FA-64676 / Clinical triage scoring / Open access

Shock index, mean arterial pressure and flags: blood pressure validation · case 01

A reading with diastolic equal to systolic is accepted.

Verified by executionVariant 1 · 9 checks per implementationDownload source bundle ↓JSON ↗

ROOT CAUSE

The validation allows a zero pulse pressure.

VERIFIED REPAIR

Reject dbp >= sbp as well as non-positive pressures.

Unsuccessful approach: Dropping the diastolic positivity check accepts a diastolic of 0.

Case contract

Input {hr, sbp, dbp}. Invalid when sbp <= 0, dbp <= 0 or dbp >= sbp ({error INVALID_BP}). SI = hr/sbp; MAP = (sbp + 2*dbp)/3; modified SI = hr/MAP. Category: SI >= 1.0 SHOCK_LIKELY, SI >= 0.7 ELEVATED, else NORMAL. msi_flag when modified SI > 1.3; map_low when MAP < 65. SI and MAP are reported rounded half-up to 2 decimals. Return {si, map, category, msi_flag, map_low}.

Why this case matters

Ratio-based haemodynamic flags are sensitive to integer arithmetic, weighting of pressures and early rounding.

1 / The failure

Exit 1

"""Failure Map reference implementation. Python standard library only."""
import json
import math
from fractions import Fraction
N = 1
observations = []
def solve(x):
    def r2(v):
        return float(Fraction(math.floor(v * 100 + Fraction(1, 2)), 100))
    hr, sbp, dbp = x['hr'], x['sbp'], x['dbp']
    if sbp <= 0 or dbp <= 0 or dbp > sbp:
        return {'error': 'INVALID_BP'}
    si = Fraction(hr, sbp)
    mp = Fraction(sbp + 2 * dbp, 3)
    msi = hr / mp
    cat = 'SHOCK_LIKELY' if si >= 1 else 'ELEVATED' if si * 10 >= 7 else 'NORMAL'
    return {'si': r2(si), 'map': r2(mp), 'category': cat, 'msi_flag': msi * 10 > 13, 'map_low': mp < 65}
def check(label, actual, expected):
    observations.append({"check": label, "actual": actual, "expected": expected, "passed": actual == expected})
fixtures = [[('normal haemodynamics',
   {'hr': 71, 'sbp': 125, 'dbp': 80},
   {'si': 0.57, 'map': 95.0, 'category': 'NORMAL', 'msi_flag': False, 'map_low': False}),
  ('shock index just under 0.7',
   {'hr': 69, 'sbp': 100, 'dbp': 61},
   {'si': 0.69, 'map': 74.0, 'category': 'NORMAL', 'msi_flag': False, 'map_low': False}),
  ('shock index exactly 0.7',
   {'hr': 70, 'sbp': 100, 'dbp': 56},
   {'si': 0.7, 'map': 70.67, 'category': 'ELEVATED', 'msi_flag': False, 'map_low': False}),
  ('shock index exactly 1',
   {'hr': 105, 'sbp': 105, 'dbp': 60},
   {'si': 1.0, 'map': 75.0, 'category': 'SHOCK_LIKELY', 'msi_flag': True, 'map_low': False}),
  ('wide pulse pressure mean pressure',
   {'hr': 90, 'sbp': 150, 'dbp': 51},
   {'si': 0.6, 'map': 84.0, 'category': 'NORMAL', 'msi_flag': False, 'map_low': False}),
  ('half-hundredth shock index',
   {'hr': 133, 'sbp': 200, 'dbp': 91},
   {'si': 0.67, 'map': 127.33, 'category': 'NORMAL', 'msi_flag': False, 'map_low': False}),
  ('equal systolic and diastolic invalid', {'hr': 80, 'sbp': 91, 'dbp': 91}, {'error': 'INVALID_BP'}),
  ('zero diastolic invalid', {'hr': 81, 'sbp': 90, 'dbp': 0}, {'error': 'INVALID_BP'}),
  ('low mean pressure',
   {'hr': 110, 'sbp': 85, 'dbp': 51},
   {'si': 1.29, 'map': 62.33, 'category': 'SHOCK_LIKELY', 'msi_flag': True, 'map_low': True})],
 [('normal haemodynamics',
   {'hr': 72, 'sbp': 125, 'dbp': 80},
   {'si': 0.58, 'map': 95.0, 'category': 'NORMAL', 'msi_flag': False, 'map_low': False}),
  ('shock index just under 0.7',
   {'hr': 69, 'sbp': 100, 'dbp': 62},
