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FA-64616 / Clinical triage scoring / Open access

Prehospital stroke severity and time-window routing: overnight last-known-well · case 01

A patient last seen well yesterday evening gets a negative elapsed time and a thrombolysis window.

Verified by executionVariant 1 · 8 checks per implementationDownload source bundle ↓JSON ↗

ROOT CAUSE

The yesterday flag is ignored, so overnight intervals go negative.

THE FAILURE

The yesterday flag is ignored, so overnight intervals go negative.

Unsuccessful approach: Taking the absolute clock difference measures the wrong side of midnight.

Case contract

Input {face 0-1, arm 0-2, grip 0-2, lkw "HH:MM", now "HH:MM", lkw_yesterday}. Score = face+arm+grip; large-vessel suspicion when score >= 4. elapsed = now - lkw in minutes (+1440 if last known well was yesterday). Pathway: elapsed <= 270 THROMBOLYSIS_WINDOW; else elapsed <= 1440 with suspicion THROMBECTOMY_EVAL; else OUTSIDE_WINDOW. Destination COMPREHENSIVE for any large-vessel suspicion, else NEAREST. Return {score, lvo, elapsed_min, pathway, destination}.

Why this case matters

Stroke routing couples a severity threshold with clock arithmetic over last-known-well; each is a distinct failure mode.

1 / The failure

Exit 1
"""Failure Map reference implementation. Python standard library only."""
import json

