.js
+1 -1
View File
@@ -26,7 +26,7 @@ describe('AlertCard', () => {
it('showsAlertTypeAndSeverity', () => {
const wrapper = mount(AlertCard, { props: { alert: openAlert } })
expect(wrapper.text()).toContain('Critical')
expect(wrapper.text()).toContain('SEPSIS_WARNING')
expect(wrapper.text()).toContain('Sepsis Warning (SIRS — Legacy)')
})
it('acknowledgeButtonEmitsEvent', async () => {
vigilcare-dashboard/src/__tests__/AlertLabels.test.js
+28
View File
@@ -0,0 +1,28 @@
import { describe, it, expect } from 'vitest'
import { alertTypeLabel, bundleTriggerLabel } from '@/api/normalize'
describe('AlertLabels', () => {
it('sofaSepsisLabel', () => {
expect(alertTypeLabel('SofaSepsis')).toBe('Sepsis Alert (SOFA)')
})
it('legacySepsisLabel', () => {
expect(alertTypeLabel('SepsisWarning')).toBe('Sepsis Warning (SIRS — Legacy)')
})
it('qsofaScreenLabel', () => {
expect(alertTypeLabel('QsofaScreen')).toBe('qSOFA Screen')
})
it('gcsCriticalLabel', () => {
expect(alertTypeLabel('GcsCritical')).toBe('GCS Critical (≤ 8)')
})
it('bundleTriggerSofa', () => {
expect(bundleTriggerLabel('SOFA_SEPSIS')).toBe('SOFA delta ≥ 2')
})
it('bundleTriggerLegacy', () => {
expect(bundleTriggerLabel('SEPSIS_WARNING')).toBe('SIRS criteria (Legacy)')
})
})
vigilcare-dashboard/src/__tests__/AlertReasoning.test.js
+12 -10
View File
@@ -11,11 +11,11 @@ const sepsisAlert = {
triggeredAt: '2026-06-19T12:00:00Z',
}
const qsofaAlert = {
const qsofaScreenAlert = {
id: 'alert-2',
alertType: 'QsofaWarning',
alertType: 'QsofaScreen',
severity: 'Warning',
details: 'qSOFA score elevated',
details: 'qSOFA screen positive',
triggeredAt: '2026-06-19T12:30:00Z',
}
@@ -24,16 +24,18 @@ describe('AlertReasoning', () => {
setActivePinia(createPinia())
})
it('showsExplanationForSepsisWarning', () => {
it('showsExplanationForLegacySepsisWarning', () => {
const wrapper = mount(AlertReasoning, { props: { alert: sepsisAlert } })
expect(wrapper.text()).toContain('SIRS / Sepsis Alert')
expect(wrapper.text()).toContain('≥2 of 4 SIRS criteria met')
expect(wrapper.text()).toContain('SIRS / Sepsis Alert (Legacy)')
expect(wrapper.text()).toContain('Historical alert')
expect(wrapper.text()).toContain('SOFA delta')
})
it('showsExplanationForQsofa', () => {
const wrapper = mount(AlertReasoning, { props: { alert: qsofaAlert } })
expect(wrapper.text()).toContain('qSOFA Alert')
expect(wrapper.text()).toContain('≥2 of 3 qSOFA criteria met')
it('showsExplanationForQsofaScreen', () => {
const wrapper = mount(AlertReasoning, { props: { alert: qsofaScreenAlert } })
expect(wrapper.text()).toContain('qSOFA Screen')
expect(wrapper.text()).toContain('Bedside screen positive')
expect(wrapper.text()).toContain('Recommend ordering SOFA labs (PaO₂')
})
it('showsRawDetailsForUnknownType', () => {
vigilcare-dashboard/src/__tests__/FeedbackSummary.test.js
+2 -2
View File
@@ -28,8 +28,8 @@ describe('FeedbackSummary', () => {
it('showsPerAlertTypeBreakdown', () => {
const wrapper = mount(FeedbackSummary)
expect(wrapper.text()).toContain('SEPSIS_WARNING')
expect(wrapper.text()).toContain('WARNING_HEART_RATE')
expect(wrapper.text()).toContain('Sepsis Warning (SIRS — Legacy)')
expect(wrapper.text()).toContain('Warning Heart Rate')
expect(wrapper.text()).toContain('2 ratings')
expect(wrapper.text()).toContain('1 ratings')
})
vigilcare-dashboard/src/__tests__/GcsEntryForm.test.js
+63
View File
@@ -0,0 +1,63 @@
import { describe, it, expect } from 'vitest'
import { mount } from '@vue/test-utils'
import GcsEntryForm from '@/components/patient/GcsEntryForm.vue'
describe('GcsEntryForm', () => {
it('rendersThreeDropdowns', () => {
const wrapper = mount(GcsEntryForm)
expect(wrapper.findAll('select')).toHaveLength(3)
expect(wrapper.text()).toContain('Eye (E)')
expect(wrapper.text()).toContain('Verbal (V)')
expect(wrapper.text()).toContain('Motor (M)')
})
it('computesTotalCorrectly', async () => {
const wrapper = mount(GcsEntryForm)
await wrapper.findAll('select')[0].setValue(2)
await wrapper.findAll('select')[1].setValue(3)
await wrapper.findAll('select')[2].setValue(4)
expect(wrapper.text()).toContain('GCS 9/15')
})
it('showsClassification', async () => {
const wrapper = mount(GcsEntryForm)
await wrapper.findAll('select')[0].setValue(2)
await wrapper.findAll('select')[1].setValue(3)
await wrapper.findAll('select')[2].setValue(3)
expect(wrapper.text()).toContain('Severe')
await wrapper.findAll('select')[0].setValue(4)
await wrapper.findAll('select')[1].setValue(4)
await wrapper.findAll('select')[2].setValue(4)
expect(wrapper.text()).toContain('Moderate')
await wrapper.findAll('select')[0].setValue(4)
await wrapper.findAll('select')[1].setValue(5)
await wrapper.findAll('select')[2].setValue(6)
expect(wrapper.text()).toContain('Mild')
})
it('emitsSubmitWithComponents', async () => {
const wrapper = mount(GcsEntryForm)
await wrapper.findAll('select')[0].setValue(3)
await wrapper.findAll('select')[1].setValue(4)
await wrapper.findAll('select')[2].setValue(5)
await wrapper.find('button').trigger('click')
expect(wrapper.emitted('submit')?.[0]?.[0]).toEqual({ eye: 3, verbal: 4, motor: 5 })
})
it('defaultsToNormalValues', () => {
const wrapper = mount(GcsEntryForm)
expect(wrapper.text()).toContain('GCS 15/15')
expect(wrapper.text()).toContain('E4 V5 M6')
})
it('usesResponsiveLayout', () => {
const wrapper = mount(GcsEntryForm)
const grid = wrapper.find('.grid')
expect(grid.classes()).toContain('grid-cols-1')
expect(grid.classes()).toContain('sm:grid-cols-3')
expect(wrapper.find('button').classes()).toContain('w-full')
expect(wrapper.find('button').classes()).toContain('sm:w-auto')
})
})
vigilcare-dashboard/src/__tests__/ScoresPanel.test.js
+49
View File
@@ -0,0 +1,49 @@
import { describe, it, expect, beforeEach } from 'vitest'
import { mount } from '@vue/test-utils'
