private IEnumerable <DecisionSupportResult> CheckMentalStatusOrPalpableSkullFracture(Patient patient,
ICollection <DecisionSupportResult> results)
{
if (patient.Data.SignsOfAlteredMentalStatus == Trilean.Yes ||
patient.Data.SignsOfPalpableSkullFracture == Trilean.Yes)
{
results.Add(DecisionSupportResult.ActionRecommended(RuleLabel, CtRecommended));
return(results);
}
if (patient.Data.SignsOfAlteredMentalStatus == Trilean.Unknown ||
patient.Data.SignsOfPalpableSkullFracture == Trilean.Unknown)
{
var dataNeeded = new List <string>();
if (patient.Data.SignsOfAlteredMentalStatus == Trilean.Unknown)
{
dataNeeded.Add(nameof(patient.Data.SignsOfAlteredMentalStatus));
}
if (patient.Data.SignsOfPalpableSkullFracture == Trilean.Unknown)
{
dataNeeded.Add(nameof(patient.Data.SignsOfPalpableSkullFracture));
}
results.Add(DecisionSupportResult.NeedMoreData(RuleLabel, dataNeeded));
return(results);
}
return(CheckHematomaLocSevereInjuryOrAbnormalBehavior(patient, results));
}
private IEnumerable <DecisionSupportResult> PersistentMentalStatusCheck(Patient patient)
{
var results = new List <DecisionSupportResult>();
if (patient.Data.PersistentMentalStatusChanges == Trilean.Yes ||
patient.Data.CerebralContusionsSuspected == Trilean.Yes)
{
return(MriCheck(patient));
}
var dataNeeded = new List <string>();
if (patient.Data.PersistentMentalStatusChanges == Trilean.Unknown)
{
dataNeeded.Add(nameof(Observations.PersistentMentalStatusChanges));
}
if (patient.Data.CerebralContusionsSuspected == Trilean.Unknown)
{
dataNeeded.Add(nameof(Observations.CerebralContusionsSuspected));
}
if (dataNeeded.Count > 0)
{
results.Add(DecisionSupportResult.NeedMoreData(RuleLabel, dataNeeded));
return(results);
}
results.Add(DoNotHospitalize());
return(results);
}
private IEnumerable <DecisionSupportResult> CheckHematomaLocSevereInjuryOrAbnormalBehavior(Patient patient,
ICollection <DecisionSupportResult> results)
{
var findings = new List <bool>
{
patient.Data.OptScalpHematoma == Trilean.Yes,
patient.Data.LossOfConsciousness == Trilean.Yes &&
patient.Data.LossOfConsciousnessTime.HasValue &&
patient.Data.LossOfConsciousnessTime.Value >= TimeSpan.FromSeconds(5),
patient.Data.SevereMechanismOfInjury == Trilean.Yes,
patient.Data.AbnormalBehaviorPerParentalAssessment == Trilean.Yes
};
var findingCount = findings.Count(finding => finding);
switch (findingCount)
{
case 0:
if (patient.Data.OptScalpHematoma == Trilean.Unknown ||
patient.Data.LossOfConsciousness == Trilean.Unknown ||
(patient.Data.LossOfConsciousness == Trilean.Yes && patient.Data.LossOfConsciousnessTime == null) ||
patient.Data.SevereMechanismOfInjury == Trilean.Unknown ||
patient.Data.AbnormalBehaviorPerParentalAssessment == Trilean.Unknown)
{
var dataNeeded = new List <string>();
if (patient.Data.OptScalpHematoma == Trilean.Unknown)
{
dataNeeded.Add(nameof(patient.Data.OptScalpHematoma));
}
if (patient.Data.LossOfConsciousness == Trilean.Unknown)
{
dataNeeded.Add(nameof(patient.Data.LossOfConsciousness));
}
if (patient.Data.LossOfConsciousness == Trilean.Yes && patient.Data.LossOfConsciousnessTime == null)
{
dataNeeded.Add(nameof(patient.Data.LossOfConsciousnessTime));
}
if (patient.Data.SevereMechanismOfInjury == Trilean.Unknown)
{
dataNeeded.Add(nameof(patient.Data.SevereMechanismOfInjury));
}
if (patient.Data.AbnormalBehaviorPerParentalAssessment == Trilean.Unknown)
{
dataNeeded.Add(nameof(patient.Data.AbnormalBehaviorPerParentalAssessment));
}
results.Add(DecisionSupportResult.NeedMoreData(RuleLabel, dataNeeded));
return(results);
}
results.Add(DecisionSupportResult.ActionRecommended(RuleLabel, CtNotRecommended));
return(results);
case 1:
return(CheckWorseningSymptomsOrAge(patient, results));
default:
results.Add(DecisionSupportResult.ActionRecommended(RuleLabel, CtRecommended));
return(results);