   {'si': 0.69, 'map': 74.67, 'category': 'NORMAL', 'msi_flag': False, 'map_low': False}),
  ('shock index exactly 0.7',
   {'hr': 70, 'sbp': 100, 'dbp': 57},
   {'si': 0.7, 'map': 71.33, 'category': 'ELEVATED', 'msi_flag': False, 'map_low': False}),
  ('shock index exactly 1',
   {'hr': 110, 'sbp': 110, 'dbp': 60},
   {'si': 1.0, 'map': 76.67, 'category': 'SHOCK_LIKELY', 'msi_flag': True, 'map_low': False}),
  ('wide pulse pressure mean pressure',
   {'hr': 90, 'sbp': 150, 'dbp': 52},
   {'si': 0.6, 'map': 84.67, 'category': 'NORMAL', 'msi_flag': False, 'map_low': False}),
  ('half-hundredth shock index',
   {'hr': 133, 'sbp': 200, 'dbp': 92},
   {'si': 0.67, 'map': 128.0, 'category': 'NORMAL', 'msi_flag': False, 'map_low': False}),
  ('equal systolic and diastolic invalid', {'hr': 80, 'sbp': 92, 'dbp': 92}, {'error': 'INVALID_BP'}),
  ('zero diastolic invalid', {'hr': 82, 'sbp': 90, 'dbp': 0}, {'error': 'INVALID_BP'}),
  ('low mean pressure',
   {'hr': 110, 'sbp': 85, 'dbp': 52},
   {'si': 1.29, 'map': 63.0, 'category': 'SHOCK_LIKELY', 'msi_flag': True, 'map_low': True})],
 [('normal haemodynamics',
   {'hr': 73, 'sbp': 125, 'dbp': 80},
   {'si': 0.58, 'map': 95.0, 'category': 'NORMAL', 'msi_flag': False, 'map_low': False}),
  ('shock index just under 0.7',
   {'hr': 69, 'sbp': 100, 'dbp': 63},
   {'si': 0.69, 'map': 75.33, 'category': 'NORMAL', 'msi_flag': False, 'map_low': False}),
  ('shock index exactly 0.7',
   {'hr': 70, 'sbp': 100, 'dbp': 58},
   {'si': 0.7, 'map': 72.0, 'category': 'ELEVATED', 'msi_flag': False, 'map_low': False}),
  ('shock index exactly 1',
   {'hr': 115, 'sbp': 115, 'dbp': 60},
   {'si': 1.0, 'map': 78.33, 'category': 'SHOCK_LIKELY', 'msi_flag': True, 'map_low': False}),
  ('wide pulse pressure mean pressure',
   {'hr': 90, 'sbp': 150, 'dbp': 53},
   {'si': 0.6, 'map': 85.33, 'category': 'NORMAL', 'msi_flag': False, 'map_low': False}),
  ('half-hundredth shock index',
   {'hr': 133, 'sbp': 200, 'dbp': 93},
   {'si': 0.67, 'map': 128.67, 'category': 'NORMAL', 'msi_flag': False, 'map_low': False}),
  ('equal systolic and diastolic invalid', {'hr': 80, 'sbp': 93, 'dbp': 93}, {'error': 'INVALID_BP'}),
  ('zero diastolic invalid', {'hr': 83, 'sbp': 90, 'dbp': 0}, {'error': 'INVALID_BP'}),
  ('low mean pressure',
   {'hr': 110, 'sbp': 85, 'dbp': 53},
   {'si': 1.29, 'map': 63.67, 'category': 'SHOCK_LIKELY', 'msi_flag': True, 'map_low': True})],
 [('normal haemodynamics',
   {'hr': 74, 'sbp': 125, 'dbp': 80},
   {'si': 0.59, 'map': 95.0, 'category': 'NORMAL', 'msi_flag': False, 'map_low': False}),
  ('shock index just under 0.7',
   {'hr': 69, 'sbp': 100, 'dbp': 64},
   {'si': 0.69, 'map': 76.0, 'category': 'NORMAL', 'msi_flag': False, 'map_low': False}),
  ('shock index exactly 0.7',
   {'hr': 70, 'sbp': 100, 'dbp': 59},
   {'si': 0.7, 'map': 72.67, 'category': 'ELEVATED', 'msi_flag': False, 'map_low': False}),
  ('shock index exactly 1',
   {'hr': 120, 'sbp': 120, 'dbp': 60},
   {'si': 1.0, 'map': 80.0, 'category': 'SHOCK_LIKELY', 'msi_flag': True, 'map_low': False}),
  ('wide pulse pressure mean pressure',
   {'hr': 90, 'sbp': 150, 'dbp': 54},
   {'si': 0.6, 'map': 86.0, 'category': 'NORMAL', 'msi_flag': False, 'map_low': False}),
  ('half-hundredth shock index',
   {'hr': 133, 'sbp': 200, 'dbp': 94},
   {'si': 0.67, 'map': 129.33, 'category': 'NORMAL', 'msi_flag': False, 'map_low': False}),