import { createPinia, setActivePinia } from 'pinia'
import ScoresPanel from '@/components/patient/ScoresPanel.vue'
import { useScoringStore } from '@/stores/scoring'
describe('ScoresPanel', () => {
beforeEach(() => {
setActivePinia(createPinia())
const store = useScoringStore()
store.$patch({
news2: { totalScore: 5, riskLevel: 'Medium' },
gcs: { eyeScore: 4, verbalScore: 5, motorScore: 6, totalScore: 15 },
sofa: { totalScore: 4, deltaFromBaseline: 0, respiratoryScore: 1, coagulationScore: 0, liverScore: 0, cardiovascularScore: 1, cnsScore: 1, renalScore: 1 },
qsofa: { activeCriteria: 2 },
})
})
it('showsGcsSection', () => {
const wrapper = mount(ScoresPanel)
expect(wrapper.text()).toContain('GCS')
expect(wrapper.text()).toContain('15/15')
expect(wrapper.text()).toContain('E4 V5 M6')
})
it('showsSofaSection', () => {
const wrapper = mount(ScoresPanel)
expect(wrapper.text()).toContain('SOFA')
expect(wrapper.text()).toContain('4/24')
})
it('noSirsReference', () => {
const wrapper = mount(ScoresPanel)
expect(wrapper.text().toUpperCase()).not.toContain('SIRS')
})
it('qsofaLabeledAsScreen', () => {
const wrapper = mount(ScoresPanel)
expect(wrapper.text()).toContain('qSOFA Screen')
expect(wrapper.text()).toContain('Bedside screening')
})
it('sofaOrganBadgesUseResponsiveGrid', () => {
const wrapper = mount(ScoresPanel)
const grid = wrapper.find('.grid.grid-cols-2')
expect(grid.exists()).toBe(true)
expect(grid.classes()).toContain('sm:flex')
})
})
vigilcare-dashboard/src/__tests__/SofaScorePanel.test.js
+110
View File
@@ -0,0 +1,110 @@
import { describe, it, expect, vi, beforeEach } from 'vitest'
import { mount } from '@vue/test-utils'
import SofaScorePanel from '@/components/patient/SofaScorePanel.vue'
const mockFetch = vi.fn()
const mockState = {
total: null,
delta: null,
organs: [],
hasStaleData: false,
staleness: null,
loading: false,
fetch: mockFetch,
}
vi.mock('@/composables/useSofa', () => ({
useSofa: () => mockState,
}))
describe('SofaScorePanel', () => {
beforeEach(() => {
mockState.total = null
mockState.delta = null
mockState.organs = []
mockState.hasStaleData = false
mockState.staleness = null
mockState.loading = false
mockFetch.mockClear()
})
it('showsLabsPending_WhenNoScore', () => {
const wrapper = mount(SofaScorePanel, {
props: { encounterId: 'enc-1' },
})
expect(wrapper.text()).toContain('Labs pending')
})
it('showsOrganBreakdown', () => {
mockState.total = 8
mockState.organs = [
{ name: 'Respiratory', score: 2, max: 4 },
{ name: 'Coagulation', score: 1, max: 4 },
{ name: 'Liver', score: 0, max: 4 },
{ name: 'Cardiovascular', score: 3, max: 4 },
{ name: 'CNS', score: 1, max: 4 },
{ name: 'Renal', score: 1, max: 4 },
]
const wrapper = mount(SofaScorePanel, {
props: { encounterId: 'enc-1' },
})
expect(wrapper.text()).toContain('Respiratory')
expect(wrapper.text()).toContain('Renal')
expect(wrapper.text()).toContain('8/24')
})
it('showsDeltaBadge_WhenDeltaGe2', () => {
mockState.total = 10
mockState.delta = 2
mockState.organs = [{ name: 'CNS', score: 2, max: 4 }]
const wrapper = mount(SofaScorePanel, {
props: { encounterId: 'enc-1' },
})
expect(wrapper.text()).toContain('+2 from baseline')
})
it('showsStalenessWarning', () => {
mockState.total = 6
mockState.hasStaleData = true
mockState.staleness = {
staleComponents: ['Platelets'],
missingComponents: ['PaO2'],
usedSpO2Fallback: true,
}
mockState.organs = [{ name: 'Coagulation', score: 1, max: 4 }]
const wrapper = mount(SofaScorePanel, {
props: { encounterId: 'enc-1' },
})
expect(wrapper.text()).toContain('Missing: PaO2')
expect(wrapper.text()).toContain('Stale: Platelets')
expect(wrapper.text()).toContain('SpO₂/FiO₂ proxy')
})
it('organScoreColors', () => {
mockState.total = 3
mockState.organs = [
{ name: 'Liver', score: 0, max: 4 },
{ name: 'CNS', score: 2, max: 4 },
{ name: 'Renal', score: 4, max: 4 },
]
const wrapper = mount(SofaScorePanel, {
props: { encounterId: 'enc-1' },
})
const badges = wrapper.findAll('span')
expect(badges.some(b => b.text().includes('0/4'))).toBe(true)
expect(badges.some(b => b.text().includes('2/4'))).toBe(true)
expect(badges.some(b => b.text().includes('4/4'))).toBe(true)
})
it('usesResponsiveOrganGrid', () => {
mockState.total = 4
mockState.organs = [{ name: 'CNS', score: 1, max: 4 }]
const wrapper = mount(SofaScorePanel, {
props: { encounterId: 'enc-1' },
})
const grid = wrapper.find('.grid')
expect(grid.classes()).toContain('grid-cols-2')
expect(grid.classes()).toContain('sm:grid-cols-3')
expect(grid.classes()).toContain('lg:grid-cols-6')
})
})
vigilcare-dashboard/src/api/clinical.js
+37
View File
@@ -8,6 +8,14 @@ export function fetchCurrentQsofa(encounterId) {
return api.get(`/api/v1/encounters/${encounterId}/qsofa/current`)
}
export function fetchCurrentGcs(encounterId) {
return api.get(`/api/v1/encounters/${encounterId}/gcs`)
}
export function fetchCurrentSofa(encounterId) {
return api.get(`/api/v1/encounters/${encounterId}/sofa`)
}
export function fetchSepsisBundle(encounterId) {
return api.get(`/api/v1/encounters/${encounterId}/sepsis-bundle/current`)
}
@@ -16,6 +24,35 @@ export function fetchOrders(encounterId) {
return api.get(`/api/v1/encounters/${encounterId}/orders`)
}
export async function submitGcsObservations(encounterId, eye, verbal, motor) {
const recordedAt = new Date().toISOString()
return api.post(`/api/v1/encounters/${encounterId}/observations`, {
observations: [
{
observationCode: 'GCS_EYE',
value: eye,
unit: 'score',
source: 'Manual',
recordedAt,
},
{
observationCode: 'GCS_VERBAL',
value: verbal,
unit: 'score',
source: 'Manual',
recordedAt,
},
{
observationCode: 'GCS_MOTOR',
value: motor,
unit: 'score',
source: 'Manual',
recordedAt,
},
],
})
}
export async function fetchNews2History(encounterId, { limit = 100 } = {}) {
