feature: NEWS2 Composite Scoring Engine
This commit is contained in:
voltsrage
@@ -8,7 +8,7 @@ public static class DbResetHelper
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{
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await db.Database.ExecuteSqlRawAsync(@"
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TRUNCATE TABLE reconciliation_alerts, outbox_events, orders,
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clinical_alerts, observations, encounters,
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clinical_alerts, news2_scores, observations, encounters,
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alert_thresholds, patients
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RESTART IDENTITY CASCADE;
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");
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@@ -0,0 +1,107 @@
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using FluentAssertions;
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public class News2CalculatorTests
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{
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// --- Respiratory rate ---
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[Theory]
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[InlineData(8, 3)] // ≤8
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[InlineData(9, 1)] // 9-11
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[InlineData(11, 1)]
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[InlineData(12, 0)] // 12-20
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[InlineData(20, 0)]
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[InlineData(21, 2)] // 21-24
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[InlineData(24, 2)]
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[InlineData(25, 3)] // ≥25
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public void ScoreRespRate(int value, int expected) =>
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News2Calculator.ScoreRespRate(value).Should().Be(expected);
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// --- SpO2 (Scale 1) ---
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[Theory]
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[InlineData(91, 3)]
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[InlineData(92, 2)]
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[InlineData(93, 2)]
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[InlineData(94, 1)]
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[InlineData(95, 1)]
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[InlineData(96, 0)]
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[InlineData(99, 0)]
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public void ScoreSpo2(int value, int expected) =>
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News2Calculator.ScoreSpo2(value).Should().Be(expected);
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// --- Systolic BP ---
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[Theory]
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[InlineData(90, 3)]
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[InlineData(91, 2)]
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[InlineData(100, 2)]
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[InlineData(101, 1)]
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[InlineData(110, 1)]
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[InlineData(111, 0)]
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[InlineData(219, 0)]
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[InlineData(220, 3)]
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public void ScoreSystolicBp(int value, int expected) =>
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News2Calculator.ScoreSystolicBp(value).Should().Be(expected);
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// --- Heart rate ---
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[Theory]
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[InlineData(40, 3)]
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[InlineData(41, 1)]
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[InlineData(50, 1)]
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[InlineData(51, 0)]
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[InlineData(90, 0)]
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[InlineData(91, 1)]
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[InlineData(110, 1)]
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[InlineData(111, 2)]
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[InlineData(130, 2)]
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[InlineData(131, 3)]
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public void ScoreHeartRate(int value, int expected) =>
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News2Calculator.ScoreHeartRate(value).Should().Be(expected);
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// --- AVPU ---
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[Theory]
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[InlineData(0, 0)] // Alert
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[InlineData(1, 3)] // Voice
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[InlineData(2, 3)] // Pain
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[InlineData(3, 3)] // Unresponsive
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public void ScoreConsciousness(int value, int expected) =>
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News2Calculator.ScoreConsciousness(value).Should().Be(expected);
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// --- Temperature ---
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[Theory]
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[InlineData(35.0, 3)]
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[InlineData(35.1, 1)]
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[InlineData(36.0, 1)]
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[InlineData(36.1, 0)]
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[InlineData(38.0, 0)]
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[InlineData(38.1, 1)]
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[InlineData(39.0, 1)]
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[InlineData(39.1, 2)]
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public void ScoreTemperature(double value, int expected) =>
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News2Calculator.ScoreTemperature((decimal)value).Should().Be(expected);
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// --- Supplemental O2 ---
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[Theory]
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[InlineData(0, 0)]
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[InlineData(1, 2)]
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public void ScoreSupplementalO2(int value, int expected) =>
