feature: NEWS2 Composite Scoring Engine
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voltsrage
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using FluentAssertions;
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using Microsoft.EntityFrameworkCore;
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using Microsoft.Extensions.DependencyInjection;
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using StackExchange.Redis;
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[Collection("Integration")]
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public class 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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