N = 1
observations = []
def solve(x):
    s = x['face'] + x['arm'] + x['grip']
    lvo = s >= 4
    def mins(t):
        h, m = map(int, t.split(':'))
        return h * 60 + m
    elapsed = mins(x['now']) - mins(x['lkw'])
    if elapsed <= 270:
        path = 'THROMBOLYSIS_WINDOW'
    elif elapsed <= 1440 and lvo:
        path = 'THROMBECTOMY_EVAL'
    else:
        path = 'OUTSIDE_WINDOW'
    dest = 'COMPREHENSIVE' if lvo else 'NEAREST'
    return {'score': s, 'lvo': lvo, 'elapsed_min': elapsed, 'pathway': path, 'destination': dest}
def check(label, actual, expected):
    observations.append({"check": label, "actual": actual, "expected": expected, "passed": actual == expected})
fixtures = [[('mild deficit early',
   {'face': 1, 'arm': 1, 'grip': 0, 'lkw': '10:00', 'now': '10:10', 'lkw_yesterday': False},
   {'score': 2, 'lvo': False, 'elapsed_min': 10, 'pathway': 'THROMBOLYSIS_WINDOW', 'destination': 'NEAREST'}),
  ('score exactly 4 without facial droop',
   {'face': 0, 'arm': 2, 'grip': 2, 'lkw': '10:00', 'now': '12:00', 'lkw_yesterday': False},
   {'score': 4,
    'lvo': True,
    'elapsed_min': 120,
    'pathway': 'THROMBOLYSIS_WINDOW',
    'destination': 'COMPREHENSIVE'}),
  ('last known well yesterday evening',
   {'face': 1, 'arm': 2, 'grip': 2, 'lkw': '22:00', 'now': '01:00', 'lkw_yesterday': True},
   {'score': 5,
    'lvo': True,
    'elapsed_min': 180,
    'pathway': 'THROMBOLYSIS_WINDOW',
    'destination': 'COMPREHENSIVE'}),
  ('exactly 4.5 hours',
   {'face': 1, 'arm': 1, 'grip': 1, 'lkw': '01:00', 'now': '05:30', 'lkw_yesterday': False},
   {'score': 3,
    'lvo': False,
    'elapsed_min': 270,
    'pathway': 'THROMBOLYSIS_WINDOW',
    'destination': 'NEAREST'}),
  ('4 hours 50 minutes',
   {'face': 0, 'arm': 1, 'grip': 1, 'lkw': '08:00', 'now': '12:46', 'lkw_yesterday': False},
   {'score': 2, 'lvo': False, 'elapsed_min': 286, 'pathway': 'OUTSIDE_WINDOW', 'destination': 'NEAREST'}),
  ('large vessel at 20 hours',
   {'face': 1, 'arm': 2, 'grip': 2, 'lkw': '14:00', 'now': '10:00', 'lkw_yesterday': True},
   {'score': 5,
    'lvo': True,
    'elapsed_min': 1200,
    'pathway': 'THROMBECTOMY_EVAL',
    'destination': 'COMPREHENSIVE'}),
  ('large vessel beyond 24 hours',
   {'face': 1, 'arm': 2, 'grip': 2, 'lkw': '08:00', 'now': '08:10', 'lkw_yesterday': True},
   {'score': 5,
    'lvo': True,
    'elapsed_min': 1450,
    'pathway': 'OUTSIDE_WINDOW',
    'destination': 'COMPREHENSIVE'}),
  ('large vessel exactly 24 hours',
   {'face': 1, 'arm': 2, 'grip': 1, 'lkw': '01:00', 'now': '01:00', 'lkw_yesterday': True},
   {'score': 4,
    'lvo': True,
    'elapsed_min': 1440,
    'pathway': 'THROMBECTOMY_EVAL',
    'destination': 'COMPREHENSIVE'})],
 [('mild deficit early',
   {'face': 1, 'arm': 1, 'grip': 0, 'lkw': '10:00', 'now': '10:20', 'lkw_yesterday': False},
   {'score': 2, 'lvo': False, 'elapsed_min': 20, 'pathway': 'THROMBOLYSIS_WINDOW', 'destination': 'NEAREST'}),
  ('score exactly 4 without facial droop',
   {'face': 0, 'arm': 2, 'grip': 2, 'lkw': '10:00', 'now': '12:00', 'lkw_yesterday': False},
   {'score': 4,
    'lvo': True,
    'elapsed_min': 120,
    'pathway': 'THROMBOLYSIS_WINDOW',
    'destination': 'COMPREHENSIVE'}),
  ('last known well yesterday evening',
   {'face': 1, 'arm': 2, 'grip': 2, 'lkw': '22:00', 'now': '02:00', 'lkw_yesterday': True},
   {'score': 5,
    'lvo': True,
    'elapsed_min': 240,
    'pathway': 'THROMBOLYSIS_WINDOW',
    'destination': 'COMPREHENSIVE'}),
  ('exactly 4.5 hours',
   {'face': 1, 'arm': 1, 'grip': 1, 'lkw': '02:00', 'now': '06:30', 'lkw_yesterday': False},
   {'score': 3,
    'lvo': False,
    'elapsed_min': 270,
    'pathway': 'THROMBOLYSIS_WINDOW',
    'destination': 'NEAREST'}),
  ('4 hours 50 minutes',
   {'face': 0, 'arm': 1, 'grip': 1, 'lkw': '08:00', 'now': '12:47', 'lkw_yesterday': False},
   {'score': 2, 'lvo': False, 'elapsed_min': 287, 'pathway': 'OUTSIDE_WINDOW', 'destination': 'NEAREST'}),
  ('large vessel at 20 hours',
   {'face': 1, 'arm': 2, 'grip': 1, 'lkw': '14:00', 'now': '10:00', 'lkw_yesterday': True},
   {'score': 4,
    'lvo': True,
    'elapsed_min': 1200,
    'pathway': 'THROMBECTOMY_EVAL',
    'destination': 'COMPREHENSIVE'}),
  ('large vessel beyond 24 hours',
   {'face': 1, 'arm': 2, 'grip': 2, 'lkw': '08:00', 'now': '08:20', 'lkw_yesterday': True},
   {'score': 5,