const all = []
let cursor = null
vigilcare-dashboard/src/api/normalize.js
+58 -2
View File
@@ -1,7 +1,60 @@
// Map API PascalCase alert types to display labels (e.g. WarningHeartRate → WARNING_HEART_RATE)
const ALERT_TYPE_LABELS = {
SepsisWarning: 'Sepsis Warning (SIRS — Legacy)',
QsofaWarning: 'qSOFA Alert (Legacy)',
QsofaScreen: 'qSOFA Screen',
SofaSepsis: 'Sepsis Alert (SOFA)',
SofaWarning: 'SOFA Warning',
GcsCritical: 'GCS Critical (≤ 8)',
GcsWarning: 'GCS Warning (9–12)',
News2Warning: 'NEWS2 Warning',
News2Emergency: 'NEWS2 Emergency',
RapidDeterioration: 'Rapid Deterioration',
CriticalHeartRate: 'Critical Heart Rate',
CriticalTempC: 'Critical Temperature',
CriticalPotassiumMeqL: 'Critical Potassium',
CriticalSpo2: 'Critical SpO₂',
CriticalRespRate: 'Critical Respiratory Rate',
CriticalWbcKUl: 'Critical WBC',
CriticalSystolicBp: 'Critical Systolic BP',
CriticalDiastolicBp: 'Critical Diastolic BP',
CriticalLactateMmolL: 'Critical Lactate',
CriticalAvpu: 'Critical AVPU',
CriticalGlucoseMgDl: 'Critical Glucose',
WarningHeartRate: 'Warning Heart Rate',
WarningTempC: 'Warning Temperature',
WarningPotassiumMeqL: 'Warning Potassium',
WarningSpo2: 'Warning SpO₂',
WarningRespRate: 'Warning Respiratory Rate',
WarningWbcKUl: 'Warning WBC',
WarningSystolicBp: 'Warning Systolic BP',
WarningDiastolicBp: 'Warning Diastolic BP',
WarningLactateMmolL: 'Warning Lactate',
WarningGlucoseMgDl: 'Warning Glucose',
CriticalPao2MmHg: 'Critical PaO₂',
WarningPao2MmHg: 'Warning PaO₂',
CriticalPlateletKUl: 'Critical Platelets',
WarningPlateletKUl: 'Warning Platelets',
CriticalBilirubinMgDl: 'Critical Bilirubin',
WarningBilirubinMgDl: 'Warning Bilirubin',
CriticalCreatinineMgDl: 'Critical Creatinine',
WarningCreatinineMgDl: 'Warning Creatinine',
}
const BUNDLE_TRIGGER_LABELS = {
SOFA_SEPSIS: 'SOFA delta ≥ 2',
SEPSIS_WARNING: 'SIRS criteria (Legacy)',
QSOFA_WARNING: 'qSOFA alert (Legacy)',
}
export function alertTypeLabel(type) {
if (!type) return ''
return type.replace(/([A-Z])/g, '_$1').slice(1).toUpperCase()
return ALERT_TYPE_LABELS[type]
?? type.replace(/([A-Z])/g, '_$1').slice(1).toUpperCase()
}
export function bundleTriggerLabel(triggerType) {
if (!triggerType) return ''
return BUNDLE_TRIGGER_LABELS[triggerType] ?? triggerType.replace(/_/g, ' ')
}
export function alertStatusToApiFilter(status) {
@@ -23,6 +76,9 @@ const OBSERVATION_LABELS = {
AVPU: 'AVPU',
SUPPLEMENTAL_O2: 'Supplemental O₂',
WBC_K_UL: 'WBC',
GCS_EYE: 'GCS Eye',
GCS_VERBAL: 'GCS Verbal',
GCS_MOTOR: 'GCS Motor',
}
export function observationCodeLabel(code) {
vigilcare-dashboard/src/components/alerts/AlertCard.vue
+14 -2
View File
@@ -1,16 +1,27 @@
<script setup>
import { computed } from 'vue'
import Card from '@/components/ui/Card.vue'
import Badge from '@/components/ui/Badge.vue'
import Button from '@/components/ui/Button.vue'
import FeedbackButtons from '@/components/feedback/FeedbackButtons.vue'
import { alertTypeLabel } from '@/api/normalize'
defineProps({
const props = defineProps({
alert: { type: Object, required: true },
})
const emit = defineEmits(['acknowledge', 'resolve'])
const actionHint = computed(() => {
const hints = {
QsofaScreen: 'Recommend SOFA labs',
SofaSepsis: 'Review organ breakdown · Initiate bundle',
GcsCritical: 'Urgent neuro assessment',
GcsWarning: 'Monitor consciousness',
}
return hints[props.alert.alertType] ?? null
})
function severityVariant(severity) {
return severity === 'Critical' ? 'critical' : 'warning'
}
@@ -35,11 +46,12 @@ function formatTime(iso) {
<template>
<Card>
<div class="flex flex-col gap-4 sm:flex-row sm:items-start sm:justify-between">
<div class="flex flex-col gap-4 sm:flex-row sm:items-start sm:justify-between">
<div class="min-w-0 flex-1">
<div class="flex flex-wrap items-center gap-2">
<Badge :variant="severityVariant(alert.severity)">{{ alert.severity }}</Badge>
<Badge variant="info" size="xs">{{ alert.status }}</Badge>
<Badge v-if="actionHint" variant="info" size="xs">{{ actionHint }}</Badge>
</div>
<h3 class="mt-2 text-sm font-semibold text-gray-900 dark:text-white">
{{ alertTypeLabel(alert.alertType) }}
vigilcare-dashboard/src/components/alerts/AlertReasoning.vue
+99 -9
View File
@@ -12,14 +12,60 @@ const props = defineProps({
const CORRELATION_WINDOW_MS = 90 * 60 * 1000
const reasoningMap = {
WarningHeartRate: { label: 'Heart Rate Warning', explain: (a) => `Heart rate ${extractValue(a)} is in the warning range (91–110 bpm or 41–50 bpm).` },
WarningSystolicBp: { label: 'Systolic BP Warning', explain: (a) => `Systolic BP ${extractValue(a)} is in the warning range (101–110 mmHg).` },
WarningTempC: { label: 'Temperature Warning', explain: (a) => `Temperature ${extractValue(a)} is in the warning range.` },
SepsisWarning: { label: 'SIRS / Sepsis Alert', explain: () => '≥2 of 4 SIRS criteria met: temperature, heart rate, respiratory rate, WBC.' },
QsofaWarning: { label: 'qSOFA Alert', explain: () => '≥2 of 3 qSOFA criteria met: RR ≥22, SBP ≤100, altered mentation (AVPU ≥1).' },
News2Warning: { label: 'NEWS2 Medium Risk', explain: () => 'NEWS2 composite score 5–6 indicating medium clinical risk.' },
News2Emergency: { label: 'NEWS2 High Risk', explain: () => 'NEWS2 composite score ≥7 or any single parameter scored 3.' },
RapidDeterioration: { label: 'Rapid Deterioration', explain: () => 'Vital sign trajectory shows rapid change within the sliding window.' },
WarningHeartRate: {
label: 'Heart Rate Warning',
explain: (a) => `Heart rate ${extractValue(a)} is in the warning range (91–110 bpm or 41–50 bpm).`,
},
WarningSystolicBp: {
label: 'Systolic BP Warning',
explain: (a) => `Systolic BP ${extractValue(a)} is in the warning range (101–110 mmHg).`,
},
WarningTempC: {
label: 'Temperature Warning',
explain: (a) => `Temperature ${extractValue(a)} is in the warning range.`,