  ('equal systolic and diastolic invalid', {'hr': 80, 'sbp': 94, 'dbp': 94}, {'error': 'INVALID_BP'}),
  ('zero diastolic invalid', {'hr': 84, 'sbp': 90, 'dbp': 0}, {'error': 'INVALID_BP'}),
  ('low mean pressure',
   {'hr': 110, 'sbp': 85, 'dbp': 54},
   {'si': 1.29, 'map': 64.33, 'category': 'SHOCK_LIKELY', 'msi_flag': True, 'map_low': True})],
 [('normal haemodynamics',
   {'hr': 75, 'sbp': 125, 'dbp': 80},
   {'si': 0.6, 'map': 95.0, 'category': 'NORMAL', 'msi_flag': False, 'map_low': False}),
  ('shock index just under 0.7',
   {'hr': 69, 'sbp': 100, 'dbp': 65},
   {'si': 0.69, 'map': 76.67, 'category': 'NORMAL', 'msi_flag': False, 'map_low': False}),
  ('shock index exactly 0.7',
   {'hr': 70, 'sbp': 100, 'dbp': 60},
   {'si': 0.7, 'map': 73.33, 'category': 'ELEVATED', 'msi_flag': False, 'map_low': False}),
  ('shock index exactly 1',
   {'hr': 125, 'sbp': 125, 'dbp': 60},
   {'si': 1.0, 'map': 81.67, 'category': 'SHOCK_LIKELY', 'msi_flag': True, 'map_low': False}),
  ('wide pulse pressure mean pressure',
   {'hr': 90, 'sbp': 150, 'dbp': 55},
   {'si': 0.6, 'map': 86.67, 'category': 'NORMAL', 'msi_flag': False, 'map_low': False}),
  ('half-hundredth shock index',
   {'hr': 133, 'sbp': 200, 'dbp': 95},
   {'si': 0.67, 'map': 130.0, 'category': 'NORMAL', 'msi_flag': False, 'map_low': False}),
  ('equal systolic and diastolic invalid', {'hr': 80, 'sbp': 95, 'dbp': 95}, {'error': 'INVALID_BP'}),
  ('zero diastolic invalid', {'hr': 85, 'sbp': 90, 'dbp': 0}, {'error': 'INVALID_BP'}),
  ('low mean pressure',
   {'hr': 110, 'sbp': 85, 'dbp': 55},
   {'si': 1.29, 'map': 65.0, 'category': 'SHOCK_LIKELY', 'msi_flag': True, 'map_low': False})]]
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 fixture	Actual	Expected	Outcome
normal haemodynamics	`{'category': 'NORMAL', 'map': 95.0, 'map_low': False, 'msi_flag': False, 'si': 0.57}`	`{'category': 'NORMAL', 'map': 95.0, 'map_low': False, 'msi_flag': False, 'si': 0.57}`	Passed
shock index just under 0.7	`{'category': 'NORMAL', 'map': 74.0, 'map_low': False, 'msi_flag': False, 'si': 0.69}`	`{'category': 'NORMAL', 'map': 74.0, 'map_low': False, 'msi_flag': False, 'si': 0.69}`	Passed
shock index exactly 0.7	`{'category': 'ELEVATED', 'map': 70.67, 'map_low': False, 'msi_flag': False, 'si': 0.7}`	`{'category': 'ELEVATED', 'map': 70.67, 'map_low': False, 'msi_flag': False, 'si': 0.7}`	Passed
shock index exactly 1	`{'category': 'SHOCK_LIKELY', 'map': 75.0, 'map_low': False, 'msi_flag': True, 'si': 1.0}`	`{'category': 'SHOCK_LIKELY', 'map': 75.0, 'map_low': False, 'msi_flag': True, 'si': 1.0}`	Passed
wide pulse pressure mean pressure	`{'category': 'NORMAL', 'map': 84.0, 'map_low': False, 'msi_flag': False, 'si': 0.6}`	`{'category': 'NORMAL', 'map': 84.0, 'map_low': False, 'msi_flag': False, 'si': 0.6}`	Passed
half-hundredth shock index	`{'category': 'NORMAL', 'map': 127.33, 'map_low': False, 'msi_flag': False, 'si': 0.67}`	`{'category': 'NORMAL', 'map': 127.33, 'map_low': False, 'msi_flag': False, 'si': 0.67}`	Passed
equal systolic and diastolic invalid	`{'category': 'ELEVATED', 'map': 91.0, 'map_low': False, 'msi_flag': False, 'si': 0.88}`	`{'error': 'INVALID_BP'}`	Failed
zero diastolic invalid	`{'error': 'INVALID_BP'}`	`{'error': 'INVALID_BP'}`	Passed
low mean pressure	`{'category': 'SHOCK_LIKELY', 'map': 62.33, 'map_low': True, 'msi_flag': True, 'si': 1.29}`	`{'category': 'SHOCK_LIKELY', 'map': 62.33, 'map_low': True, 'msi_flag': True, 'si': 1.29}`	Passed

