t2a_v2/tests/test_clinical_context.py

"""Tests pour le module d'enrichissement du contexte clinique."""

import pytest

from src.medical.clinical_context import (
    BIO_INTERPRETATIONS,
    TREATMENT_INDICATORS,
    interpret_bio_value,
    detect_treatment_indicators,
    detect_severity_markers,
    build_enriched_context,
    format_enriched_context,
)
from src.config import (
    BiologieCle,
    Diagnostic,
    DossierMedical,
    Imagerie,
    Sejour,
    Traitement,
)


# --- interpret_bio_value ---

class TestInterpretBioValue:
    def test_crp_major(self):
        assert interpret_bio_value("CRP", "180", True) == "syndrome inflammatoire majeur"

    def test_crp_moderate(self):
        assert interpret_bio_value("CRP", "45", True) == "syndrome inflammatoire modéré"

    def test_crp_minor(self):
        assert interpret_bio_value("CRP", "8", True) == "syndrome inflammatoire mineur"

    def test_crp_normal(self):
        assert interpret_bio_value("CRP", "3", False) is None

    def test_lipase_pancreatite(self):
        assert interpret_bio_value("Lipasémie", "450", True) == "pancréatite biologique (>3N)"

    def test_lipase_moderee(self):
        assert interpret_bio_value("Lipasémie", "90", True) == "élévation modérée de la lipase"

    def test_hemoglobine_severe(self):
        assert interpret_bio_value("Hémoglobine", "6.5", True) == "anémie sévère (transfusion probable)"

    def test_hemoglobine_moderee(self):
        assert interpret_bio_value("Hémoglobine", "9", True) == "anémie modérée"

    def test_plaquettes_severe(self):
        assert interpret_bio_value("Plaquettes", "30", True) == "thrombopénie sévère"

    def test_leucocytes_high(self):
        assert interpret_bio_value("Leucocytes", "25", True) == "hyperleucocytose majeure (infection, inflammation)"

    def test_leucocytes_low(self):
        assert interpret_bio_value("Leucocytes", "1.5", True) == "leucopénie sévère (aplasie, immunodépression)"

    def test_creatinine_severe(self):
        assert interpret_bio_value("Créatinine", "350", True) == "insuffisance rénale sévère"

    def test_unknown_test(self):
        assert interpret_bio_value("Glycémie", "2.5", True) is None

    def test_invalid_value(self):
        assert interpret_bio_value("CRP", "positive", True) is None

    def test_comma_separator(self):
        assert interpret_bio_value("Hémoglobine", "6,5", True) == "anémie sévère (transfusion probable)"

    def test_bilirubine_ictere(self):
        assert interpret_bio_value("Bilirubine totale", "55", True) == "ictère franc"

    def test_asat_cytolyse_majeure(self):
        assert interpret_bio_value("ASAT", "250", True) == "cytolyse hépatique majeure (>5N)"

    def test_asat_cytolyse_moderee(self):
        assert interpret_bio_value("ASAT", "100", True) == "cytolyse hépatique modérée (>2N)"


# --- detect_treatment_indicators ---

class TestDetectTreatmentIndicators:
    def test_insuline(self):
        traitements = [Traitement(medicament="INSULINE LANTUS 20UI")]
        result = detect_treatment_indicators(traitements)
        assert len(result) == 1
        assert result[0]["condition"] == "diabète insulino-traité"

    def test_antibiotique_iv(self):
        traitements = [Traitement(medicament="CEFTRIAXONE 1g IV")]
        result = detect_treatment_indicators(traitements)
        assert len(result) == 1
        assert result[0]["condition"] == "antibiothérapie IV"

    def test_multiple(self):
        traitements = [
            Traitement(medicament="Metformine 1000mg"),
            Traitement(medicament="Enoxaparine 4000UI"),
            Traitement(medicament="Paracétamol 1g"),
        ]
        result = detect_treatment_indicators(traitements)
        assert len(result) == 2
        conditions = {r["condition"] for r in result}
        assert "diabète type 2" in conditions
        assert "anticoagulation (HBPM)" in conditions

    def test_no_match(self):
        traitements = [Traitement(medicament="Paracétamol 1g")]
        result = detect_treatment_indicators(traitements)
        assert result == []

    def test_dedup_conditions(self):
        traitements = [
            Traitement(medicament="Enoxaparine 4000UI"),
            Traitement(medicament="Lovenox 4000UI"),
        ]
        result = detect_treatment_indicators(traitements)
        # Les deux sont HBPM, mais une seule condition
        assert len(result) == 1

    def test_dict_input(self):
        traitements = [{"medicament": "morphine 10mg"}]
        result = detect_treatment_indicators(traitements)
        assert len(result) == 1
        assert result[0]["condition"] == "analgésie palier 3 (douleur sévère)"