},
SepsisWarning: {
label: 'SIRS / Sepsis Alert (Legacy)',
explain: () =>
'Historical alert: ≥2 of 4 SIRS criteria met. New sepsis detection uses SOFA delta ≥ 2.',
},
QsofaWarning: {
label: 'qSOFA Alert (Legacy)',
explain: () => 'Historical alert: ≥2 of 3 qSOFA criteria met.',
},
QsofaScreen: {
label: 'qSOFA Screen',
explain: () =>
'Bedside screen positive (≥2/3). Recommend ordering SOFA labs to evaluate organ dysfunction.',
},
SofaSepsis: {
label: 'Sepsis Alert (SOFA)',
explain: (a) => explainSofaAlert(a, true),
},
SofaWarning: {
label: 'SOFA Warning',
explain: (a) => explainSofaAlert(a, false),
},
GcsCritical: {
label: 'GCS Critical',
explain: (a) => explainGcsAlert(a),
},
GcsWarning: {
label: 'GCS Warning',
explain: (a) => explainGcsAlert(a),
},
News2Warning: {
label: 'NEWS2 Medium Risk',
explain: () => 'NEWS2 composite score 5–6 indicating medium clinical risk.',
},
News2Emergency: {
label: 'NEWS2 High Risk',
explain: () => 'NEWS2 composite score ≥7 or any single parameter scored 3.',
},
RapidDeterioration: {
label: 'Rapid Deterioration',
explain: () => 'Vital sign trajectory shows rapid change within the sliding window.',
},
}
const recentMedications = computed(() => {
@@ -32,11 +78,45 @@ const recentMedications = computed(() => {
})
})
const actionHint = computed(() => {
const hints = {
QsofaScreen: 'Recommend ordering SOFA labs (PaO₂, platelets, bilirubin, creatinine).',
SofaSepsis: 'Review organ dysfunction and confirm sepsis bundle initiation.',
GcsCritical: 'Urgent neurological assessment — GCS ≤ 8.',
GcsWarning: 'Monitor consciousness closely — GCS 9–12.',
}
return hints[props.alert.alertType] ?? null
})
function extractValue(alert) {
const match = alert.details?.match(/(\d+\.?\d*)/)
return match ? match[1] : '—'
}
function explainGcsAlert(alert) {
const e = alert.details?.match(/E[=:]?\s*(\d)/i)?.[1]
const v = alert.details?.match(/V[=:]?\s*(\d)/i)?.[1]
const m = alert.details?.match(/M[=:]?\s*(\d)/i)?.[1]
if (e && v && m) return `GCS components: Eye ${e}, Verbal ${v}, Motor ${m}.`
return alert.details ?? 'GCS threshold crossed.'
}
function explainSofaAlert(alert, isSepsis) {
const delta = alert.details?.match(/delta\s*[+:]?\s*(\d+)/i)?.[1]
const baseline = alert.details?.match(/baseline\s*(\d+)/i)?.[1]
const current = alert.details?.match(/current\s*(\d+)/i)?.[1]
const parts = []
if (baseline && current && delta) {
parts.push(`SOFA score increased from ${baseline} to ${current} (delta +${delta}).`)
} else if (delta) {
parts.push(`SOFA delta +${delta} from baseline.`)
}
const organs = alert.details?.match(/organs?:\s*([^.]+)/i)?.[1]
if (organs) parts.push(`Organ dysfunction: ${organs.trim()}.`)
if (isSepsis) parts.push('Meets sepsis criteria: suspected infection + SOFA delta ≥ 2.')
return parts.length ? parts.join(' ') : (alert.details ?? 'SOFA threshold crossed.')
}
function formatMed(med) {
return `${med.drugName} ${med.dose}${med.doseUnit} (${med.route})`
}
@@ -58,6 +138,13 @@ function formatMed(med) {
{{ reasoningMap[alert.alertType]?.explain(alert) ?? alert.details }}
</p>
<p
v-if="actionHint"
class="rounded bg-blue-50 px-4 py-2 text-sm text-blue-800 dark:bg-blue-950/40 dark:text-blue-200"
>
{{ actionHint }}
</p>
<div
v-if="recentMedications.length"
class="rounded bg-amber-50 p-4 text-sm text-amber-900 dark:bg-amber-950/40 dark:text-amber-200"
@@ -70,7 +157,10 @@ function formatMed(med) {
</ul>
</div>
<div v-if="alert.details" class="rounded bg-gray-50 p-4 text-xs font-mono text-gray-700 dark:bg-gray-800 dark:text-gray-300">
<div
v-if="alert.details"
class="rounded bg-gray-50 p-4 text-xs font-mono text-gray-700 dark:bg-gray-800 dark:text-gray-300"
>
{{ alert.details }}
</div>
vigilcare-dashboard/src/components/patient/GcsEntryForm.vue
+107
View File
@@ -0,0 +1,107 @@
<script setup>
import { ref, computed } from 'vue'
import Badge from '@/components/ui/Badge.vue'
defineProps({
submitting: { type: Boolean, default: false },
})
const emit = defineEmits(['submit'])
const eye = ref(4)
const verbal = ref(5)
const motor = ref(6)
const total = computed(() => eye.value + verbal.value + motor.value)
const classification = computed(() => {
if (total.value <= 8) return { label: 'Severe', variant: 'critical' }
if (total.value <= 12) return { label: 'Moderate', variant: 'warning' }
return { label: 'Mild', variant: 'success' }
})
const eyeOptions = [
{ value: 1, label: '1 — No opening' },
{ value: 2, label: '2 — To pressure' },
{ value: 3, label: '3 — To voice' },
{ value: 4, label: '4 — Spontaneous' },
]
const verbalOptions = [
{ value: 1, label: '1 — None' },
{ value: 2, label: '2 — Incomprehensible' },
{ value: 3, label: '3 — Inappropriate' },
{ value: 4, label: '4 — Confused' },
{ value: 5, label: '5 — Oriented' },
]
const motorOptions = [
{ value: 1, label: '1 — None' },
{ value: 2, label: '2 — Extension' },
{ value: 3, label: '3 — Abnormal flexion' },
{ value: 4, label: '4 — Withdrawal' },
{ value: 5, label: '5 — Localizing' },
{ value: 6, label: '6 — Obeys commands' },
]
function submit() {
emit('submit', { eye: eye.value, verbal: verbal.value, motor: motor.value })
}
</script>
<template>
<div class="space-y-4">
<h3 class="text-sm font-semibold dark:text-white">Record Glasgow Coma Scale</h3>
<div class="grid grid-cols-1 gap-4 sm:grid-cols-3">
<div class="min-w-0">
<label class="mb-2 block text-xs text-gray-500 dark:text-gray-400">Eye (E)</label>
<select
v-model.number="eye"
class="w-full rounded border border-gray-300 px-4 py-2 text-sm focus-visible:ring-2 focus-visible:ring-blue-500 dark:border-gray-600 dark:bg-gray-800 dark:text-white"
>
<option v-for="opt in eyeOptions" :key="opt.value" :value="opt.value">
{{ opt.label }}
</option>
</select>
</div>
<div class="min-w-0">
