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Marc-André Bombeck
f2a9716671
The hypertensive-crisis floors were defined in three modules with a divergent diastolic value: the notification engine and the Coach acute clause used 180/120, but the dashboard hero used 180/110. A reading like 170/112 lit the red critical-BP banner on the hero yet never tripped the notification alarm or matched the Coach's stated acute number — one surface said crisis, the other two stayed calm on the same row. Promote the absolute floors into a dependency-free clinical-floors leaf and have the hero, the safety-floor engine, the status registry's fever band, and the illness escalation all import from it. The crisis diastolic floor is the guideline-correct 120 (ACC/AHA hypertensive urgency); the wider 110 hero net is dropped so the surfaces tell one story. A coverage test pins that every consumer resolves the same constants.
82 lines
4.7 KiB
TypeScript
82 lines
4.7 KiB
TypeScript
/**
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* Canonical clinical safety floors — ONE source of truth (v1.21.0, D3-H1).
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*
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* Before this module the "is this a crisis?" thresholds were defined in three
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* places with a divergent diastolic floor: the safety-floor notification engine
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* and the Coach acute clause used 180/120, but the dashboard hero's `bpCritical`
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* rung used 180/110 — so a reading like 170/112 lit the red "critical BP" hero
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* banner yet never tripped the notification alarm or the Coach's stated acute
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* number. One surface said crisis, the other two stayed calm on the same row.
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*
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* This leaf holds the absolute, guideline-backed floors as plain constants and
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* every consumer imports from here:
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* - `src/lib/illness/safety-floors.ts` (the confirm-before-alarm engine),
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* - `src/lib/dashboard/verdict.ts` (the hero `bpCritical` rung),
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* - `src/lib/insights/metric-status-registry.ts` (the fever band line),
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* - and (left to the prompt agent) the `safetyAcute` / `safetyGlp1` Coach
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* contracts, which must bind their prose numbers to these exports rather
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* than hardcoding literals — see the comment at each constant.
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*
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* CLIENT-SAFE: dependency-free literals only. `verdict.ts` runs inside the
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* `"use client"` dashboard hero, and its import-graph client-safety test
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* (`verdict-client-safety.test.ts`) walks every VALUE import reachable from
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* `verdict.ts`. Do NOT add any import to this file — no prisma, no `node:`
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* builtins, no server graph. Constants only.
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*
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* Units: mmHg (BP), mg/dL (glucose), °C (temperature) — HealthLog canonical
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* store units throughout.
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*
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* Citations (general guidance, not medical advice; wide individual variation):
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* - BP ≥ 180/120: ACC/AHA 2017; AHA "Management of Elevated BP in the Acute
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* Care Setting" 2024. The number is identical for emergency vs non-
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* emergency — symptoms are the differentiator, not the value. The crisis
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* DIASTOLIC floor is 120, NOT the old hero 110: 120 is the hypertensive-
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* urgency standard, so the wider 110 net is dropped to keep the three
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* surfaces telling one story (D3-H1).
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* - Low BP (SBP < 90): NHLBI low-blood-pressure guidance; Hypotension —
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* StatPearls/NIH 2024.
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* - Hypoglycemia: ADA Standards of Care §6 — Level 1 alert < 70 mg/dL,
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* Level 2 (clinically significant) < 54 mg/dL.
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* - Hyperglycemia / DKA: ADA Standards of Care 2026 — DKA hyperglycemia
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* criterion ≥ 200 mg/dL; ~10% of DKA is euglycemic, so a glucose value
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* alone cannot rule it out. We never show "all clear" below 200 and reserve
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* the urgent escalation for a sustained very-high band (≥ 250 mg/dL).
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* - Fever: J Gen Intern Med systematic review (2019) — population
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* oral-equivalent fever line ≥ 38.0 °C (single-reading band); the illness
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* engine escalates only a SUSTAINED fever at ≥ 38.5 °C (multi-day adverse
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* run). These are two intentional lines for two questions; they live here
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* together so the band and the escalation are visibly the same pair.
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* - SpO₂: red-flag floor ≤ 92% (sustained-low escalation).
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*/
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/* ── blood pressure ─────────────────────────────────────────────────────── */
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/** Hypertensive-crisis floor: systolic ≥ this (mmHg). */
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export const BP_SYS_CRITICAL = 180;
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/**
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* Hypertensive-crisis floor: diastolic ≥ this (mmHg). 120 (ACC/AHA), the
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* single crisis diastolic floor across the hero, the notification engine, and
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* the Coach acute clause (D3-H1 — was 110 on the hero only).
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*/
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export const BP_DIA_CRITICAL = 120;
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/** Symmetric low-BP cautionary floor: systolic < this (mmHg). */
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export const BP_SYS_HYPOTENSIVE_FLOOR = 90;
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/* ── glucose (mg/dL) ────────────────────────────────────────────────────── */
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/** Hypoglycemia Level-1 alert: glucose < this. */
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export const GLUCOSE_HYPO_FLOOR = 70;
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/** Hypoglycemia Level-2 (clinically significant): glucose < this. */
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export const GLUCOSE_HYPO_SEVERE_FLOOR = 54;
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/** Hyperglycemia urgent escalation (sustained very-high seek-care trigger). */
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export const GLUCOSE_HYPER_FLOOR = 250;
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/* ── temperature (°C) ───────────────────────────────────────────────────── */
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/** Single-reading fever band line (status cards). */
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export const FEVER_BAND_C = 38.0;
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/** Sustained-fever escalation floor (illness engine red flag). */
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export const FEVER_RED_FLAG_C = 38.5;
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/** Sustained-low SpO₂ red-flag floor (%). */
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export const SPO2_RED_FLAG_PCT = 92;
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