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News2Calculator.ScoreSupplementalO2(value).Should().Be(expected);
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// --- Risk level determination ---
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[Theory]
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[InlineData(0, false, "LOW")]
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[InlineData(4, false, "LOW")]
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[InlineData(3, true, "LOW_MEDIUM")] // single param = 3
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[InlineData(5, false, "MEDIUM")]
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[InlineData(6, true, "MEDIUM")] // 5-6 is MEDIUM regardless of single-3
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[InlineData(7, false, "HIGH")]
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[InlineData(12, true, "HIGH")]
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public void DetermineRiskLevel(int total, bool singleThree, string expected) =>
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News2Calculator.DetermineRiskLevel(total, singleThree).Should().Be(expected);
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// --- All 7 keys returned ---
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[Fact]
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public void AllParameterKeys_ReturnsSeven()
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{
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var keys = News2Calculator.AllParameterKeys(Guid.NewGuid());
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keys.Should().HaveCount(7);
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keys.Select(k => k.ToString()).Should().OnlyHaveUniqueItems();
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}
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}
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@@ -0,0 +1,225 @@
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using FluentAssertions;
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using Microsoft.EntityFrameworkCore;
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using Microsoft.Extensions.DependencyInjection;
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using StackExchange.Redis;
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[Collection("Integration")]
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public class News2DetectorTests : IAsyncLifetime
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{
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private readonly ApiFixture _fixture;
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private Guid _encounterId;
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private Guid _patientId;
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public News2DetectorTests(ApiFixture fixture) => _fixture = fixture;
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public async Task InitializeAsync()
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{
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using var scope = _fixture.Services.CreateScope();
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var db = scope.ServiceProvider.GetRequiredService<AppDbContext>();
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await DbResetHelper.ResetAsync(db);
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var patient = new Patient
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{
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Id = Guid.NewGuid(), Mrn = "MRN-NEWS2-001", FirstName = "NEWS2", LastName = "Test",
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DateOfBirth = new DateOnly(1960, 1, 1), Gender = "M",
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CreatedAt = DateTimeOffset.UtcNow
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};
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var encounter = new Encounter
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{
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Id = Guid.NewGuid(), PatientId = patient.Id, EncounterType = EncounterType.Inpatient,
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Status = EncounterStatus.Active, Department = Department.Icu,
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AttendingPhysician = "Dr. NEWS2", AdmittedAt = DateTimeOffset.UtcNow,
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CreatedAt = DateTimeOffset.UtcNow
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};
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db.Patients.Add(patient);
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db.Encounters.Add(encounter);
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await db.SaveChangesAsync();
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_patientId = patient.Id;
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_encounterId = encounter.Id;
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var redis = scope.ServiceProvider.GetRequiredService<IConnectionMultiplexer>();
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var cache = redis.GetDatabase();
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foreach (var key in News2Calculator.AllParameterKeys(_encounterId))
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await cache.KeyDeleteAsync(key);
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}
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public Task DisposeAsync() => Task.CompletedTask;
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[Fact]
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public async Task AllNormalParameters_ScoreZero_NoAlert()
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{
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using var scope = _fixture.Services.CreateScope();
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var detector = scope.ServiceProvider.GetRequiredService<News2Detector>();
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await detector.ProcessObservationAsync(_encounterId, _patientId, "RESP_RATE", 16m);
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await detector.ProcessObservationAsync(_encounterId, _patientId, "SPO2", 98m);
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await detector.ProcessObservationAsync(_encounterId, _patientId, "SYSTOLIC_BP", 120m);
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await detector.ProcessObservationAsync(_encounterId, _patientId, "HEART_RATE", 72m);
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await detector.ProcessObservationAsync(_encounterId, _patientId, "AVPU", 0m);
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await detector.ProcessObservationAsync(_encounterId, _patientId, "TEMP_C", 36.8m);
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var result = await detector.ProcessObservationAsync(