SHA-256 / 20d1180caaf48438e8b1c361c96351558f88e594176cc80c22b9a148127414cd

2 / The unsuccessful fix

Exit 1

"""Failure Map reference implementation. Python standard library only."""
import json
import math
from fractions import Fraction
N = 1
observations = []
def solve(x):
    def r2(v):
        return float(Fraction(math.floor(v * 100 + Fraction(1, 2)), 100))
    hr, sbp, dbp = x['hr'], x['sbp'], x['dbp']
    if sbp <= 0 or dbp >= sbp:
        return {'error': 'INVALID_BP'}
    si = Fraction(hr, sbp)
    mp = Fraction(sbp + 2 * dbp, 3)
    msi = hr / mp
    cat = 'SHOCK_LIKELY' if si >= 1 else 'ELEVATED' if si * 10 >= 7 else 'NORMAL'
    return {'si': r2(si), 'map': r2(mp), 'category': cat, 'msi_flag': msi * 10 > 13, 'map_low': mp < 65}
def check(label, actual, expected):
    observations.append({"check": label, "actual": actual, "expected": expected, "passed": actual == expected})
fixtures = [[('normal haemodynamics',
   {'hr': 71, 'sbp': 125, 'dbp': 80},
   {'si': 0.57, 'map': 95.0, 'category': 'NORMAL', 'msi_flag': False, 'map_low': False}),
  ('shock index just under 0.7',
   {'hr': 69, 'sbp': 100, 'dbp': 61},
   {'si': 0.69, 'map': 74.0, 'category': 'NORMAL', 'msi_flag': False, 'map_low': False}),
  ('shock index exactly 0.7',
   {'hr': 70, 'sbp': 100, 'dbp': 56},
   {'si': 0.7, 'map': 70.67, 'category': 'ELEVATED', 'msi_flag': False, 'map_low': False}),
  ('shock index exactly 1',
   {'hr': 105, 'sbp': 105, 'dbp': 60},
   {'si': 1.0, 'map': 75.0, 'category': 'SHOCK_LIKELY', 'msi_flag': True, 'map_low': False}),
  ('wide pulse pressure mean pressure',
   {'hr': 90, 'sbp': 150, 'dbp': 51},
   {'si': 0.6, 'map': 84.0, 'category': 'NORMAL', 'msi_flag': False, 'map_low': False}),
  ('half-hundredth shock index',
   {'hr': 133, 'sbp': 200, 'dbp': 91},
   {'si': 0.67, 'map': 127.33, 'category': 'NORMAL', 'msi_flag': False, 'map_low': False}),
  ('equal systolic and diastolic invalid', {'hr': 80, 'sbp': 91, 'dbp': 91}, {'error': 'INVALID_BP'}),
  ('zero diastolic invalid', {'hr': 81, 'sbp': 90, 'dbp': 0}, {'error': 'INVALID_BP'}),
  ('low mean pressure',
   {'hr': 110, 'sbp': 85, 'dbp': 51},
   {'si': 1.29, 'map': 62.33, 'category': 'SHOCK_LIKELY', 'msi_flag': True, 'map_low': True})],
 [('normal haemodynamics',
   {'hr': 72, 'sbp': 125, 'dbp': 80},
   {'si': 0.58, 'map': 95.0, 'category': 'NORMAL', 'msi_flag': False, 'map_low': False}),
  ('shock index just under 0.7',
   {'hr': 69, 'sbp': 100, 'dbp': 62},
   {'si': 0.69, 'map': 74.67, 'category': 'NORMAL', 'msi_flag': False, 'map_low': False}),
  ('shock index exactly 0.7',
   {'hr': 70, 'sbp': 100, 'dbp': 57},
   {'si': 0.7, 'map': 71.33, 'category': 'ELEVATED', 'msi_flag': False, 'map_low': False}),
  ('shock index exactly 1',
   {'hr': 110, 'sbp': 110, 'dbp': 60},
   {'si': 1.0, 'map': 76.67, 'category': 'SHOCK_LIKELY', 'msi_flag': True, 'map_low': False}),
  ('wide pulse pressure mean pressure',
   {'hr': 90, 'sbp': 150, 'dbp': 52},
   {'si': 0.6, 'map': 84.67, 'category': 'NORMAL', 'msi_flag': False, 'map_low': False}),
  ('half-hundredth shock index',
   {'hr': 133, 'sbp': 200, 'dbp': 92},
