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name: healthcare-cdss-patterns description: 临床决策支持系统（CDSS）开发模式。药物相互作用检查、剂量验证、临床评分（NEWS2、qSOFA）、警报严重性分类以及 EMR 工作流集成。 origin: Health1 Super Speciality Hospitals — contributed by Dr. Keyur Patel version: "1.0.0"

医疗 CDSS 开发模式

用于构建集成到 EMR 工作流中的临床决策支持系统的模式。CDSS 模块对患者安全至关重要——对假阴性零容忍。

适用场景

• 实现药物相互作用检查
• 构建剂量验证引擎
• 实现临床评分系统（NEWS2、qSOFA、APACHE、GCS）
• 设计异常临床值的警报系统
• 构建带安全检查的药物医嘱录入
• 将实验室结果解读与临床上下文集成

工作原理

CDSS 引擎是一个零副作用的纯函数库。输入临床数据，输出警报。这使其完全可测试。

三个主要模块：

1. checkInteractions(newDrug, currentMeds, allergies) — 检查新药物与当前用药和已知过敏的相互作用。返回按严重性排序的 InteractionAlert[]。使用 DrugInteractionPair 数据模型。
2. validateDose(drug, dose, route, weight, age, renalFunction) — 根据基于体重、年龄调整和肾功能调整的规则验证处方剂量。返回 DoseValidationResult。
3. calculateNEWS2(vitals) — 从 NEWS2Input 计算国家早期预警评分 2。返回包含总分、风险等级和升级指导的 NEWS2Result。

EMR UI
  ↓ (user enters data)
CDSS Engine (pure functions, no side effects)
  ├── Drug Interaction Checker
  ├── Dose Validator
  ├── Clinical Scoring (NEWS2, qSOFA, etc.)
  └── Alert Classifier
  ↓ (returns alerts)
EMR UI (displays alerts inline, blocks if critical)

药物相互作用检查

interface DrugInteractionPair {
  drugA: string;           // generic name
  drugB: string;           // generic name
  severity: 'critical' | 'major' | 'minor';
  mechanism: string;
  clinicalEffect: string;
  recommendation: string;
}

function checkInteractions(
  newDrug: string,
  currentMedications: string[],
  allergyList: string[]
): InteractionAlert[] {
  if (!newDrug) return [];
  const alerts: InteractionAlert[] = [];
  for (const current of currentMedications) {
    const interaction = findInteraction(newDrug, current);
    if (interaction) {
      alerts.push({ severity: interaction.severity, pair: [newDrug, current],
        message: interaction.clinicalEffect, recommendation: interaction.recommendation });
    }
  }
  for (const allergy of allergyList) {
    if (isCrossReactive(newDrug, allergy)) {
      alerts.push({ severity: 'critical', pair: [newDrug, allergy],
        message: 'Cross-reactivity with documented allergy: ' + allergy,
        recommendation: 'Do not prescribe without allergy consultation' });
    }
  }
  return alerts.sort((a, b) => severityOrder(a.severity) - severityOrder(b.severity));
}

相互作用对必须是双向的：如果药物 A 与药物 B 有相互作用，那么药物 B 也与药物 A 有相互作用。

剂量验证

interface DoseValidationResult {
  valid: boolean;
  message: string;
  suggestedRange: { min: number; max: number; unit: string } | null;
  factors: string[];
}

function validateDose(
  drug: string,
  dose: number,
  route: 'oral' | 'iv' | 'im' | 'sc' | 'topical',
  patientWeight?: number,
  patientAge?: number,
  renalFunction?: number
): DoseValidationResult {
  const rules = getDoseRules(drug, route);
  if (!rules) return { valid: true, message: 'No validation rules available', suggestedRange: null, factors: [] };
  const factors: string[] = [];

  // SAFETY: if rules require weight but weight missing, BLOCK (not pass)
  if (rules.weightBased) {
    if (!patientWeight || patientWeight <= 0) {
      return { valid: false, message: 'Weight required for ' + drug + ' (mg/kg drug)',
        suggestedRange: null, factors: ['weight_missing'] };
    }
    factors.push('weight');
    const maxDose = rules.maxPerKg * patientWeight;
    if (dose > maxDose) {
      return { valid: false, message: 'Dose exceeds max for ' + patientWeight + 'kg',
        suggestedRange: { min: rules.minPerKg * patientWeight, max: maxDose, unit: rules.unit }, factors };
    }
  }

  // Age-based adjustment
  if (rules.ageAdjusted && patientAge !== undefined) {
    factors.push('age');
    const ageMax = rules.getAgeAdjustedMax(patientAge);
    if (dose > ageMax) {
      return { valid: false, message: 'Exceeds age-adjusted max for ' + patientAge + 'yr',
        suggestedRange: { min: rules.typicalMin, max: ageMax, unit: rules.unit }, factors };
    }
  }

  // Renal adjustment
  if (rules.renalAdjusted && renalFunction !== undefined) {
    factors