<label class="mb-2 block text-xs text-gray-500 dark:text-gray-400">Verbal (V)</label>
<select
v-model.number="verbal"
class="w-full rounded border border-gray-300 px-4 py-2 text-sm focus-visible:ring-2 focus-visible:ring-blue-500 dark:border-gray-600 dark:bg-gray-800 dark:text-white"
>
<option v-for="opt in verbalOptions" :key="opt.value" :value="opt.value">
{{ opt.label }}
</option>
</select>
</div>
<div class="min-w-0">
<label class="mb-2 block text-xs text-gray-500 dark:text-gray-400">Motor (M)</label>
<select
v-model.number="motor"
class="w-full rounded border border-gray-300 px-4 py-2 text-sm focus-visible:ring-2 focus-visible:ring-blue-500 dark:border-gray-600 dark:bg-gray-800 dark:text-white"
>
<option v-for="opt in motorOptions" :key="opt.value" :value="opt.value">
{{ opt.label }}
</option>
</select>
</div>
</div>
<div class="flex flex-col gap-4 sm:flex-row sm:flex-wrap sm:items-center sm:justify-between">
<div class="flex flex-wrap items-center gap-2">
<span class="text-lg font-bold dark:text-white">GCS {{ total }}/15</span>
<Badge :variant="classification.variant" size="xs">{{ classification.label }}</Badge>
<span class="text-xs text-gray-500 dark:text-gray-400">E{{ eye }} V{{ verbal }} M{{ motor }}</span>
</div>
<button
type="button"
class="w-full rounded bg-blue-500 px-6 py-2 text-sm font-medium text-white hover:bg-blue-600 focus-visible:ring-2 focus-visible:ring-blue-500 focus-visible:ring-offset-2 disabled:opacity-50 sm:w-auto"
:disabled="submitting"
@click="submit"
>
{{ submitting ? 'Saving…' : 'Record GCS' }}
</button>
</div>
</div>
</template>
vigilcare-dashboard/src/components/patient/ScoresPanel.vue
+117 -40
View File
@@ -1,40 +1,38 @@
<script setup>
import { ref, computed, watch } from 'vue'
import { ref } from 'vue'
import { storeToRefs } from 'pinia'
import Card from '@/components/ui/Card.vue'
import Badge from '@/components/ui/Badge.vue'
import * as clinicalApi from '@/api/clinical'
import GcsEntryForm from '@/components/patient/GcsEntryForm.vue'
import { useScoringStore } from '@/stores/scoring'
const props = defineProps({
news2: { type: Object, default: null },
encounter: { type: Object, required: true },
})
const scoring = useScoringStore()
const {
news2,
qsofa,
gcsTotal,
gcsComponents,
gcsClassificationDisplay,
sofaTotal,
sofaDelta,
sofaOrgans,
news2Variant,
qsofaVariant,
submittingGcs,
} = storeToRefs(scoring)
const qsofa = ref(null)
const showGcsForm = ref(false)
async function loadQsofa() {
if (!props.encounter?.id) return
try {
qsofa.value = await clinicalApi.fetchCurrentQsofa(props.encounter.id)
} catch {
qsofa.value = null
}
function sofaOrganVariant(score) {
if (score === 0) return 'success'
if (score <= 2) return 'warning'
return 'critical'
}
watch(() => props.encounter?.id, loadQsofa, { immediate: true })
const news2Variant = computed(() => {
const score = props.news2?.totalScore ?? 0
if (score >= 7 || props.news2?.hasSingleParamThree) return 'critical'
if (score >= 5) return 'warning'
return 'success'
})
const qsofaVariant = computed(() => {
const count = qsofa.value?.activeCriteria ?? 0
if (count >= 2) return 'critical'
if (count === 1) return 'warning'
return 'success'
})
async function onGcsSubmit({ eye, verbal, motor }) {
await scoring.submitGcs(eye, verbal, motor)
showGcsForm.value = false
}
</script>
<template>
@@ -45,23 +43,102 @@ const qsofaVariant = computed(() => {
</h2>
</template>
<div class="grid grid-cols-2 gap-4">
<div>
<div class="text-xs text-gray-500 dark:text-gray-400">NEWS2</div>
<div class="mt-2 flex items-center gap-2">
<div class="space-y-6">
<!-- NEWS2 -->
<section class="space-y-2">
<div class="text-xs font-medium text-gray-500 dark:text-gray-400">NEWS2</div>
<div class="flex flex-wrap items-center gap-2">
<Badge :variant="news2Variant">{{ news2?.totalScore ?? '—' }}</Badge>
<span v-if="news2?.riskLevel" class="text-xs text-gray-500 dark:text-gray-400">
{{ news2.riskLevel }}
</span>
</div>
</div>
<div>
<div class="text-xs text-gray-500 dark:text-gray-400">qSOFA</div>
<div class="mt-2">
<Badge :variant="qsofaVariant">{{ qsofa?.activeCriteria ?? '—' }}</Badge>
<span class="ml-2 text-xs text-gray-500 dark:text-gray-400">/ 3 criteria</span>
</section>
<!-- GCS -->
<section class="space-y-2 border-t border-gray-100 pt-4 dark:border-gray-700">
<div class="flex flex-wrap items-center justify-between gap-2">
<div class="text-xs font-medium text-gray-500 dark:text-gray-400">GCS</div>
<button
type="button"
class="text-xs text-blue-600 hover:underline dark:text-blue-400"
@click="showGcsForm = !showGcsForm"
>
{{ showGcsForm ? 'Cancel' : 'Record GCS' }}
</button>
</div>
</div>
<div v-if="gcsTotal != null" class="flex flex-wrap items-center gap-2">
<Badge :variant="gcsClassificationDisplay?.variant ?? 'info'">
{{ gcsTotal }}/15
</Badge>
<span v-if="gcsClassificationDisplay" class="text-xs text-gray-500 dark:text-gray-400">
{{ gcsClassificationDisplay.label }}
</span>
<span v-if="gcsComponents" class="text-xs text-gray-500 dark:text-gray-400">
E{{ gcsComponents.eye }} V{{ gcsComponents.verbal }} M{{ gcsComponents.motor }}
</span>
</div>
<div v-else class="text-xs text-gray-400 dark:text-gray-500">No GCS recorded</div>
<Transition name="fade">
<GcsEntryForm
v-if="showGcsForm"
:submitting="submittingGcs"
@submit="onGcsSubmit"
/>
</Transition>
</section>
<!-- SOFA (compact) -->
<section class="space-y-2 border-t border-gray-100 pt-4 dark:border-gray-700">
<div class="text-xs font-medium text-gray-500 dark:text-gray-400">SOFA</div>
<div v-if="sofaTotal != null" class="space-y-2">
<div class="flex flex-wrap items-center gap-2">
<Badge :variant="sofaDelta != null && sofaDelta >= 2 ? 'critical' : 'info'">
{{ sofaTotal }}/24
</Badge>
<Badge v-if="sofaDelta != null && sofaDelta >= 2" variant="critical" size="xs">
Δ +{{ sofaDelta }}
