feature: Sepsis Early Warning Engine
This commit is contained in:
voltsrage
@@ -0,0 +1,214 @@
|
||||
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 = "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();
|
||||
outbox.Topic.Should().Be("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();
|
||||
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();
|
||||
}
|
||||
}
|
||||
Reference in New Issue
Block a user