    'lvo': True,
    'elapsed_min': 1460,
    'pathway': 'OUTSIDE_WINDOW',
    'destination': 'COMPREHENSIVE'}),
  ('large vessel exactly 24 hours',
   {'face': 1, 'arm': 2, 'grip': 1, 'lkw': '02:00', 'now': '02:00', 'lkw_yesterday': True},
   {'score': 4,
    'lvo': True,
    'elapsed_min': 1440,
    'pathway': 'THROMBECTOMY_EVAL',
    'destination': 'COMPREHENSIVE'})],
 [('mild deficit early',
   {'face': 1, 'arm': 1, 'grip': 0, 'lkw': '10:00', 'now': '10:30', 'lkw_yesterday': False},
   {'score': 2, 'lvo': False, 'elapsed_min': 30, 'pathway': 'THROMBOLYSIS_WINDOW', 'destination': 'NEAREST'}),
  ('score exactly 4 without facial droop',
   {'face': 0, 'arm': 2, 'grip': 2, 'lkw': '10:00', 'now': '12:00', 'lkw_yesterday': False},
   {'score': 4,
    'lvo': True,
    'elapsed_min': 120,
    'pathway': 'THROMBOLYSIS_WINDOW',
    'destination': 'COMPREHENSIVE'}),
  ('last known well yesterday evening',
   {'face': 1, 'arm': 2, 'grip': 2, 'lkw': '22:00', 'now': '03:00', 'lkw_yesterday': True},
   {'score': 5,
    'lvo': True,
    'elapsed_min': 300,
    'pathway': 'THROMBECTOMY_EVAL',
    'destination': 'COMPREHENSIVE'}),
  ('exactly 4.5 hours',
   {'face': 1, 'arm': 1, 'grip': 1, 'lkw': '03:00', 'now': '07:30', 'lkw_yesterday': False},
   {'score': 3,
    'lvo': False,
    'elapsed_min': 270,
    'pathway': 'THROMBOLYSIS_WINDOW',
    'destination': 'NEAREST'}),
  ('4 hours 50 minutes',
   {'face': 0, 'arm': 1, 'grip': 1, 'lkw': '08:00', 'now': '12:48', 'lkw_yesterday': False},
   {'score': 2, 'lvo': False, 'elapsed_min': 288, 'pathway': 'OUTSIDE_WINDOW', 'destination': 'NEAREST'}),
  ('large vessel at 20 hours',
   {'face': 1, 'arm': 2, 'grip': 2, 'lkw': '14:00', 'now': '10:00', 'lkw_yesterday': True},
   {'score': 5,
    'lvo': True,
    'elapsed_min': 1200,
    'pathway': 'THROMBECTOMY_EVAL',
    'destination': 'COMPREHENSIVE'}),
  ('large vessel beyond 24 hours',
   {'face': 1, 'arm': 2, 'grip': 2, 'lkw': '08:00', 'now': '08:30', 'lkw_yesterday': True},
   {'score': 5,
    'lvo': True,
    'elapsed_min': 1470,
    'pathway': 'OUTSIDE_WINDOW',
    'destination': 'COMPREHENSIVE'}),
  ('large vessel exactly 24 hours',
   {'face': 1, 'arm': 2, 'grip': 1, 'lkw': '03:00', 'now': '03:00', 'lkw_yesterday': True},
   {'score': 4,
    'lvo': True,
    'elapsed_min': 1440,
    'pathway': 'THROMBECTOMY_EVAL',
    'destination': 'COMPREHENSIVE'})],
 [('mild deficit early',
   {'face': 1, 'arm': 1, 'grip': 0, 'lkw': '10:00', 'now': '10:40', 'lkw_yesterday': False},
   {'score': 2, 'lvo': False, 'elapsed_min': 40, 'pathway': 'THROMBOLYSIS_WINDOW', 'destination': 'NEAREST'}),
  ('score exactly 4 without facial droop',
   {'face': 0, 'arm': 2, 'grip': 2, 'lkw': '10:00', 'now': '12:00', 'lkw_yesterday': False},
   {'score': 4,
    'lvo': True,
    'elapsed_min': 120,
    'pathway': 'THROMBOLYSIS_WINDOW',
    'destination': 'COMPREHENSIVE'}),
  ('last known well yesterday evening',
   {'face': 1, 'arm': 2, 'grip': 2, 'lkw': '22:00', 'now': '04:00', 'lkw_yesterday': True},
   {'score': 5,
    'lvo': True,
    'elapsed_min': 360,
    'pathway': 'THROMBECTOMY_EVAL',
    'destination': 'COMPREHENSIVE'}),
  ('exactly 4.5 hours',
   {'face': 1, 'arm': 1, 'grip': 1, 'lkw': '04:00', 'now': '08:30', 'lkw_yesterday': False},
   {'score': 3,
    'lvo': False,
    'elapsed_min': 270,
    'pathway': 'THROMBOLYSIS_WINDOW',
    'destination': 'NEAREST'}),
  ('4 hours 50 minutes',
   {'face': 0, 'arm': 1, 'grip': 1, 'lkw': '08:00', 'now': '12:49', 'lkw_yesterday': False},
   {'score': 2, 'lvo': False, 'elapsed_min': 289, 'pathway': 'OUTSIDE_WINDOW', 'destination': 'NEAREST'}),
  ('large vessel at 20 hours',
   {'face': 1, 'arm': 2, 'grip': 1, 'lkw': '14:00', 'now': '10:00', 'lkw_yesterday': True},
   {'score': 4,
    'lvo': True,
    'elapsed_min': 1200,
    'pathway': 'THROMBECTOMY_EVAL',
    'destination': 'COMPREHENSIVE'}),
  ('large vessel beyond 24 hours',
   {'face': 1, 'arm': 2, 'grip': 2, 'lkw': '08:00', 'now': '08:40', 'lkw_yesterday': True},
   {'score': 5,
    'lvo': True,
    'elapsed_min': 1480,
    'pathway': 'OUTSIDE_WINDOW',
    'destination': 'COMPREHENSIVE'}),
  ('large vessel exactly 24 hours',
   {'face': 1, 'arm': 2, 'grip': 1, 'lkw': '04:00', 'now': '04:00', 'lkw_yesterday': True},
   {'score': 4,
    'lvo': True,
    'elapsed_min': 1440,
    'pathway': 'THROMBECTOMY_EVAL',