   {'si': 0.67, 'map': 128.0, 'category': 'NORMAL', 'msi_flag': False, 'map_low': False}),
  ('equal systolic and diastolic invalid', {'hr': 80, 'sbp': 92, 'dbp': 92}, {'error': 'INVALID_BP'}),
  ('zero diastolic invalid', {'hr': 82, 'sbp': 90, 'dbp': 0}, {'error': 'INVALID_BP'}),
  ('low mean pressure',
   {'hr': 110, 'sbp': 85, 'dbp': 52},
   {'si': 1.29, 'map': 63.0, 'category': 'SHOCK_LIKELY', 'msi_flag': True, 'map_low': True})],
 [('normal haemodynamics',
   {'hr': 73, 'sbp': 125, 'dbp': 80},
   {'si': 0.58, 'map': 95.0, 'category': 'NORMAL', 'msi_flag': False, 'map_low': False}),
  ('shock index just under 0.7',
   {'hr': 69, 'sbp': 100, 'dbp': 63},
   {'si': 0.69, 'map': 75.33, 'category': 'NORMAL', 'msi_flag': False, 'map_low': False}),
  ('shock index exactly 0.7',
   {'hr': 70, 'sbp': 100, 'dbp': 58},
   {'si': 0.7, 'map': 72.0, 'category': 'ELEVATED', 'msi_flag': False, 'map_low': False}),
  ('shock index exactly 1',
   {'hr': 115, 'sbp': 115, 'dbp': 60},
   {'si': 1.0, 'map': 78.33, 'category': 'SHOCK_LIKELY', 'msi_flag': True, 'map_low': False}),
  ('wide pulse pressure mean pressure',
   {'hr': 90, 'sbp': 150, 'dbp': 53},
   {'si': 0.6, 'map': 85.33, 'category': 'NORMAL', 'msi_flag': False, 'map_low': False}),
  ('half-hundredth shock index',
   {'hr': 133, 'sbp': 200, 'dbp': 93},
   {'si': 0.67, 'map': 128.67, 'category': 'NORMAL', 'msi_flag': False, 'map_low': False}),
  ('equal systolic and diastolic invalid', {'hr': 80, 'sbp': 93, 'dbp': 93}, {'error': 'INVALID_BP'}),
  ('zero diastolic invalid', {'hr': 83, 'sbp': 90, 'dbp': 0}, {'error': 'INVALID_BP'}),
  ('low mean pressure',
   {'hr': 110, 'sbp': 85, 'dbp': 53},
   {'si': 1.29, 'map': 63.67, 'category': 'SHOCK_LIKELY', 'msi_flag': True, 'map_low': True})],
 [('normal haemodynamics',
   {'hr': 74, 'sbp': 125, 'dbp': 80},
   {'si': 0.59, 'map': 95.0, 'category': 'NORMAL', 'msi_flag': False, 'map_low': False}),
  ('shock index just under 0.7',
   {'hr': 69, 'sbp': 100, 'dbp': 64},
   {'si': 0.69, 'map': 76.0, 'category': 'NORMAL', 'msi_flag': False, 'map_low': False}),
  ('shock index exactly 0.7',
   {'hr': 70, 'sbp': 100, 'dbp': 59},
   {'si': 0.7, 'map': 72.67, 'category': 'ELEVATED', 'msi_flag': False, 'map_low': False}),
  ('shock index exactly 1',
   {'hr': 120, 'sbp': 120, 'dbp': 60},
   {'si': 1.0, 'map': 80.0, 'category': 'SHOCK_LIKELY', 'msi_flag': True, 'map_low': False}),
  ('wide pulse pressure mean pressure',
   {'hr': 90, 'sbp': 150, 'dbp': 54},
   {'si': 0.6, 'map': 86.0, 'category': 'NORMAL', 'msi_flag': False, 'map_low': False}),
  ('half-hundredth shock index',
   {'hr': 133, 'sbp': 200, 'dbp': 94},
   {'si': 0.67, 'map': 129.33, 'category': 'NORMAL', 'msi_flag': False, 'map_low': False}),
  ('equal systolic and diastolic invalid', {'hr': 80, 'sbp': 94, 'dbp': 94}, {'error': 'INVALID_BP'}),
  ('zero diastolic invalid', {'hr': 84, 'sbp': 90, 'dbp': 0}, {'error': 'INVALID_BP'}),
  ('low mean pressure',
   {'hr': 110, 'sbp': 85, 'dbp': 54},
   {'si': 1.29, 'map': 64.33, 'category': 'SHOCK_LIKELY', 'msi_flag': True, 'map_low': True})],