# --- detect_severity_markers ---

class TestDetectSeverityMarkers:
    def test_sejour_prolonge(self):
        dossier = DossierMedical(sejour=Sejour(duree_sejour=20))
        markers = detect_severity_markers(dossier)
        assert any("séjour prolongé" in m for m in markers)

    def test_sejour_gt7(self):
        dossier = DossierMedical(sejour=Sejour(duree_sejour=10))
        markers = detect_severity_markers(dossier)
        assert any("séjour >7 jours" in m for m in markers)

    def test_patient_tres_age(self):
        dossier = DossierMedical(sejour=Sejour(age=85))
        markers = detect_severity_markers(dossier)
        assert any("très âgé" in m for m in markers)

    def test_patient_age(self):
        dossier = DossierMedical(sejour=Sejour(age=72))
        markers = detect_severity_markers(dossier)
        assert any("patient âgé" in m for m in markers)

    def test_obesite_morbide(self):
        dossier = DossierMedical(sejour=Sejour(imc=42.0))
        markers = detect_severity_markers(dossier)
        assert any("obésité morbide" in m for m in markers)

    def test_complications(self):
        dossier = DossierMedical(complications=["Fièvre", "Hématome"])
        markers = detect_severity_markers(dossier)
        assert any("2 complication(s)" in m for m in markers)

    def test_no_markers(self):
        dossier = DossierMedical(sejour=Sejour(age=45, duree_sejour=3))
        markers = detect_severity_markers(dossier)
        assert markers == []


# --- build_enriched_context ---

class TestBuildEnrichedContext:
    def test_basic_context(self):
        dossier = DossierMedical(
            sejour=Sejour(sexe="M", age=65, duree_sejour=5),
            biologie_cle=[
                BiologieCle(test="CRP", valeur="150", anomalie=True),
            ],
            traitements_sortie=[
                Traitement(medicament="Ceftriaxone 1g"),
            ],
        )
        ctx = build_enriched_context(dossier)

        assert ctx["sexe"] == "M"
        assert ctx["age"] == 65
        assert len(ctx["interpretations_bio"]) == 1
        assert ctx["interpretations_bio"][0]["interpretation"] == "syndrome inflammatoire majeur"
        assert len(ctx["conditions_traitements"]) == 1
        assert ctx["conditions_traitements"][0]["condition"] == "antibiothérapie IV"

    def test_no_abnormal_bio(self):
        dossier = DossierMedical(
            biologie_cle=[
                BiologieCle(test="CRP", valeur="3", anomalie=False),
            ],
        )
        ctx = build_enriched_context(dossier)
        assert ctx["interpretations_bio"] == []


# --- format_enriched_context ---

class TestFormatEnrichedContext:
    def test_with_interpretations(self):
        ctx = {
            "sexe": "F",
            "age": 70,
            "imc": None,
            "duree_sejour": 10,
            "antecedents": ["HTA", "Diabète"],
            "biologie_cle": [("CRP", "180", True)],
            "imagerie": [],
            "complications": [],
            "dp_texte": None,
            "das_codes_existants": None,
            "interpretations_bio": [
                {"test": "CRP", "valeur": "180 mg/L", "interpretation": "syndrome inflammatoire majeur"},
            ],
            "conditions_traitements": [
                {"medicament": "Insuline", "condition": "diabète insulino-traité"},
            ],
            "marqueurs_severite": ["séjour >7 jours (10 jours)"],
        }
        result = format_enriched_context(ctx)
        assert "Patient : F, 70 ans" in result
        assert "Durée séjour : 10 jours" in result
        assert "HTA" in result
        assert "CRP 180" in result
        assert "INTERPRÉTATION CLINIQUE" in result
        assert "syndrome inflammatoire majeur" in result
        assert "diabète insulino-traité" in result
        assert "séjour >7 jours" in result

    def test_empty_context(self):
        ctx = {
            "sexe": None, "age": None, "imc": None,
            "duree_sejour": None, "antecedents": [],
            "biologie_cle": [], "imagerie": [],
            "complications": [], "dp_texte": None,
            "das_codes_existants": None,
            "interpretations_bio": [],
            "conditions_traitements": [],
            "marqueurs_severite": [],
        }
        result = format_enriched_context(ctx)
        assert result == "Non précisé"

    def test_backward_compat_bio_format(self):
        """Le format bio tuple (test, valeur, anomalie) doit rester compatible."""
        ctx = {
            "sexe": None, "age": None, "imc": None,
            "duree_sejour": None, "antecedents": [],
            "biologie_cle": [("CRP", "180", True)],
            "imagerie": [],
            "complications": [],
            "dp_texte": None,
            "das_codes_existants": None,
            "interpretations_bio": [],
            "conditions_traitements": [],
            "marqueurs_severite": [],
        }
        result = format_enriched_context(ctx)
        assert "CRP 180" in result
        assert "(\u2191)" in result