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_encounterId, _patientId, "SUPPLEMENTAL_O2", 0m);
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result.Outcome.Should().Be(News2Outcome.ScoreComputed);
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result.TotalScore.Should().Be(0);
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result.RiskLevel.Should().Be("LOW");
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result.AlertCreated.Should().BeFalse();
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var db = scope.ServiceProvider.GetRequiredService<AppDbContext>();
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var score = await db.News2Scores.SingleAsync();
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score.TotalScore.Should().Be(0);
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score.RiskLevel.Should().Be("LOW");
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(await db.ClinicalAlerts.CountAsync()).Should().Be(0);
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}
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[Fact]
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public async Task MediumRisk_WarningAlert()
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{
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using var scope = _fixture.Services.CreateScope();
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var detector = scope.ServiceProvider.GetRequiredService<News2Detector>();
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await detector.ProcessObservationAsync(_encounterId, _patientId, "RESP_RATE", 22m);
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await detector.ProcessObservationAsync(_encounterId, _patientId, "SPO2", 93m);
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await detector.ProcessObservationAsync(_encounterId, _patientId, "SYSTOLIC_BP", 105m);
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await detector.ProcessObservationAsync(_encounterId, _patientId, "HEART_RATE", 95m);
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await detector.ProcessObservationAsync(_encounterId, _patientId, "AVPU", 0m);
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await detector.ProcessObservationAsync(_encounterId, _patientId, "TEMP_C", 37.0m);
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var result = await detector.ProcessObservationAsync(
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_encounterId, _patientId, "SUPPLEMENTAL_O2", 0m);
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result.TotalScore.Should().Be(6);
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result.RiskLevel.Should().Be("MEDIUM");
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result.AlertCreated.Should().BeTrue();
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var db = scope.ServiceProvider.GetRequiredService<AppDbContext>();
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var alert = await db.ClinicalAlerts.SingleAsync();
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alert.AlertType.Should().Be(AlertType.News2Warning);
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alert.Severity.Should().Be(AlertSeverity.Warning);
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}
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[Fact]
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public async Task HighRisk_CriticalAlert()
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{
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using var scope = _fixture.Services.CreateScope();
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var detector = scope.ServiceProvider.GetRequiredService<News2Detector>();
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await detector.ProcessObservationAsync(_encounterId, _patientId, "RESP_RATE", 25m);
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await detector.ProcessObservationAsync(_encounterId, _patientId, "SPO2", 91m);
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await detector.ProcessObservationAsync(_encounterId, _patientId, "SYSTOLIC_BP", 95m);
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await detector.ProcessObservationAsync(_encounterId, _patientId, "HEART_RATE", 72m);
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await detector.ProcessObservationAsync(_encounterId, _patientId, "AVPU", 0m);
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await detector.ProcessObservationAsync(_encounterId, _patientId, "TEMP_C", 37.0m);
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var result = await detector.ProcessObservationAsync(
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_encounterId, _patientId, "SUPPLEMENTAL_O2", 0m);
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result.TotalScore.Should().Be(8);
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result.RiskLevel.Should().Be("HIGH");
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result.AlertCreated.Should().BeTrue();
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var db = scope.ServiceProvider.GetRequiredService<AppDbContext>();
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var alert = await db.ClinicalAlerts.SingleAsync();
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alert.AlertType.Should().Be(AlertType.News2Emergency);
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alert.Severity.Should().Be(AlertSeverity.Critical);
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}
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[Fact]
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public async Task SingleParamThree_LowMedium_Warning()
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{
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using var scope = _fixture.Services.CreateScope();
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var detector = scope.ServiceProvider.GetRequiredService<News2Detector>();
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await detector.ProcessObservationAsync(_encounterId, _patientId, "RESP_RATE", 8m);
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await detector.ProcessObservationAsync(_encounterId, _patientId, "SPO2", 98m);
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await detector.ProcessObservationAsync(_encounterId, _patientId, "SYSTOLIC_BP", 120m);
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await detector.ProcessObservationAsync(_encounterId, _patientId, "HEART_RATE", 72m);
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await detector.ProcessObservationAsync(_encounterId, _patientId, "AVPU", 0m);
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await detector.ProcessObservationAsync(_encounterId, _patientId, "TEMP_C", 37.0m);
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var result = await detector.ProcessObservationAsync(
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_encounterId, _patientId, "SUPPLEMENTAL_O2", 0m);
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result.TotalScore.Should().Be(3);