 [('normal haemodynamics',
   {'hr': 75, 'sbp': 125, 'dbp': 80},
   {'si': 0.6, 'map': 95.0, 'category': 'NORMAL', 'msi_flag': False, 'map_low': False}),
  ('shock index just under 0.7',
   {'hr': 69, 'sbp': 100, 'dbp': 65},
   {'si': 0.69, 'map': 76.67, 'category': 'NORMAL', 'msi_flag': False, 'map_low': False}),
  ('shock index exactly 0.7',
   {'hr': 70, 'sbp': 100, 'dbp': 60},
   {'si': 0.7, 'map': 73.33, 'category': 'ELEVATED', 'msi_flag': False, 'map_low': False}),
  ('shock index exactly 1',
   {'hr': 125, 'sbp': 125, 'dbp': 60},
   {'si': 1.0, 'map': 81.67, 'category': 'SHOCK_LIKELY', 'msi_flag': True, 'map_low': False}),
  ('wide pulse pressure mean pressure',
   {'hr': 90, 'sbp': 150, 'dbp': 55},
   {'si': 0.6, 'map': 86.67, 'category': 'NORMAL', 'msi_flag': False, 'map_low': False}),
  ('half-hundredth shock index',
   {'hr': 133, 'sbp': 200, 'dbp': 95},
   {'si': 0.67, 'map': 130.0, 'category': 'NORMAL', 'msi_flag': False, 'map_low': False}),
  ('equal systolic and diastolic invalid', {'hr': 80, 'sbp': 95, 'dbp': 95}, {'error': 'INVALID_BP'}),
  ('zero diastolic invalid', {'hr': 85, 'sbp': 90, 'dbp': 0}, {'error': 'INVALID_BP'}),
  ('low mean pressure',
   {'hr': 110, 'sbp': 85, 'dbp': 55},
   {'si': 1.29, 'map': 65.0, 'category': 'SHOCK_LIKELY', 'msi_flag': True, 'map_low': False})]]
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 fixture	Actual	Expected	Outcome
normal haemodynamics	`{'category': 'NORMAL', 'map': 95.0, 'map_low': False, 'msi_flag': False, 'si': 0.57}`	`{'category': 'NORMAL', 'map': 95.0, 'map_low': False, 'msi_flag': False, 'si': 0.57}`	Passed
shock index just under 0.7	`{'category': 'NORMAL', 'map': 74.0, 'map_low': False, 'msi_flag': False, 'si': 0.69}`	`{'category': 'NORMAL', 'map': 74.0, 'map_low': False, 'msi_flag': False, 'si': 0.69}`	Passed
shock index exactly 0.7	`{'category': 'ELEVATED', 'map': 70.67, 'map_low': False, 'msi_flag': False, 'si': 0.7}`	`{'category': 'ELEVATED', 'map': 70.67, 'map_low': False, 'msi_flag': False, 'si': 0.7}`	Passed
shock index exactly 1	`{'category': 'SHOCK_LIKELY', 'map': 75.0, 'map_low': False, 'msi_flag': True, 'si': 1.0}`	`{'category': 'SHOCK_LIKELY', 'map': 75.0, 'map_low': False, 'msi_flag': True, 'si': 1.0}`	Passed
wide pulse pressure mean pressure	`{'category': 'NORMAL', 'map': 84.0, 'map_low': False, 'msi_flag': False, 'si': 0.6}`	`{'category': 'NORMAL', 'map': 84.0, 'map_low': False, 'msi_flag': False, 'si': 0.6}`	Passed
half-hundredth shock index	`{'category': 'NORMAL', 'map': 127.33, 'map_low': False, 'msi_flag': False, 'si': 0.67}`	`{'category': 'NORMAL', 'map': 127.33, 'map_low': False, 'msi_flag': False, 'si': 0.67}`	Passed
equal systolic and diastolic invalid	`{'error': 'INVALID_BP'}`	`{'error': 'INVALID_BP'}`	Passed
zero diastolic invalid	`{'category': 'ELEVATED', 'map': 30.0, 'map_low': True, 'msi_flag': True, 'si': 0.9}`	`{'error': 'INVALID_BP'}`	Failed
low mean pressure	`{'category': 'SHOCK_LIKELY', 'map': 62.33, 'map_low': True, 'msi_flag': True, 'si': 1.29}`	`{'category': 'SHOCK_LIKELY', 'map': 62.33, 'map_low': True, 'msi_flag': True, 'si': 1.29}`	Passed