</Badge>
<Badge v-else-if="sofaDelta === 1" variant="warning" size="xs">Δ +1</Badge>
</div>
<div class="grid grid-cols-2 gap-2 sm:flex sm:flex-wrap">
<Badge
v-for="organ in sofaOrgans"
:key="organ.name"
:variant="sofaOrganVariant(organ.score)"
size="xs"
>
{{ organ.name }} {{ organ.score }}
</Badge>
</div>
</div>
<div v-else class="text-xs text-gray-400 dark:text-gray-500">Labs pending</div>
</section>
<!-- qSOFA Screen -->
<section class="space-y-2 border-t border-gray-100 pt-4 dark:border-gray-700">
<div class="text-xs font-medium text-gray-500 dark:text-gray-400">qSOFA Screen</div>
<p class="text-xs text-gray-500 dark:text-gray-400">
Bedside screening — qSOFA ≥ 2 suggests ordering SOFA labs
</p>
<div class="flex flex-wrap items-center gap-2">
<Badge :variant="qsofaVariant">
{{ qsofa?.activeCriteria ?? '—' }}
</Badge>
<span class="text-xs text-gray-500 dark:text-gray-400">/ 3 criteria</span>
</div>
</section>
</div>
</Card>
</template>
<style scoped>
.fade-enter-active,
.fade-leave-active {
transition: opacity 0.15s ease;
}
.fade-enter-from,
.fade-leave-to {
opacity: 0;
}
</style>
vigilcare-dashboard/src/components/patient/SepsisBundlePanel.vue
+72 -31
View File
@@ -2,10 +2,12 @@
import { ref, computed, onMounted, onBeforeUnmount } from 'vue'
import Card from '@/components/ui/Card.vue'
import Badge from '@/components/ui/Badge.vue'
import { bundleElementLabel } from '@/api/normalize'
import { bundleElementLabel, bundleTriggerLabel } from '@/api/normalize'
const props = defineProps({
bundle: { type: Object, required: true },
bundle: { type: Object, default: null },
qsofa: { type: Object, default: null },
sofa: { type: Object, default: null },
})
const now = ref(Date.now())
@@ -21,7 +23,17 @@ onBeforeUnmount(() => {
if (timer) clearInterval(timer)
})
const showQsofaScreenMessage = computed(() => {
if (props.bundle) return false
return (props.qsofa?.activeCriteria ?? 0) >= 2
})
const triggerLabel = computed(() =>
bundleTriggerLabel(props.bundle?.triggeringAlertType),
)
const remainingMs = computed(() => {
if (!props.bundle?.deadlineAt) return 0
const deadline = new Date(props.bundle.deadlineAt).getTime()
return Math.max(0, deadline - now.value)
})
@@ -34,7 +46,7 @@ const countdown = computed(() => {
})
const complianceVariant = computed(() => {
const status = props.bundle.complianceStatus
const status = props.bundle?.complianceStatus
if (status === 'Compliant') return 'success'
if (status === 'NonCompliant') return 'critical'
return 'warning'
@@ -52,43 +64,72 @@ function elementComplete(element) {
<h2 class="text-sm font-semibold uppercase tracking-wide text-gray-500 dark:text-gray-400">
Sepsis Bundle
</h2>
<Badge :variant="complianceVariant">{{ bundle.complianceStatus }}</Badge>
<Badge v-if="bundle" :variant="complianceVariant">{{ bundle.complianceStatus }}</Badge>
</div>
</template>
<div class="mb-4 flex items-center justify-between rounded-lg bg-gray-50 p-4 dark:bg-gray-800">
<span class="text-sm text-gray-600 dark:text-gray-300">Time to deadline</span>
<span
class="font-mono text-lg font-semibold"
:class="remainingMs === 0 ? 'text-red-600 dark:text-red-400' : 'text-gray-900 dark:text-white'"
>
{{ countdown }}
</span>
<div
v-if="showQsofaScreenMessage"
class="mb-4 rounded-lg bg-amber-50 px-4 py-2 text-sm text-amber-800 dark:bg-amber-900/20 dark:text-amber-200"
>
qSOFA screen positive — order SOFA labs to evaluate organ dysfunction.
</div>
<ul class="space-y-2">
<li
v-for="element in bundle.elements"
:key="element.id"
class="flex items-center gap-4 rounded-lg border border-gray-200 p-4 dark:border-gray-700"
<div v-if="sofa?.totalScore != null" class="mb-4 flex flex-wrap items-center gap-2 text-sm dark:text-gray-300">
<span>Current SOFA:</span>
<Badge variant="info" size="xs">{{ sofa.totalScore }}/24</Badge>
<Badge
v-if="sofa.deltaFromBaseline != null && sofa.deltaFromBaseline >= 2"
variant="critical"
size="xs"
>
Δ +{{ sofa.deltaFromBaseline }}
</Badge>
</div>
<template v-if="bundle">
<p class="mb-4 text-xs text-gray-500 dark:text-gray-400">
Triggered by {{ triggerLabel }}
</p>
<div class="mb-4 flex flex-wrap items-center justify-between gap-4 rounded-lg bg-gray-50 p-4 dark:bg-gray-800">
<span class="text-sm text-gray-600 dark:text-gray-300">Time to deadline</span>
<span
class="flex h-8 w-8 shrink-0 items-center justify-center rounded-full text-xs"
:class="elementComplete(element)
? 'bg-green-100 text-green-700 dark:bg-green-900/30 dark:text-green-300'
: 'bg-gray-100 text-gray-400 dark:bg-gray-800 dark:text-gray-500'"
class="font-mono text-lg font-semibold"
:class="remainingMs === 0 ? 'text-red-600 dark:text-red-400' : 'text-gray-900 dark:text-white'"
>
{{ elementComplete(element) ? '✓' : '○' }}
{{ countdown }}
</span>
<span
class="text-sm"
:class="elementComplete(element)
? 'text-gray-500 line-through dark:text-gray-400'
: 'text-gray-900 dark:text-white'"
</div>
<ul class="space-y-2">
<li
v-for="element in bundle.elements"
:key="element.id"
class="flex flex-wrap items-center gap-4 rounded-lg border border-gray-200 p-4 dark:border-gray-700"
>
{{ bundleElementLabel(element.elementType) }}
</span>
</li>
</ul>
<span
class="flex h-8 w-8 shrink-0 items-center justify-center rounded-full text-xs"
:class="elementComplete(element)
? 'bg-green-100 text-green-700 dark:bg-green-900/30 dark:text-green-300'
: 'bg-gray-100 text-gray-400 dark:bg-gray-800 dark:text-gray-500'"
>
{{ elementComplete(element) ? '✓' : '○' }}
</span>
<span
class="min-w-0 flex-1 text-sm"
:class="elementComplete(element)
? 'text-gray-500 line-through dark:text-gray-400'
: 'text-gray-900 dark:text-white'"
>
{{ bundleElementLabel(element.elementType) }}
</span>
</li>
</ul>
</template>
<p v-else class="text-sm text-gray-500 dark:text-gray-400">
No active sepsis bundle for this encounter.
