t2a/tests/test_severity.py

"""Tests pour le module de sévérité heuristique (CMA/CMS)."""

import pytest

from src.config import Diagnostic
from src.medical.severity import (
    evaluate_severity,
    enrich_dossier_severity,
    _detect_severity_markers,
    _is_heuristic_cma,
    _load_cma_levels,
)


class TestDetectSeverityMarkers:
    def test_severe_markers(self):
        niveau, marqueurs = _detect_severity_markers("Pancréatite aiguë sévère")
        assert niveau == "severe"
        assert any(m in ("severe", "aigue") for m in marqueurs)

    def test_moderate_markers(self):
        niveau, marqueurs = _detect_severity_markers("Insuffisance rénale modérée")
        assert niveau == "modere"
        assert "modere" in marqueurs or "moderee" in marqueurs

    def test_mild_markers(self):
        niveau, marqueurs = _detect_severity_markers("Anémie chronique bénigne")
        assert niveau == "leger"
        assert any(m in ("chronique", "benin", "benigne") for m in marqueurs)

    def test_no_markers(self):
        niveau, marqueurs = _detect_severity_markers("Hypertension artérielle")
        assert niveau == "non_evalue"
        assert marqueurs == []

    def test_severe_overrides_mild(self):
        """Si 'sévère' et 'chronique' sont présents, 'severe' l'emporte."""
        niveau, marqueurs = _detect_severity_markers("Insuffisance cardiaque chronique décompensée")
        assert niveau == "severe"


class TestHeuristicCMA:
    def test_e11_is_cma(self):
        assert _is_heuristic_cma("E11.9") is True

    def test_i48_is_cma(self):
        assert _is_heuristic_cma("I48.9") is True

    def test_a41_is_cma(self):
        assert _is_heuristic_cma("A41.9") is True

    def test_k85_not_cma(self):
        assert _is_heuristic_cma("K85.1") is False

    def test_i10_not_cma(self):
        assert _is_heuristic_cma("I10") is False

    def test_empty(self):
        assert _is_heuristic_cma("") is False
        assert _is_heuristic_cma(None) is False


class TestCMALevels:
    """Tests pour le lookup CMA officiel ATIH."""

    def test_load_cma_levels(self):
        levels = _load_cma_levels()
        assert len(levels) > 0
        # A01.0 est severity 2 dans cocoa_entries
        assert levels.get("A01.0") == 2

    def test_official_level_4(self):
        """Un code CMA niveau 4 est bien détecté."""
        levels = _load_cma_levels()
        level4_codes = [k for k, v in levels.items() if v == 4]
        assert len(level4_codes) > 0

    def test_official_level_propagated(self):
        """evaluate_severity propage le niveau CMA officiel."""
        levels = _load_cma_levels()
        # Prendre un code de niveau 3
        code_lv3 = next((k for k, v in levels.items() if v == 3), None)
        if code_lv3:
            diag = Diagnostic(texte="Test diagnostic", cim10_suggestion=code_lv3)
            info = evaluate_severity(diag)
            assert info.niveau_cma == 3
            assert info.est_cma_probable is True

    def test_heuristic_fallback_level_2(self):
        """Un code heuristique CMA sans entrée officielle → niveau 2."""
        # E11.9 est dans les racines heuristiques ET dans le fichier officiel
        # Testons avec un code heuristique qui n'est pas dans le fichier officiel
        diag = Diagnostic(texte="Test", cim10_suggestion="E11.9")
        info = evaluate_severity(diag)
        assert info.est_cma_probable is True
        assert info.niveau_cma >= 2

    def test_non_cma_remains_level_1(self):
        """Un code non-CMA reste au niveau 1."""
        diag = Diagnostic(texte="Grippe", cim10_suggestion="J11.1")
        info = evaluate_severity(diag)
        if not info.est_cma_probable:
            assert info.niveau_cma == 1


class TestEvaluateSeverity:
    def test_cma_code_detected(self):
        diag = Diagnostic(texte="Diabète type 2", cim10_suggestion="E11.9")
        info = evaluate_severity(diag)
        assert info.est_cma_probable is True

    def test_non_cma_code(self):
        """Un code non CMA (J11.1 grippe) n'est pas détecté comme CMA."""
        diag = Diagnostic(texte="Grippe", cim10_suggestion="J11.1")
        info = evaluate_severity(diag)
        assert info.est_cma_probable is False

    def test_severity_from_text(self):
        diag = Diagnostic(texte="Sepsis sévère", cim10_suggestion="A41.9")
        info = evaluate_severity(diag)
        assert info.niveau_severite == "severe"
        assert info.est_cma_probable is True

    def test_combined_text_and_dict_label(self):
        """Le label du dictionnaire CIM-10 enrichit la détection de sévérité."""
        diag = Diagnostic(texte="Embolie pulmonaire", cim10_suggestion="I26.9")
        info = evaluate_severity(diag)
        assert info.est_cma_probable is True

    def test_niveau_cma_in_result(self):
        """Le champ niveau_cma est toujours renseigné."""
        diag = Diagnostic(texte="Sepsis", cim10_suggestion="A41.9")
        info = evaluate_severity(diag)
        assert info.niveau_cma >= 1


class TestEnrichDossierSeverity:
    def test_enriches_das_in_place(self):
        dp = Diagnostic(texte="Pancréatite aiguë biliaire", cim10_suggestion="K85.1")
        das = [
            Diagnostic(texte="Fibrillation auriculaire", cim10_suggestion="I48.9"),
            Diagnostic(texte="Obésité", cim10_suggestion="E66.0"),
        ]
        alertes, cma_count, cms_count = enrich_dossier_severity(dp, das)

        # I48.9 = CMA probable
        assert das[0].est_cma is True
        assert das[0].niveau_severite is not None

        # E66.0 = non CMA
        assert das[1].est_cma is None

        # Au moins une alerte CMA
        assert any("CMA" in a for a in alertes)
        assert cma_count >= 1

    def test_dp_severity_set(self):
        dp = Diagnostic(texte="Sepsis sévère", cim10_suggestion="A41.9")
        alertes, cma_count, cms_count = enrich_dossier_severity(dp, [])
        assert dp.niveau_severite == "severe"
        assert dp.est_cma is True

    def test_cms_detection(self):
        """CMS détecté quand CMA + sévérité severe."""
        dp = Diagnostic(texte="Pancréatite", cim10_suggestion="K85.1")
        das = [
            Diagnostic(texte="Sepsis sévère", cim10_suggestion="A41.9"),
        ]
        alertes, cma_count, cms_count = enrich_dossier_severity(dp, das)
        assert das[0].est_cma is True
        assert das[0].est_cms is True
        assert cms_count == 1

    def test_niveau_cma_set_on_das(self):
        """enrich_dossier_severity propage niveau_cma sur chaque DAS."""
        dp = Diagnostic(texte="Pancréatite", cim10_suggestion="K85.1")
        das = [
            Diagnostic(texte="Fibrillation auriculaire", cim10_suggestion="I48.9"),
        ]
        enrich_dossier_severity(dp, das)
        assert das[0].niveau_cma is not None
        assert das[0].niveau_cma >= 2

    def test_alertes_contain_cma_level(self):
        """Les alertes mentionnent le niveau CMA."""
        dp = Diagnostic(texte="Test", cim10_suggestion="K85.1")
        das = [
            Diagnostic(texte="Sepsis", cim10_suggestion="A41.9"),
        ]
        alertes, _, _ = enrich_dossier_severity(dp, das)
        assert any("CMA niveau" in a for a in alertes)