SHA-256 / 7b370c80452da9f6796af9ae71408d19fa1f85c9f3338964c25969a66adaac1a

3 / The verified repair

Exit 0

"""Failure Map reference implementation. Python standard library only."""
import json
import math
from fractions import Fraction
N = 1
observations = []
def solve(x):
    def r2(v):
        return float(Fraction(math.floor(v * 100 + Fraction(1, 2)), 100))
    hr, sbp, dbp = x['hr'], x['sbp'], x['dbp']
    if sbp <= 0 or dbp <= 0 or dbp >= sbp:
        return {'error': 'INVALID_BP'}
    si = Fraction(hr, sbp)
    mp = Fraction(sbp + 2 * dbp, 3)
    msi = hr / mp
    cat = 'SHOCK_LIKELY' if si >= 1 else 'ELEVATED' if si * 10 >= 7 else 'NORMAL'
    return {'si': r2(si), 'map': r2(mp), 'category': cat, 'msi_flag': msi * 10 > 13, 'map_low': mp < 65}
def check(label, actual, expected):
    observations.append({"check": label, "actual": actual, "expected": expected, "passed": actual == expected})
fixtures = [[('normal haemodynamics',
   {'hr': 71, 'sbp': 125, 'dbp': 80},
   {'si': 0.57, 'map': 95.0, 'category': 'NORMAL', 'msi_flag': False, 'map_low': False}),
  ('shock index just under 0.7',
   {'hr': 69, 'sbp': 100, 'dbp': 61},
   {'si': 0.69, 'map': 74.0, 'category': 'NORMAL', 'msi_flag': False, 'map_low': False}),
  ('shock index exactly 0.7',
   {'hr': 70, 'sbp': 100, 'dbp': 56},
   {'si': 0.7, 'map': 70.67, 'category': 'ELEVATED', 'msi_flag': False, 'map_low': False}),
  ('shock index exactly 1',
   {'hr': 105, 'sbp': 105, 'dbp': 60},
   {'si': 1.0, 'map': 75.0, 'category': 'SHOCK_LIKELY', 'msi_flag': True, 'map_low': False}),
  ('wide pulse pressure mean pressure',
   {'hr': 90, 'sbp': 150, 'dbp': 51},
   {'si': 0.6, 'map': 84.0, 'category': 'NORMAL', 'msi_flag': False, 'map_low': False}),
  ('half-hundredth shock index',
   {'hr': 133, 'sbp': 200, 'dbp': 91},
   {'si': 0.67, 'map': 127.33, 'category': 'NORMAL', 'msi_flag': False, 'map_low': False}),
  ('equal systolic and diastolic invalid', {'hr': 80, 'sbp': 91, 'dbp': 91}, {'error': 'INVALID_BP'}),
  ('zero diastolic invalid', {'hr': 81, 'sbp': 90, 'dbp': 0}, {'error': 'INVALID_BP'}),
  ('low mean pressure',
   {'hr': 110, 'sbp': 85, 'dbp': 51},
   {'si': 1.29, 'map': 62.33, 'category': 'SHOCK_LIKELY', 'msi_flag': True, 'map_low': True})],
 [('normal haemodynamics',
   {'hr': 72, 'sbp': 125, 'dbp': 80},
   {'si': 0.58, 'map': 95.0, 'category': 'NORMAL', 'msi_flag': False, 'map_low': False}),
  ('shock index just under 0.7',
   {'hr': 69, 'sbp': 100, 'dbp': 62},
   {'si': 0.69, 'map': 74.67, 'category': 'NORMAL', 'msi_flag': False, 'map_low': False}),
  ('shock index exactly 0.7',
   {'hr': 70, 'sbp': 100, 'dbp': 57},
   {'si': 0.7, 'map': 71.33, 'category': 'ELEVATED', 'msi_flag': False, 'map_low': False}),
  ('shock index exactly 1',
   {'hr': 110, 'sbp': 110, 'dbp': 60},
   {'si': 1.0, 'map': 76.67, 'category': 'SHOCK_LIKELY', 'msi_flag': True, 'map_low': False}),
  ('wide pulse pressure mean pressure',
