vigilcare-clinical/VigilCareClinicalAPI.Tests/QsofaDetectorTests.cs

using FluentAssertions;
using Microsoft.EntityFrameworkCore;
using Microsoft.Extensions.DependencyInjection;
using StackExchange.Redis;

[Collection("Integration")]
public class QsofaDetectorTests : IAsyncLifetime
{
    private readonly ApiFixture _fixture;
    private Guid _encounterId;
    private Guid _patientId;

    public QsofaDetectorTests(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-QSOFA-001", FirstName = "qSOFA", 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. qSOFA", AdmittedAt = DateTimeOffset.UtcNow,
            CreatedAt = DateTimeOffset.UtcNow
        };
        db.Patients.Add(patient);
        db.Encounters.Add(encounter);
        await db.SaveChangesAsync();

        _patientId = patient.Id;
        _encounterId = encounter.Id;

        var redis = scope.ServiceProvider.GetRequiredService<IConnectionMultiplexer>();
        var cache = redis.GetDatabase();
        foreach (var key in QsofaCalculator.AllCriterionKeys(_encounterId))
            await cache.KeyDeleteAsync(key);
    }

    public Task DisposeAsync() => Task.CompletedTask;

    [Fact]
    public async Task OneCriterionMet_NoAlert()
    {
        using var scope = _fixture.Services.CreateScope();
        var detector = scope.ServiceProvider.GetRequiredService<QsofaDetector>();

        var result = await detector.ProcessObservationAsync(
            _encounterId, _patientId, "RESP_RATE", 24m);

        result.Outcome.Should().Be(QsofaOutcome.InsufficientCriteria);
        result.ActiveCriteria.Should().Be(1);

        var redis = scope.ServiceProvider.GetRequiredService<IConnectionMultiplexer>();
        var ttl = await redis.GetDatabase()
            .KeyTimeToLiveAsync(QsofaCalculator.CriterionKey(_encounterId, "RESP_RATE"));
        ttl.Should().NotBeNull().And.BeGreaterThan(TimeSpan.Zero);
    }

    [Fact]
    public async Task TwoCriteriaMet_CreatesAlert()
    {
        using var scope = _fixture.Services.CreateScope();
        var detector = scope.ServiceProvider.GetRequiredService<QsofaDetector>();
        var db = scope.ServiceProvider.GetRequiredService<AppDbContext>();

        var r1 = await detector.ProcessObservationAsync(
            _encounterId, _patientId, "RESP_RATE", 24m);
        r1.Outcome.Should().Be(QsofaOutcome.InsufficientCriteria);

        var r2 = await detector.ProcessObservationAsync(
            _encounterId, _patientId, "SYSTOLIC_BP", 95m);
        r2.Outcome.Should().Be(QsofaOutcome.AlertCreated);

        var alert = await db.ClinicalAlerts.SingleAsync();
        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("order SOFA labs");

        var outbox = await db.OutboxEvents.SingleAsync(e => e.Topic == "alert.generated");
        outbox.PartitionKey.Should().Be(_encounterId.ToString());
    }

    [Fact]
    public async Task CriterionNormalizes_KeyDeleted()
    {
        using var scope = _fixture.Services.CreateScope();
        var detector = scope.ServiceProvider.GetRequiredService<QsofaDetector>();
        var db = scope.ServiceProvider.GetRequiredService<AppDbContext>();
        var redis = scope.ServiceProvider.GetRequiredService<IConnectionMultiplexer>();
        var cache = redis.GetDatabase();

        await detector.ProcessObservationAsync(_encounterId, _patientId, "RESP_RATE", 24m);
        await detector.ProcessObservationAsync(_encounterId, _patientId, "SYSTOLIC_BP", 95m);

        var result = await detector.ProcessObservationAsync(
            _encounterId, _patientId, "RESP_RATE", 18m);

        var respKeyExists = await cache.KeyExistsAsync(
            QsofaCalculator.CriterionKey(_encounterId, "RESP_RATE"));
        respKeyExists.Should().BeFalse("a normalized respiratory rate must clear the criterion key");

        var sbpKeyExists = await cache.KeyExistsAsync(
            QsofaCalculator.CriterionKey(_encounterId, "SYSTOLIC_BP"));
        sbpKeyExists.Should().BeTrue("the other active criterion must remain in Redis");

        result.Outcome.Should().Be(QsofaOutcome.InsufficientCriteria);
        result.ActiveCriteria.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");
    }

    [Fact]
    public async Task DuplicateAlert_Idempotent()
    {
        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 r3 = await detector.ProcessObservationAsync(
            _encounterId, _patientId, "SYSTOLIC_BP", 95m);

        r3.Outcome.Should().Be(QsofaOutcome.AlertAlreadyOpen);

        var alertCount = await db.ClinicalAlerts.CountAsync();
        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");
    }

    [Fact]
    public async Task NonQsofaCode_Ignored()
    {
        using var scope = _fixture.Services.CreateScope();
        var detector = scope.ServiceProvider.GetRequiredService<QsofaDetector>();
        var redis = scope.ServiceProvider.GetRequiredService<IConnectionMultiplexer>();

        var result = await detector.ProcessObservationAsync(
            _encounterId, _patientId, "HEART_RATE", 95m);

        result.Outcome.Should().Be(QsofaOutcome.NotQsofaCode);

        foreach (var key in QsofaCalculator.AllCriterionKeys(_encounterId))
        {
            var exists = await redis.GetDatabase().KeyExistsAsync(key);
            exists.Should().BeFalse("non-qSOFA codes must not create Redis state");
        }
    }
}