</p>
</Card>
</template>
vigilcare-dashboard/src/components/patient/SofaScorePanel.vue
+78
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@@ -0,0 +1,78 @@
<script setup>
import { computed } from 'vue'
import { useSofa } from '@/composables/useSofa'
import Badge from '@/components/ui/Badge.vue'
import Card from '@/components/ui/Card.vue'
const props = defineProps({
encounterId: { type: String, required: true },
})
const encounterIdRef = computed(() => props.encounterId)
const { total, delta, organs, hasStaleData, staleness, loading, fetch } = useSofa(encounterIdRef)
function organVariant(score) {
if (score === 0) return 'success'
if (score <= 2) return 'warning'
return 'critical'
}
</script>
<template>
<Card>
<div class="space-y-4">
<div class="flex flex-wrap items-center justify-between gap-4">
<h3 class="text-sm font-semibold dark:text-white">SOFA Score</h3>
<div v-if="loading" class="text-sm text-gray-400 dark:text-gray-500">Loading…</div>
<div v-else-if="total !== null" class="flex flex-wrap items-center gap-2">
<span class="text-2xl font-bold dark:text-white">{{ total }}/24</span>
<Badge v-if="delta !== null && delta >= 2" variant="critical" size="xs">
+{{ delta }} from baseline
</Badge>
<Badge v-else-if="delta !== null && delta === 1" variant="warning" size="xs">
+{{ delta }} from baseline
</Badge>
</div>
<span v-else class="text-sm text-gray-400 dark:text-gray-500">Labs pending</span>
</div>
<div v-if="organs.length" class="grid grid-cols-2 gap-2 sm:grid-cols-3 lg:grid-cols-6">
<div
v-for="organ in organs"
:key="organ.name"
class="rounded-lg bg-gray-50 p-4 text-center dark:bg-gray-800"
>
<div class="text-xs text-gray-500 dark:text-gray-400">{{ organ.name }}</div>
<div class="mt-2">
<Badge :variant="organVariant(organ.score)" size="sm">
{{ organ.score }}/{{ organ.max }}
</Badge>
</div>
</div>
</div>
<div
v-if="hasStaleData"
class="rounded bg-amber-50 px-4 py-2 text-xs text-amber-700 dark:bg-amber-900/20 dark:text-amber-300"
>
<span v-if="staleness?.missingComponents?.length">
Missing: {{ staleness.missingComponents.join(', ') }}.
</span>
<span v-if="staleness?.staleComponents?.length">
Stale: {{ staleness.staleComponents.join(', ') }}.
</span>
<span v-if="staleness?.usedSpO2Fallback">
Using SpO₂/FiO₂ proxy (no arterial blood gas).
</span>
</div>
<button
type="button"
class="text-xs text-blue-600 hover:underline dark:text-blue-400"
@click="fetch"
>
Refresh SOFA
</button>
</div>
</Card>
</template>
vigilcare-dashboard/src/composables/useGcs.js
+87
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@@ -0,0 +1,87 @@
import { ref, computed, unref, watch } from 'vue'
import * as clinicalApi from '@/api/clinical'
function gcsClassification(total) {
if (total <= 8) return { label: 'Severe', variant: 'critical' }
if (total <= 12) return { label: 'Moderate', variant: 'warning' }
return { label: 'Mild', variant: 'success' }
}
export function useGcs(encounterId) {
const gcs = ref(null)
const loading = ref(false)
const submitting = ref(false)
const error = ref(null)
async function fetch() {
const id = unref(encounterId)
if (!id) return
loading.value = true
error.value = null
try {
gcs.value = await clinicalApi.fetchCurrentGcs(id)
} catch (e) {
gcs.value = null
error.value = e.message
} finally {
loading.value = false
}
}
async function submit(eye, verbal, motor) {
const id = unref(encounterId)
if (!id) return
const previous = gcs.value
const optimisticTotal = eye + verbal + motor
gcs.value = {
eyeScore: eye,
verbalScore: verbal,
motorScore: motor,
totalScore: optimisticTotal,
classification: gcsClassification(optimisticTotal).label.toUpperCase(),
calculatedAt: new Date().toISOString(),
}
submitting.value = true
error.value = null
try {
await clinicalApi.submitGcsObservations(id, eye, verbal, motor)
await fetch()
} catch (e) {
gcs.value = previous
error.value = e.message
throw e
} finally {
submitting.value = false
}
}
const total = computed(() => gcs.value?.totalScore ?? null)
const components = computed(() => {
if (!gcs.value) return null
return {
eye: gcs.value.eyeScore,
verbal: gcs.value.verbalScore,
motor: gcs.value.motorScore,
}
})
const classification = computed(() => {
if (total.value == null) return null
return gcsClassification(total.value)
})
watch(() => unref(encounterId), fetch, { immediate: true })
return {
gcs,
loading,
submitting,
error,
total,
components,
classification,
fetch,
submit,
}
}
vigilcare-dashboard/src/composables/useSofa.js
+67
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@@ -0,0 +1,67 @@
import { ref, computed, unref, watch } from 'vue'
import * as clinicalApi from '@/api/clinical'
const ORGAN_FIELDS = [
{ name: 'Respiratory', key: 'respiratoryScore' },
{ name: 'Coagulation', key: 'coagulationScore' },
{ name: 'Liver', key: 'liverScore' },
{ name: 'Cardiovascular', key: 'cardiovascularScore' },
{ name: 'CNS', key: 'cnsScore' },
{ name: 'Renal', key: 'renalScore' },
]
export function useSofa(encounterId) {
const sofa = ref(null)
const loading = ref(false)
const error = ref(null)
async function fetch() {
const id = unref(encounterId)
if (!id) return
loading.value = true
error.value = null
try {
sofa.value = await clinicalApi.fetchCurrentSofa(id)
} catch (e) {
sofa.value = null
error.value = e.message
} finally {
loading.value = false
}
}
const total = computed(() => sofa.value?.totalScore ?? null)
const delta = computed(() => sofa.value?.deltaFromBaseline ?? null)
const isBaseline = computed(() => sofa.value?.isBaseline ?? false)
const organs = computed(() => {
if (!sofa.value) return []
return ORGAN_FIELDS.map(({ name, key }) => ({
name,
score: sofa.value[key] ?? 0,
max: 4,
}))
})
const staleness = computed(() => sofa.value?.staleness ?? null)
const hasStaleData = computed(() => {
const s = staleness.value
if (!s) return false
return (s.staleComponents?.length ?? 0) > 0
|| (s.missingComponents?.length ?? 0) > 0
|| s.usedSpO2Fallback
})
watch(() => unref(encounterId), fetch, { immediate: true })
return {
sofa,
loading,
error,
total,
delta,
isBaseline,
organs,
staleness,
hasStaleData,
fetch,
}
}
vigilcare-dashboard/src/stores/scoring.js
+130
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@@ -0,0 +1,130 @@
import { defineStore } from 'pinia'
import { ref, computed } from 'vue'
import * as clinicalApi from '@/api/clinical'
const POLL_MS = 15_000
function gcsClassification(total) {