}
}
private IEnumerable <DecisionSupportResult> CheckMentalStatusOrBasilarSkullFracture(Patient patient,
ICollection <DecisionSupportResult> results)
{
if (patient.Data.SignsOfAlteredMentalStatus == Trilean.Yes ||
patient.Data.SignsOfBasilarSkullFracture == Trilean.Yes)
{
results.Add(DecisionSupportResult.ActionRecommended(RuleLabel, CtRecommended));
return(results);
}
if (patient.Data.SignsOfAlteredMentalStatus == Trilean.Unknown ||
patient.Data.SignsOfBasilarSkullFracture == Trilean.Unknown)
{
var dataNeeded = new List <string>();
if (patient.Data.SignsOfAlteredMentalStatus == Trilean.Unknown)
{
dataNeeded.Add(nameof(patient.Data.SignsOfAlteredMentalStatus));
}
if (patient.Data.SignsOfBasilarSkullFracture == Trilean.Unknown)
{
dataNeeded.Add(nameof(patient.Data.SignsOfBasilarSkullFracture));
}
results.Add(DecisionSupportResult.NeedMoreData(RuleLabel, dataNeeded));
return(results);
}
return(CheckLocVomitingSevereInjuryOrHeadache(patient, results));
}
public async Task <IEnumerable <DecisionSupportResult> > EvaluateAsync(Patient patient)
{
await Task.Delay(10); // TODO: remove this if other async methodology included
var results = new List <DecisionSupportResult>();
if (patient.Data.CtImagingTaken == Trilean.Yes)
{
results.Add(DecisionSupportResult.NoAction(RuleLabel));
return(results);
}
switch (patient.Data.GlasgowComaScale)
{
case 15:
// gcs is 15, so check age
return(CheckAge(patient, results));
case var gcs when gcs == 13 || gcs == 14:
results.Add(DecisionSupportResult.ActionRecommended(RuleLabel, CtRecommended));
return(results);
case null:
results.Add(DecisionSupportResult.NeedMoreData(RuleLabel, nameof(patient.Data.GlasgowComaScale)));
return(results);
default:
results.Add(DecisionSupportResult.NoAction(RuleLabel));
return(results);
}
}
private IEnumerable <DecisionSupportResult> CheckWorseningSymptomsOrAge(Patient patient,
ICollection <DecisionSupportResult> results)
{
if (patient.Data.WorseningSymptoms == Trilean.Yes ||
(!Equals(patient.Age, null) && patient.Age < ThreeMonthsOfAge))
{
results.Add(DecisionSupportResult.ActionRecommended(RuleLabel, CtRecommended));
return(results);
}
if (patient.Data.WorseningSymptoms == Trilean.Unknown ||
Equals(patient.Age, null))
{
var dataNeeded = new List <string>();
if (patient.Data.WorseningSymptoms == Trilean.Unknown)
{
dataNeeded.Add(nameof(patient.Data.WorseningSymptoms));
}
if (Equals(patient.Age, null))
{
dataNeeded.Add(nameof(patient.Age));
}
results.Add(DecisionSupportResult.NeedMoreData(RuleLabel, dataNeeded));
return(results);
}
results.Add(DecisionSupportResult.ActionRecommended(RuleLabel, ObservationInHospital));
return(results);
}
private static IEnumerable <DecisionSupportResult> MriRecommendedResults()
{
var results = new DecisionSupportResult[2];
results[0] = DecisionSupportResult.ActionRecommended(RuleLabel, MriRecommended);
results[1] = DecisionSupportResult.NeedMoreData(RuleLabel, nameof(Observations.MriTaken));
return(results);
}
private IEnumerable <DecisionSupportResult> CheckLocVomitingSevereInjuryOrHeadache(Patient patient,
ICollection <DecisionSupportResult> results)
{
if (patient.Data.LossOfConsciousness == Trilean.Unknown ||
patient.Data.Vomiting == Trilean.Unknown ||
patient.Data.SevereMechanismOfInjury == Trilean.Unknown ||
patient.Data.SevereHeadache == Trilean.Unknown)
{
var dataNeeded = new List <string>();
if (patient.Data.LossOfConsciousness == Trilean.Unknown)
{
dataNeeded.Add(nameof(patient.Data.LossOfConsciousness));
}
if (patient.Data.Vomiting == Trilean.Unknown)
{
dataNeeded.Add(nameof(patient.Data.Vomiting));
}
if (patient.Data.SevereMechanismOfInjury == Trilean.Unknown)
{
dataNeeded.Add(nameof(patient.Data.SevereMechanismOfInjury));
}
if (patient.Data.SevereHeadache == Trilean.Unknown)
{
dataNeeded.Add(nameof(patient.Data.SevereHeadache));