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result.RiskLevel.Should().Be("LOW_MEDIUM");
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result.AlertCreated.Should().BeTrue();
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result.HasSingleParamThree.Should().BeTrue();
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var db = scope.ServiceProvider.GetRequiredService<AppDbContext>();
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var score = await db.News2Scores.SingleAsync();
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score.HasSingleParamThree.Should().BeTrue();
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var alert = await db.ClinicalAlerts.SingleAsync();
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alert.AlertType.Should().Be(AlertType.News2Warning);
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}
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[Fact]
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public async Task IncompleteParameters_NoScore()
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{
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using var scope = _fixture.Services.CreateScope();
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var detector = scope.ServiceProvider.GetRequiredService<News2Detector>();
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await detector.ProcessObservationAsync(_encounterId, _patientId, "RESP_RATE", 16m);
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await detector.ProcessObservationAsync(_encounterId, _patientId, "SPO2", 98m);
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await detector.ProcessObservationAsync(_encounterId, _patientId, "HEART_RATE", 72m);
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var result = await detector.ProcessObservationAsync(
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_encounterId, _patientId, "TEMP_C", 37.0m);
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result.Outcome.Should().Be(News2Outcome.IncompleteParameters);
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result.PresentParameters.Should().Be(4);
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var db = scope.ServiceProvider.GetRequiredService<AppDbContext>();
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(await db.News2Scores.CountAsync()).Should().Be(0);
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(await db.ClinicalAlerts.CountAsync()).Should().Be(0);
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}
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[Fact]
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public async Task NonNews2Code_Ignored()
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{
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using var scope = _fixture.Services.CreateScope();
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var detector = scope.ServiceProvider.GetRequiredService<News2Detector>();
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var redis = scope.ServiceProvider.GetRequiredService<IConnectionMultiplexer>();
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var result = await detector.ProcessObservationAsync(
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_encounterId, _patientId, "POTASSIUM_MEQ_L", 4.0m);
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result.Outcome.Should().Be(News2Outcome.NotNews2Code);
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var anyNews2Key = false;
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foreach (var key in News2Calculator.AllParameterKeys(_encounterId))
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{
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if (await redis.GetDatabase().KeyExistsAsync(key))
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anyNews2Key = true;
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}
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anyNews2Key.Should().BeFalse();
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}
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[Fact]
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public async Task DuplicateHighRisk_Idempotent()
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{
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using var scope = _fixture.Services.CreateScope();
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var detector = scope.ServiceProvider.GetRequiredService<News2Detector>();
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var db = scope.ServiceProvider.GetRequiredService<AppDbContext>();
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// First pass — score 8, creates alert
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await FeedHighRiskSet(detector);
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// Second scoring event — one parameter update while all 7 keys remain populated.
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// Each observation after completeness triggers a new score row; alert must stay deduplicated.
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await detector.ProcessObservationAsync(_encounterId, _patientId, "HEART_RATE", 72m);
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(await db.ClinicalAlerts.CountAsync()).Should().Be(1,
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"second NEWS2_EMERGENCY must be idempotent while first is still open");
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(await db.News2Scores.CountAsync()).Should().Be(2,
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"both scores should be persisted even though alert is deduplicated");
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}
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private async Task FeedHighRiskSet(News2Detector detector)
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{
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await detector.ProcessObservationAsync(_encounterId, _patientId, "RESP_RATE", 25m);
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await detector.ProcessObservationAsync(_encounterId, _patientId, "SPO2", 91m);
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await detector.ProcessObservationAsync(_encounterId, _patientId, "SYSTOLIC_BP", 95m);
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await detector.ProcessObservationAsync(_encounterId, _patientId, "HEART_RATE", 72m);
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await detector.ProcessObservationAsync(_encounterId, _patientId, "AVPU", 0m);
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await detector.ProcessObservationAsync(_encounterId, _patientId, "TEMP_C", 37.0m);
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await detector.ProcessObservationAsync(_encounterId, _patientId, "SUPPLEMENTAL_O2", 0m);
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}
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}
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