    'destination': 'COMPREHENSIVE'})],
 [('mild deficit early',
   {'face': 1, 'arm': 1, 'grip': 0, 'lkw': '10:00', 'now': '10:50', 'lkw_yesterday': False},
   {'score': 2, 'lvo': False, 'elapsed_min': 50, 'pathway': 'THROMBOLYSIS_WINDOW', 'destination': 'NEAREST'}),
  ('score exactly 4 without facial droop',
   {'face': 0, 'arm': 2, 'grip': 2, 'lkw': '10:00', 'now': '12:00', 'lkw_yesterday': False},
   {'score': 4,
    'lvo': True,
    'elapsed_min': 120,
    'pathway': 'THROMBOLYSIS_WINDOW',
    'destination': 'COMPREHENSIVE'}),
  ('last known well yesterday evening',
   {'face': 1, 'arm': 2, 'grip': 2, 'lkw': '22:00', 'now': '05:00', 'lkw_yesterday': True},
   {'score': 5,
    'lvo': True,
    'elapsed_min': 420,
    'pathway': 'THROMBECTOMY_EVAL',
    'destination': 'COMPREHENSIVE'}),
  ('exactly 4.5 hours',
   {'face': 1, 'arm': 1, 'grip': 1, 'lkw': '05:00', 'now': '09:30', 'lkw_yesterday': False},
   {'score': 3,
    'lvo': False,
    'elapsed_min': 270,
    'pathway': 'THROMBOLYSIS_WINDOW',
    'destination': 'NEAREST'}),
  ('4 hours 50 minutes',
   {'face': 0, 'arm': 1, 'grip': 1, 'lkw': '08:00', 'now': '12:50', 'lkw_yesterday': False},
   {'score': 2, 'lvo': False, 'elapsed_min': 290, 'pathway': 'OUTSIDE_WINDOW', 'destination': 'NEAREST'}),
  ('large vessel at 20 hours',
   {'face': 1, 'arm': 2, 'grip': 2, 'lkw': '14:00', 'now': '10:00', 'lkw_yesterday': True},
   {'score': 5,
    'lvo': True,
    'elapsed_min': 1200,
    'pathway': 'THROMBECTOMY_EVAL',
    'destination': 'COMPREHENSIVE'}),
  ('large vessel beyond 24 hours',
   {'face': 1, 'arm': 2, 'grip': 2, 'lkw': '08:00', 'now': '08:50', 'lkw_yesterday': True},
   {'score': 5,
    'lvo': True,
    'elapsed_min': 1490,
    'pathway': 'OUTSIDE_WINDOW',
    'destination': 'COMPREHENSIVE'}),
  ('large vessel exactly 24 hours',
   {'face': 1, 'arm': 2, 'grip': 1, 'lkw': '05:00', 'now': '05:00', 'lkw_yesterday': True},
   {'score': 4,
    'lvo': True,
    'elapsed_min': 1440,
    'pathway': 'THROMBECTOMY_EVAL',
    'destination': 'COMPREHENSIVE'})]]
for label, args, expected in fixtures[N-1]:
    check(label, solve(args), expected)
print(json.dumps({"observations": observations, "passed": all(x["passed"] for x in observations)}, ensure_ascii=False))
raise SystemExit(0 if all(x["passed"] for x in observations) else 1)
Boundary fixtureActualExpectedOutcome
mild deficit early{'destination': 'NEAREST', 'elapsed_min': 10, 'lvo': False, 'pathway': 'THROMBOLYSIS_WINDOW', 'score': 2}{'destination': 'NEAREST', 'elapsed_min': 10, 'lvo': False, 'pathway': 'THROMBOLYSIS_WINDOW', 'score': 2}Passed
score exactly 4 without facial droop{'destination': 'COMPREHENSIVE', 'elapsed_min': 120, 'lvo': True, 'pathway': 'THROMBOLYSIS_WINDOW', 'score': 4}{'destination': 'COMPREHENSIVE', 'elapsed_min': 120, 'lvo': True, 'pathway': 'THROMBOLYSIS_WINDOW', 'score': 4}Passed
last known well yesterday evening{'destination': 'COMPREHENSIVE', 'elapsed_min': -1260, 'lvo': True, 'pathway': 'THROMBOLYSIS_WINDOW', 'score': 5}{'destination': 'COMPREHENSIVE', 'elapsed_min': 180, 'lvo': True, 'pathway': 'THROMBOLYSIS_WINDOW', 'score': 5}Failed
exactly 4.5 hours{'destination': 'NEAREST', 'elapsed_min': 270, 'lvo': False, 'pathway': 'THROMBOLYSIS_WINDOW', 'score': 3}{'destination': 'NEAREST', 'elapsed_min': 270, 'lvo': False, 'pathway': 'THROMBOLYSIS_WINDOW', 'score': 3}Passed
4 hours 50 minutes{'destination': 'NEAREST', 'elapsed_min': 286, 'lvo': False, 'pathway': 'OUTSIDE_WINDOW', 'score': 2}{'destination': 'NEAREST', 'elapsed_min': 286, 'lvo': False, 'pathway': 'OUTSIDE_WINDOW', 'score': 2}Passed
large vessel at 20 hours{'destination': 'COMPREHENSIVE', 'elapsed_min': -240, 'lvo': True, 'pathway': 'THROMBOLYSIS_WINDOW', 'score': 5}{'destination': 'COMPREHENSIVE', 'elapsed_min': 1200, 'lvo': True, 'pathway': 'THROMBECTOMY_EVAL', 'score': 5}Failed
large vessel beyond 24 hours{'destination': 'COMPREHENSIVE', 'elapsed_min': 10, 'lvo': True, 'pathway': 'THROMBOLYSIS_WINDOW', 'score': 5}{'destination': 'COMPREHENSIVE', 'elapsed_min': 1450, 'lvo': True, 'pathway': 'OUTSIDE_WINDOW', 'score': 5}Failed
large vessel exactly 24 hours{'destination': 'COMPREHENSIVE', 'elapsed_min': 0, 'lvo': True, 'pathway': 'THROMBOLYSIS_WINDOW', 'score': 4}{'destination': 'COMPREHENSIVE', 'elapsed_min': 1440, 'lvo': True, 'pathway': 'THROMBECTOMY_EVAL', 'score': 4}Failed