}
results.Add(DecisionSupportResult.NeedMoreData(RuleLabel, dataNeeded));
return(results);
}
var findings = new List <Trilean>
{
patient.Data.LossOfConsciousness,
patient.Data.Vomiting,
patient.Data.SevereMechanismOfInjury,
patient.Data.SevereHeadache
};
var findingCount = findings.Count(finding => finding == Trilean.Yes);
switch (findingCount)
{
case 0:
results.Add(DecisionSupportResult.ActionRecommended(RuleLabel, CtNotRecommended));
return(results);
case 1:
return(CheckWorseningSymptomsOrAge(patient, results));
default:
results.Add(DecisionSupportResult.ActionRecommended(RuleLabel, CtRecommended));
return(results);
}
}
private IEnumerable <DecisionSupportResult> CheckAge(Patient patient, ICollection <DecisionSupportResult> results)
{
switch (patient.Age)
{
case null:
results.Add(DecisionSupportResult.NeedMoreData(RuleLabel, nameof(Patient.Age)));
return(results);
case var age when age < TwoYearsOfAge:
return(CheckMentalStatusOrPalpableSkullFracture(patient, results));
default:
return(CheckMentalStatusOrBasilarSkullFracture(patient, results));
}
}
public async Task <IEnumerable <DecisionSupportResult> > EvaluateAsync(Patient patient)
{
await Task.Delay(10); // TODO: remove this if other async methodology included
var results = new List <DecisionSupportResult>();
if (!patient.Data.RestRecommended.HasValue)
{
results.Add(DecisionSupportResult.NeedMoreData(RuleLabel, nameof(Observations.RestRecommended)));
}
else
{
results.Add(
patient.Data.RestRecommendedDays.HasValue
? ManagementPlanRecommendation(
string.Format(DaysRestTemplate, patient.Data.RestRecommendedDays))
: DecisionSupportResult.NeedMoreData(RuleLabel, nameof(Observations.RestRecommendedDays)));
}
if (patient.Data.SevereHeadache == Trilean.Yes)
{
results.Add(ManagementPlanRecommendation(HeadacheDrugs));
}
if (patient.Data.LightNoiseSensitivity == Trilean.Yes)
{
results.Add(ManagementPlanRecommendation(SunglassesEarplugs));
}
if (!patient.Data.IncludeSchoolRecommendations.HasValue)
{
results.Add(DecisionSupportResult.NeedMoreData(RuleLabel, nameof(Observations.IncludeSchoolRecommendations)));
}
else if (patient.Data.IncludeSchoolRecommendations.Value)
{
results.Add(ManagementPlanRecommendation(SchoolRecommendations));
}
if (!string.IsNullOrWhiteSpace(patient.Data.CustomDischargeInstructions))
{
results.Add(ManagementPlanRecommendation(patient.Data.CustomDischargeInstructions));
}
return(results);
}
private IEnumerable <DecisionSupportResult> CerebralContusionsFromBluntTraumaCheck(Patient patient)
{
var results = new List <DecisionSupportResult>();
switch (patient.Data.MinorBluntHeadTraumaContusions)
{
case Trilean.Unknown:
results.Add(DecisionSupportResult.NeedMoreData(RuleLabel, nameof(Observations.MinorBluntHeadTraumaContusions)));
return(results);
case Trilean.Yes:
return(ContusionsSmallAndIsolatedCheck(patient));
case Trilean.No:
return(PersistentMentalStatusCheck(patient));
default:
throw new ArgumentOutOfRangeException();
}
}
private IEnumerable <DecisionSupportResult> CtImagingTaken(Patient patient)
{
var results = new List <DecisionSupportResult>();
switch (patient.Data.CtImagingResultsAbnormal)
{
case Trilean.Unknown:
results.Add(DecisionSupportResult.NeedMoreData(RuleLabel, nameof(Observations.CtImagingResultsAbnormal)));
return(results);
case Trilean.Yes:
results.Add(Hospitalize());
return(results);
case Trilean.No:
return(CerebralContusionsFromBluntTraumaCheck(patient));
default:
throw new ArgumentOutOfRangeException();
}
}
private IEnumerable <DecisionSupportResult> MriResultsCheck(Patient patient)
{
var results = new List <DecisionSupportResult>();
switch (patient.Data.MriResultsAbnormal)
{
case Trilean.Unknown:
results.Add(DecisionSupportResult.NeedMoreData(RuleLabel, nameof(Observations.MriResultsAbnormal)));
break;
case Trilean.Yes:
results.Add(Hospitalize());
break;
case Trilean.No:
results.Add(DoNotHospitalize());
break;
default:
throw new ArgumentOutOfRangeException();
}
return(results);
}
private static DecisionSupportResult DoNotHospitalize()
{
return(DecisionSupportResult.ActionRecommended(RuleLabel, HospitalizationUnnecessary));
}
public async Task <IEnumerable <DecisionSupportResult> > EvaluateAsync(Patient patient)
{
await Task.Delay(10); // TODO: remove this if other async methodology included
var results = new List <DecisionSupportResult>();
if ((patient.Data.MriTaken == Trilean.Yes && patient.Data.MriResultsAbnormal == Trilean.Yes) ||
patient.Data.SevereSymptoms == Trilean.Yes ||
patient.Data.ChronicDiseases == Trilean.Yes ||
(patient.Data.GlasgowComaScale.HasValue && patient.Data.GlasgowComaScale.Value <= 13) ||
(patient.Data.CtImagingTaken == Trilean.Yes && patient.Data.CtImagingResultsAbnormal == Trilean.Yes))
{
results.Add(Hospitalize());
return(results);
}
// skull fracture and hematoma are single findings, so flatten all the possible results for each into a single count
var findings = new Dictionary <string, Trilean>
{
{ nameof(Observations.ConcussionHistory), patient.Data.ConcussionHistory },
{ nameof(Observations.SignsOfAlteredMentalStatus), patient.Data.SignsOfAlteredMentalStatus },
{ nameof(Observations.LossOfConsciousness), patient.Data.LossOfConsciousness },
{ nameof(Observations.Vomiting), patient.Data.Vomiting },
{ nameof(Observations.SevereHeadache), patient.Data.SevereHeadache },
{ nameof(Observations.SevereMechanismOfInjury), patient.Data.SevereMechanismOfInjury },
{ nameof(Observations.AbnormalBehaviorPerParentalAssessment), patient.Data.AbnormalBehaviorPerParentalAssessment }
};
var skullFractureFindings = new Dictionary <string, Trilean>
{
{ nameof(Observations.SignsOfBasilarSkullFracture), patient.Data.SignsOfBasilarSkullFracture },
{ nameof(Observations.SignsOfPalpableSkullFracture), patient.Data.SignsOfPalpableSkullFracture },
{ nameof(Observations.SignsOfOtherSkullFracture), patient.Data.SignsOfOtherSkullFracture }
};
var hematomaFindings = new Dictionary <string, Trilean>
{
{ nameof(Observations.OptScalpHematoma), patient.Data.OptScalpHematoma },
{ nameof(Observations.OtherScalpHematoma), patient.Data.OtherScalpHematoma }
};
var findingCount = findings.Count(finding => finding.Value == Trilean.Yes);
if (skullFractureFindings.Any(sff => sff.Value == Trilean.Yes))
{
findingCount++;
}
if (hematomaFindings.Any(hf => hf.Value == Trilean.Yes))
{
findingCount++;
}
if (findingCount >= 3)
{
results.Add(Hospitalize());
return(results);
}
var dataNeeded = new List <string>();
dataNeeded.AddRange(findings.Merge(skullFractureFindings).Merge(hematomaFindings)
.Where(finding => finding.Value == Trilean.Unknown).Select(fm => fm.Key));
if (patient.Data.SevereSymptoms == Trilean.Unknown)
{
dataNeeded.Add(nameof(Observations.SevereSymptoms));
}
if (patient.Data.ChronicDiseases == Trilean.Unknown)
{
dataNeeded.Add(nameof(Observations.ChronicDiseases));
}
if (patient.Data.MriTaken == Trilean.Yes && patient.Data.MriResultsAbnormal == Trilean.Unknown)
{
dataNeeded.Add(nameof(Observations.MriResultsAbnormal));
}
if (dataNeeded.Count > 0)
{
results.Add(DecisionSupportResult.NeedMoreData(RuleLabel, dataNeeded));
return(results);
}
switch (patient.Data.CtImagingTaken)
{
case Trilean.Unknown:
results.Add(DecisionSupportResult.NeedMoreData(RuleLabel, nameof(Observations.CtImagingTaken)));
return(results);
case Trilean.Yes:
return(CtImagingTaken(patient));
case Trilean.No:
return(CtImagingNotTaken(patient));
default:
throw new ArgumentOutOfRangeException();
}
}
private static DecisionSupportResult ManagementPlanRecommendation(string recommendation)
{
return(DecisionSupportResult.ManagementPlanRecommendation(RuleLabel, recommendation));
}