if (total <= 8) return { label: 'Severe', variant: 'critical' }
if (total <= 12) return { label: 'Moderate', variant: 'warning' }
return { label: 'Mild', variant: 'success' }
}
export const useScoringStore = defineStore('scoring', () => {
const encounterId = ref(null)
const gcs = ref(null)
const sofa = ref(null)
const news2 = ref(null)
const qsofa = ref(null)
const loading = ref(false)
const submittingGcs = ref(false)
let timer = null
const gcsTotal = computed(() => gcs.value?.totalScore ?? null)
const gcsComponents = computed(() => {
if (!gcs.value) return null
return {
eye: gcs.value.eyeScore,
verbal: gcs.value.verbalScore,
motor: gcs.value.motorScore,
}
})
const gcsClassificationDisplay = computed(() => {
if (gcsTotal.value == null) return null
return gcsClassification(gcsTotal.value)
})
const sofaTotal = computed(() => sofa.value?.totalScore ?? null)
const sofaDelta = computed(() => sofa.value?.deltaFromBaseline ?? null)
const sofaOrgans = computed(() => {
if (!sofa.value) return []
return [
{ name: 'Resp', score: sofa.value.respiratoryScore ?? 0 },
{ name: 'Coag', score: sofa.value.coagulationScore ?? 0 },
{ name: 'Liver', score: sofa.value.liverScore ?? 0 },
{ name: 'CV', score: sofa.value.cardiovascularScore ?? 0 },
{ name: 'CNS', score: sofa.value.cnsScore ?? 0 },
{ name: 'Renal', score: sofa.value.renalScore ?? 0 },
]
})
const news2Variant = computed(() => {
const score = news2.value?.totalScore ?? 0
if (score >= 7 || news2.value?.hasSingleParamThree) return 'critical'
if (score >= 5) return 'warning'
return 'success'
})
const qsofaVariant = computed(() => {
const count = qsofa.value?.activeCriteria ?? 0
if (count >= 2) return 'warning'
if (count === 1) return 'warning'
return 'success'
})
async function refresh() {
if (!encounterId.value) return
loading.value = true
const id = encounterId.value
try {
const [g, s, n, q] = await Promise.all([
clinicalApi.fetchCurrentGcs(id).catch(() => null),
clinicalApi.fetchCurrentSofa(id).catch(() => null),
clinicalApi.fetchCurrentNews2(id).catch(() => null),
clinicalApi.fetchCurrentQsofa(id).catch(() => null),
])
gcs.value = g
sofa.value = s
news2.value = n
qsofa.value = q
} finally {
loading.value = false
}
}
async function submitGcs(eye, verbal, motor) {
if (!encounterId.value) return
submittingGcs.value = true
try {
await clinicalApi.submitGcsObservations(encounterId.value, eye, verbal, motor)
await refresh()
} finally {
submittingGcs.value = false
}
}
function startPolling(id) {
stopPolling()
encounterId.value = id
refresh()
timer = setInterval(refresh, POLL_MS)
}
function stopPolling() {
if (timer) clearInterval(timer)
timer = null
encounterId.value = null
}
return {
encounterId,
gcs,
sofa,
news2,
qsofa,
loading,
submittingGcs,
gcsTotal,
gcsComponents,
gcsClassificationDisplay,
sofaTotal,
sofaDelta,
sofaOrgans,
news2Variant,
qsofaVariant,
refresh,
submitGcs,
startPolling,
stopPolling,
}
})
vigilcare-dashboard/src/views/PatientDetail.vue
+19 -7
View File
@@ -5,10 +5,12 @@ import { storeToRefs } from 'pinia'
import { usePolling } from '@/composables/usePolling'
import { useReplayControls } from '@/composables/useReplayControls'
import { useAlertStore } from '@/stores/alerts'
import { useScoringStore } from '@/stores/scoring'
import * as encountersApi from '@/api/encounters'
import * as clinicalApi from '@/api/clinical'
import VitalsPanel from '@/components/patient/VitalsPanel.vue'
import ScoresPanel from '@/components/patient/ScoresPanel.vue'
import SofaScorePanel from '@/components/patient/SofaScorePanel.vue'
import AlertsList from '@/components/patient/AlertsList.vue'
import OrdersPanel from '@/components/patient/OrdersPanel.vue'
import SepsisBundlePanel from '@/components/patient/SepsisBundlePanel.vue'
@@ -20,7 +22,9 @@ import Skeleton from '@/components/ui/Skeleton.vue'
const route = useRoute()
const alertStore = useAlertStore()
const scoringStore = useScoringStore()
const { alerts } = storeToRefs(alertStore)
const { qsofa, sofa } = storeToRefs(scoringStore)
const {
isPaused,
speed,
@@ -42,7 +46,6 @@ const {
const encounter = ref(null)
const loading = ref(true)
const observations = ref([])
const news2 = ref(null)
const news2History = ref([])
const medications = ref([])
const sepsisBundle = ref(null)
@@ -85,10 +88,9 @@ async function loadAll() {
const id = route.params.encounterId
loading.value = true
try {
const [enc, obs, n2, history, meds, bundle, ord] = await Promise.all([
const [enc, obs, history, meds, bundle, ord] = await Promise.all([
encountersApi.fetchEncounter(id),
encountersApi.fetchObservations(id),
clinicalApi.fetchCurrentNews2(id).catch(() => null),
clinicalApi.fetchNews2History(id).catch(() => []),
clinicalApi.fetchMedications(id).catch(() => []),
clinicalApi.fetchSepsisBundle(id).catch(() => null),
@@ -97,11 +99,11 @@ async function loadAll() {
await alertStore.loadAlerts(id)
encounter.value = enc
observations.value = obs
news2.value = n2
news2History.value = history
medications.value = meds
sepsisBundle.value = bundle
orders.value = ord.items ?? ord
scoringStore.startPolling(id)
syncReplayBounds()
} finally {
loading.value = false
@@ -134,6 +136,7 @@ watch(() => route.params.encounterId, () => {
selectedAlert.value = null
nextAlertIndex = 0
pause()
scoringStore.stopPolling()
loadAll()
})
@@ -146,7 +149,10 @@ watch(openAlerts, (list) => {
watch([observations, news2History, alerts], syncReplayBounds, { deep: true })
onBeforeUnmount(() => stopPlayback())
onBeforeUnmount(() => {
stopPlayback()
scoringStore.stopPolling()
})
</script>
<template>
@@ -162,7 +168,7 @@ onBeforeUnmount(() => stopPlayback())
</div>
<div class="grid min-w-0 gap-4 sm:grid-cols-2 lg:grid-cols-3">
<ScoresPanel :news2="news2" :encounter="encounter" />
<ScoresPanel />
<VitalsPanel :observations="replayObservations" />
<AlertsList
:encounter-id="route.params.encounterId"
@@ -178,10 +184,16 @@ onBeforeUnmount(() => stopPlayback())
/>
<div class="grid min-w-0 gap-4 lg:grid-cols-2">
<SofaScorePanel :encounter-id="route.params.encounterId" />
<OrdersPanel :orders="orders" />
<SepsisBundlePanel v-if="sepsisBundle" :bundle="sepsisBundle" />
</div>
<SepsisBundlePanel
:bundle="sepsisBundle"
:qsofa="qsofa"
:sofa="sofa"
/>
<div id="clinical-review" class="w-full min-w-0 space-y-8">
<TrendsGrid :observations="replayObservations" />
<News2History v-if="replayNews2History.length" :history="replayNews2History" />