SHA-256 / ee2c3fd62662fd83631b9cec9ef4e0486a4774f92379827284ed5313eba53602

2 / The unsuccessful fix

Exit 1
"""Failure Map reference implementation. Python standard library only."""
import json

N = 1
observations = []
def solve(x):
    s = x['face'] + x['arm'] + x['grip']
    lvo = s >= 4
    def mins(t):
        h, m = map(int, t.split(':'))
        return h * 60 + m
    elapsed = abs(mins(x['now']) - mins(x['lkw']))
    if elapsed <= 270:
        path = 'THROMBOLYSIS_WINDOW'
    elif elapsed <= 1440 and lvo:
        path = 'THROMBECTOMY_EVAL'
    else:
        path = 'OUTSIDE_WINDOW'
    dest = 'COMPREHENSIVE' if lvo else 'NEAREST'
    return {'score': s, 'lvo': lvo, 'elapsed_min': elapsed, 'pathway': path, 'destination': dest}
def check(label, actual, expected):
    observations.append({"check": label, "actual": actual, "expected": expected, "passed": actual == expected})
fixtures = [[('mild deficit early',
   {'face': 1, 'arm': 1, 'grip': 0, 'lkw': '10:00', 'now': '10:10', 'lkw_yesterday': False},
   {'score': 2, 'lvo': False, 'elapsed_min': 10, 'pathway': 'THROMBOLYSIS_WINDOW', 'destination': 'NEAREST'}),
  ('score exactly 4 without facial droop',
   {'face': 0, 'arm': 2, 'grip': 2, 'lkw': '10:00', 'now': '12:00', 'lkw_yesterday': False},
   {'score': 4,
    'lvo': True,
    'elapsed_min': 120,
    'pathway': 'THROMBOLYSIS_WINDOW',
    'destination': 'COMPREHENSIVE'}),
  ('last known well yesterday evening',
   {'face': 1, 'arm': 2, 'grip': 2, 'lkw': '22:00', 'now': '01:00', 'lkw_yesterday': True},
   {'score': 5,
    'lvo': True,
    'elapsed_min': 180,
    'pathway': 'THROMBOLYSIS_WINDOW',
    'destination': 'COMPREHENSIVE'}),
  ('exactly 4.5 hours',
   {'face': 1, 'arm': 1, 'grip': 1, 'lkw': '01:00', 'now': '05:30', 'lkw_yesterday': False},
   {'score': 3,
    'lvo': False,
    'elapsed_min': 270,
    'pathway': 'THROMBOLYSIS_WINDOW',
    'destination': 'NEAREST'}),
  ('4 hours 50 minutes',
   {'face': 0, 'arm': 1, 'grip': 1, 'lkw': '08:00', 'now': '12:46', 'lkw_yesterday': False},
   {'score': 2, 'lvo': False, 'elapsed_min': 286, 'pathway': 'OUTSIDE_WINDOW', 'destination': 'NEAREST'}),
  ('large vessel at 20 hours',
   {'face': 1, 'arm': 2, 'grip': 2, 'lkw': '14:00', 'now': '10:00', 'lkw_yesterday': True},
   {'score': 5,
    'lvo': True,
    'elapsed_min': 1200,
    'pathway': 'THROMBECTOMY_EVAL',
    'destination': 'COMPREHENSIVE'}),
  ('large vessel beyond 24 hours',
   {'face': 1, 'arm': 2, 'grip': 2, 'lkw': '08:00', 'now': '08:10', 'lkw_yesterday': True},
   {'score': 5,
    'lvo': True,
    'elapsed_min': 1450,
    'pathway': 'OUTSIDE_WINDOW',
    'destination': 'COMPREHENSIVE'}),
  ('large vessel exactly 24 hours',
   {'face': 1, 'arm': 2, 'grip': 1, 'lkw': '01:00', 'now': '01:00', 'lkw_yesterday': True},
   {'score': 4,
    'lvo': True,
    'elapsed_min': 1440,
    'pathway': 'THROMBECTOMY_EVAL',
    'destination': 'COMPREHENSIVE'})],
 [('mild deficit early',
   {'face': 1, 'arm': 1, 'grip': 0, 'lkw': '10:00', 'now': '10:20', 'lkw_yesterday': False},
   {'score': 2, 'lvo': False, 'elapsed_min': 20, 'pathway': 'THROMBOLYSIS_WINDOW', 'destination': 'NEAREST'}),
  ('score exactly 4 without facial droop',
   {'face': 0, 'arm': 2, 'grip': 2, 'lkw': '10:00', 'now': '12:00', 'lkw_yesterday': False},
   {'score': 4,
    'lvo': True,
    'elapsed_min': 120,
    'pathway': 'THROMBOLYSIS_WINDOW',
    'destination': 'COMPREHENSIVE'}),
  ('last known well yesterday evening',
   {'face': 1, 'arm': 2, 'grip': 2, 'lkw': '22:00', 'now': '02:00', 'lkw_yesterday': True},
   {'score': 5,
    'lvo': True,
    'elapsed_min': 240,
    'pathway': 'THROMBOLYSIS_WINDOW',
