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> 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 static DecisionSupportResult DoNotHospitalize()
{
return(DecisionSupportResult.ActionRecommended(RuleLabel, HospitalizationUnnecessary));
}