    'destination': 'COMPREHENSIVE'}),
  ('exactly 4.5 hours',
   {'face': 1, 'arm': 1, 'grip': 1, 'lkw': '02:00', 'now': '06:30', 'lkw_yesterday': False},
   {'score': 3,
    'lvo': False,
    'elapsed_min': 270,
    'pathway': 'THROMBOLYSIS_WINDOW',
    'destination': 'NEAREST'}),
  ('4 hours 50 minutes',
   {'face': 0, 'arm': 1, 'grip': 1, 'lkw': '08:00', 'now': '12:47', 'lkw_yesterday': False},
   {'score': 2, 'lvo': False, 'elapsed_min': 287, 'pathway': 'OUTSIDE_WINDOW', 'destination': 'NEAREST'}),
  ('large vessel at 20 hours',
   {'face': 1, 'arm': 2, 'grip': 1, 'lkw': '14:00', 'now': '10:00', 'lkw_yesterday': True},
   {'score': 4,
    'lvo': True,
    'elapsed_min': 1200,
    'pathway': 'THROMBECTOMY_EVAL',
    'destination': 'COMPREHENSIVE'}),
  ('large vessel beyond 24 hours',
   {'face': 1, 'arm': 2, 'grip': 2, 'lkw': '08:00', 'now': '08:20', 'lkw_yesterday': True},
   {'score': 5,
    'lvo': True,
    'elapsed_min': 1460,
    'pathway': 'OUTSIDE_WINDOW',
    'destination': 'COMPREHENSIVE'}),
  ('large vessel exactly 24 hours',
   {'face': 1, 'arm': 2, 'grip': 1, 'lkw': '02:00', 'now': '02:00', 'lkw_yesterday': True},
   {'score': 4,
    'lvo': True,
    'elapsed_min': 1440,
    'pathway': 'THROMBECTOMY_EVAL',
    'destination': 'COMPREHENSIVE'})],
 [('mild deficit early',
   {'face': 1, 'arm': 1, 'grip': 0, 'lkw': '10:00', 'now': '10:30', 'lkw_yesterday': False},
   {'score': 2, 'lvo': False, 'elapsed_min': 30, 'pathway': 'THROMBOLYSIS_WINDOW', 'destination': 'NEAREST'}),
  ('score exactly 4 without facial droop',
   {'face': 0, 'arm': 2, 'grip': 2, 'lkw': '10:00', 'now': '12:00', 'lkw_yesterday': False},
   {'score': 4,
    'lvo': True,
    'elapsed_min': 120,
    'pathway': 'THROMBOLYSIS_WINDOW',
    'destination': 'COMPREHENSIVE'}),
  ('last known well yesterday evening',
   {'face': 1, 'arm': 2, 'grip': 2, 'lkw': '22:00', 'now': '03:00', 'lkw_yesterday': True},
   {'score': 5,
    'lvo': True,
    'elapsed_min': 300,
    'pathway': 'THROMBECTOMY_EVAL',
    'destination': 'COMPREHENSIVE'}),
  ('exactly 4.5 hours',
   {'face': 1, 'arm': 1, 'grip': 1, 'lkw': '03:00', 'now': '07:30', 'lkw_yesterday': False},
   {'score': 3,
    'lvo': False,
    'elapsed_min': 270,
    'pathway': 'THROMBOLYSIS_WINDOW',
    'destination': 'NEAREST'}),
  ('4 hours 50 minutes',
   {'face': 0, 'arm': 1, 'grip': 1, 'lkw': '08:00', 'now': '12:48', 'lkw_yesterday': False},
   {'score': 2, 'lvo': False, 'elapsed_min': 288, 'pathway': 'OUTSIDE_WINDOW', 'destination': 'NEAREST'}),
  ('large vessel at 20 hours',
   {'face': 1, 'arm': 2, 'grip': 2, 'lkw': '14:00', 'now': '10:00', 'lkw_yesterday': True},
   {'score': 5,
    'lvo': True,
    'elapsed_min': 1200,
    'pathway': 'THROMBECTOMY_EVAL',
    'destination': 'COMPREHENSIVE'}),
  ('large vessel beyond 24 hours',
   {'face': 1, 'arm': 2, 'grip': 2, 'lkw': '08:00', 'now': '08:30', 'lkw_yesterday': True},
   {'score': 5,
    'lvo': True,
    'elapsed_min': 1470,
    'pathway': 'OUTSIDE_WINDOW',
    'destination': 'COMPREHENSIVE'}),
  ('large vessel exactly 24 hours',
   {'face': 1, 'arm': 2, 'grip': 1, 'lkw': '03:00', 'now': '03:00', 'lkw_yesterday': True},
   {'score': 4,
    'lvo': True,
    'elapsed_min': 1440,
    'pathway': 'THROMBECTOMY_EVAL',
    'destination': 'COMPREHENSIVE'})],
 [('mild deficit early',
   {'face': 1, 'arm': 1, 'grip': 0, 'lkw': '10:00', 'now': '10:40', 'lkw_yesterday': False},
   {'score': 2, 'lvo': False, 'elapsed_min': 40, 'pathway': 'THROMBOLYSIS_WINDOW', 'destination': 'NEAREST'}),
  ('score exactly 4 without facial droop',
   {'face': 0, 'arm': 2, 'grip': 2, 'lkw': '10:00', 'now': '12:00', 'lkw_yesterday': False},
   {'score': 4,
    'lvo': True,
    'elapsed_min': 120,
    'pathway': 'THROMBOLYSIS_WINDOW',
    'destination': 'COMPREHENSIVE'}),
  ('last known well yesterday evening',
   {'face': 1, 'arm': 2, 'grip': 2, 'lkw': '22:00', 'now': '04:00', 'lkw_yesterday': True},
   {'score': 5,
    'lvo': True,
    'elapsed_min': 360,
    'pathway': 'THROMBECTOMY_EVAL',
    'destination': 'COMPREHENSIVE'}),
  ('exactly 4.5 hours',
   {'face': 1, 'arm': 1, 'grip': 1, 'lkw': '04:00', 'now': '08:30', 'lkw_yesterday': False},
   {'score': 3,
    'lvo': False,
    'elapsed_min': 270,
    'pathway': 'THROMBOLYSIS_WINDOW',
    'destination': 'NEAREST'}),
  ('4 hours 50 minutes',
   {'face': 0, 'arm': 1, 'grip': 1, 'lkw': '08:00', 'now': '12:49', 'lkw_yesterday': False},
   {'score': 2, 'lvo': False, 'elapsed_min': 289, 'pathway': 'OUTSIDE_WINDOW', 'destination': 'NEAREST'}),
  ('large vessel at 20 hours',
   {'face': 1, 'arm': 2, 'grip': 1, 'lkw': '14:00', 'now': '10:00', 'lkw_yesterday': True},
   {'score': 4,
    'lvo': True,
    'elapsed_min': 1200,
    'pathway': 'THROMBECTOMY_EVAL',
    'destination': 'COMPREHENSIVE'}),
  ('large vessel beyond 24 hours',
   {'face': 1, 'arm': 2, 'grip': 2, 'lkw': '08:00', 'now': '08:40', 'lkw_yesterday': True},
   {'score': 5,
    'lvo': True,
    'elapsed_min': 1480,
    'pathway': 'OUTSIDE_WINDOW',
    'destination': 'COMPREHENSIVE'}),
  ('large vessel exactly 24 hours',
   {'face': 1, 'arm': 2, 'grip': 1, 'lkw': '04:00', 'now': '04:00', 'lkw_yesterday': True},
   {'score': 4,
    'lvo': True,
    'elapsed_min': 1440,
    'pathway': 'THROMBECTOMY_EVAL',
    'destination': 'COMPREHENSIVE'})],
 [('mild deficit early',
   {'face': 1, 'arm': 1, 'grip': 0, 'lkw': '10:00', 'now': '10:50', 'lkw_yesterday': False},
   {'score': 2, 'lvo': False, 'elapsed_min': 50, 'pathway': 'THROMBOLYSIS_WINDOW', 'destination': 'NEAREST'}),
  ('score exactly 4 without facial droop',
   {'face': 0, 'arm': 2, 'grip': 2, 'lkw': '10:00', 'now': '12:00', 'lkw_yesterday': False},
   {'score': 4,
    'lvo': True,
    'elapsed_min': 120,
    'pathway': 'THROMBOLYSIS_WINDOW',
    'destination': 'COMPREHENSIVE'}),
  ('last known well yesterday evening',
   {'face': 1, 'arm': 2, 'grip': 2, 'lkw': '22:00', 'now': '05:00', 'lkw_yesterday': True},
   {'score': 5,
    'lvo': True,
    'elapsed_min': 420,
    'pathway': 'THROMBECTOMY_EVAL',
    'destination': 'COMPREHENSIVE'}),
  ('exactly 4.5 hours',
   {'face': 1, 'arm': 1, 'grip': 1, 'lkw': '05:00', 'now': '09:30', 'lkw_yesterday': False},
   {'score': 3,
    'lvo': False,
    'elapsed_min': 270,
    'pathway': 'THROMBOLYSIS_WINDOW',
    'destination': 'NEAREST'}),
  ('4 hours 50 minutes',
   {'face': 0, 'arm': 1, 'grip': 1, 'lkw': '08:00', 'now': '12:50', 'lkw_yesterday': False},
   {'score': 2, 'lvo': False, 'elapsed_min': 290, 'pathway': 'OUTSIDE_WINDOW', 'destination': 'NEAREST'}),
  ('large vessel at 20 hours',
   {'face': 1, 'arm': 2, 'grip': 2, 'lkw': '14:00', 'now': '10:00', 'lkw_yesterday': True},
   {'score': 5,
    'lvo': True,
    'elapsed_min': 1200,
    'pathway': 'THROMBECTOMY_EVAL',
    'destination': 'COMPREHENSIVE'}),
  ('large vessel beyond 24 hours',
   {'face': 1, 'arm': 2, 'grip': 2, 'lkw': '08:00', 'now': '08:50', 'lkw_yesterday': True},
   {'score': 5,
    'lvo': True,
    'elapsed_min': 1490,
    'pathway': 'OUTSIDE_WINDOW',
    'destination': 'COMPREHENSIVE'}),
  ('large vessel exactly 24 hours',
   {'face': 1, 'arm': 2, 'grip': 1, 'lkw': '05:00', 'now': '05:00', 'lkw_yesterday': True},
   {'score': 4,
    'lvo': True,
    'elapsed_min': 1440,
    'pathway': 'THROMBECTOMY_EVAL',
    'destination': 'COMPREHENSIVE'})]]
for label, args, expected in fixtures[N-1]:
    check(label, solve(args), expected)
print(json.dumps({"observations": observations, "passed": all(x["passed"] for x in observations)}, ensure_ascii=False))
raise SystemExit(0 if all(x["passed"] for x in observations) else 1)
Boundary fixtureActualExpectedOutcome
mild deficit early{'destination': 'NEAREST', 'elapsed_min': 10, 'lvo': False, 'pathway': 'THROMBOLYSIS_WINDOW', 'score': 2}{'destination': 'NEAREST', 'elapsed_min': 10, 'lvo': False, 'pathway': 'THROMBOLYSIS_WINDOW', 'score': 2}Passed
score exactly 4 without facial droop{'destination': 'COMPREHENSIVE', 'elapsed_min': 120, 'lvo': True, 'pathway': 'THROMBOLYSIS_WINDOW', 'score': 4}{'destination': 'COMPREHENSIVE', 'elapsed_min': 120, 'lvo': True, 'pathway': 'THROMBOLYSIS_WINDOW', 'score': 4}Passed
last known well yesterday evening{'destination': 'COMPREHENSIVE', 'elapsed_min': 1260, 'lvo': True, 'pathway': 'THROMBECTOMY_EVAL', 'score': 5}{'destination': 'COMPREHENSIVE', 'elapsed_min': 180, 'lvo': True, 'pathway': 'THROMBOLYSIS_WINDOW', 'score': 5}Failed
exactly 4.5 hours{'destination': 'NEAREST', 'elapsed_min': 270, 'lvo': False, 'pathway': 'THROMBOLYSIS_WINDOW', 'score': 3}{'destination': 'NEAREST', 'elapsed_min': 270, 'lvo': False, 'pathway': 'THROMBOLYSIS_WINDOW', 'score': 3}Passed
4 hours 50 minutes{'destination': 'NEAREST', 'elapsed_min': 286, 'lvo': False, 'pathway': 'OUTSIDE_WINDOW', 'score': 2}{'destination': 'NEAREST', 'elapsed_min': 286, 'lvo': False, 'pathway': 'OUTSIDE_WINDOW', 'score': 2}Passed
large vessel at 20 hours{'destination': 'COMPREHENSIVE', 'elapsed_min': 240, 'lvo': True, 'pathway': 'THROMBOLYSIS_WINDOW', 'score': 5}{'destination': 'COMPREHENSIVE', 'elapsed_min': 1200, 'lvo': True, 'pathway': 'THROMBECTOMY_EVAL', 'score': 5}Failed
large vessel beyond 24 hours{'destination': 'COMPREHENSIVE', 'elapsed_min': 10, 'lvo': True, 'pathway': 'THROMBOLYSIS_WINDOW', 'score': 5}{'destination': 'COMPREHENSIVE', 'elapsed_min': 1450, 'lvo': True, 'pathway': 'OUTSIDE_WINDOW', 'score': 5}Failed
large vessel exactly 24 hours{'destination': 'COMPREHENSIVE', 'elapsed_min': 0, 'lvo': True, 'pathway': 'THROMBOLYSIS_WINDOW', 'score': 4}{'destination': 'COMPREHENSIVE', 'elapsed_min': 1440, 'lvo': True, 'pathway': 'THROMBECTOMY_EVAL', 'score': 4}Failed

SHA-256 / a699892fe30e6d894bccc4acb93b86a045f9f9adbd9798c9daea52a9a7f9a8cb

HELD IN THE MEMBER ARCHIVE

The verified repair and its recorded checks are member-only.

This mechanism has 8 recorded checks per implementation. The open-access tier publishes the failure and the unsuccessful fix; the repaired source that passes every check, and the observations that prove it, are available to members.

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Verification & scope

A deterministic toy software model with explicitly stipulated thresholds and formulas; it is not clinical guidance, not a validated medical calculator, and makes no claim of conformance to any published protocol. Numbered variants vary patient and order inputs. This reproducer isolates one failure mechanism. Results cover the supplied fixtures. Variants within a family share a test contract and should remain grouped when constructing evaluation splits. Related mechanisms with a shared evaluation_group must also remain together; these controlled models are not independent production incidents.

Observations recorded using Python 3.12.14 at 2026-09-29T14:47:26.254966+00:00.

Case digest / 5b2bc565ae69443edd9b7b5cb8ec7e850b3a892526ae3a344164fbbca59c876e