   {'hr': 90, 'sbp': 150, 'dbp': 52},
   {'si': 0.6, 'map': 84.67, 'category': 'NORMAL', 'msi_flag': False, 'map_low': False}),
  ('half-hundredth shock index',
   {'hr': 133, 'sbp': 200, 'dbp': 92},
   {'si': 0.67, 'map': 128.0, 'category': 'NORMAL', 'msi_flag': False, 'map_low': False}),
  ('equal systolic and diastolic invalid', {'hr': 80, 'sbp': 92, 'dbp': 92}, {'error': 'INVALID_BP'}),
  ('zero diastolic invalid', {'hr': 82, 'sbp': 90, 'dbp': 0}, {'error': 'INVALID_BP'}),
  ('low mean pressure',
   {'hr': 110, 'sbp': 85, 'dbp': 52},
   {'si': 1.29, 'map': 63.0, 'category': 'SHOCK_LIKELY', 'msi_flag': True, 'map_low': True})],
 [('normal haemodynamics',
   {'hr': 73, 'sbp': 125, 'dbp': 80},
   {'si': 0.58, 'map': 95.0, 'category': 'NORMAL', 'msi_flag': False, 'map_low': False}),
  ('shock index just under 0.7',
   {'hr': 69, 'sbp': 100, 'dbp': 63},
   {'si': 0.69, 'map': 75.33, 'category': 'NORMAL', 'msi_flag': False, 'map_low': False}),
  ('shock index exactly 0.7',
   {'hr': 70, 'sbp': 100, 'dbp': 58},
   {'si': 0.7, 'map': 72.0, 'category': 'ELEVATED', 'msi_flag': False, 'map_low': False}),
  ('shock index exactly 1',
   {'hr': 115, 'sbp': 115, 'dbp': 60},
   {'si': 1.0, 'map': 78.33, 'category': 'SHOCK_LIKELY', 'msi_flag': True, 'map_low': False}),
  ('wide pulse pressure mean pressure',
   {'hr': 90, 'sbp': 150, 'dbp': 53},
   {'si': 0.6, 'map': 85.33, 'category': 'NORMAL', 'msi_flag': False, 'map_low': False}),
  ('half-hundredth shock index',
   {'hr': 133, 'sbp': 200, 'dbp': 93},
   {'si': 0.67, 'map': 128.67, 'category': 'NORMAL', 'msi_flag': False, 'map_low': False}),
  ('equal systolic and diastolic invalid', {'hr': 80, 'sbp': 93, 'dbp': 93}, {'error': 'INVALID_BP'}),
  ('zero diastolic invalid', {'hr': 83, 'sbp': 90, 'dbp': 0}, {'error': 'INVALID_BP'}),
  ('low mean pressure',
   {'hr': 110, 'sbp': 85, 'dbp': 53},
   {'si': 1.29, 'map': 63.67, 'category': 'SHOCK_LIKELY', 'msi_flag': True, 'map_low': True})],
 [('normal haemodynamics',
   {'hr': 74, 'sbp': 125, 'dbp': 80},
   {'si': 0.59, 'map': 95.0, 'category': 'NORMAL', 'msi_flag': False, 'map_low': False}),
  ('shock index just under 0.7',
   {'hr': 69, 'sbp': 100, 'dbp': 64},
   {'si': 0.69, 'map': 76.0, 'category': 'NORMAL', 'msi_flag': False, 'map_low': False}),
  ('shock index exactly 0.7',
   {'hr': 70, 'sbp': 100, 'dbp': 59},
   {'si': 0.7, 'map': 72.67, 'category': 'ELEVATED', 'msi_flag': False, 'map_low': False}),
  ('shock index exactly 1',
   {'hr': 120, 'sbp': 120, 'dbp': 60},
   {'si': 1.0, 'map': 80.0, 'category': 'SHOCK_LIKELY', 'msi_flag': True, 'map_low': False}),
  ('wide pulse pressure mean pressure',
   {'hr': 90, 'sbp': 150, 'dbp': 54},
   {'si': 0.6, 'map': 86.0, 'category': 'NORMAL', 'msi_flag': False, 'map_low': False}),
  ('half-hundredth shock index',
   {'hr': 133, 'sbp': 200, 'dbp': 94},
   {'si': 0.67, 'map': 129.33, 'category': 'NORMAL', 'msi_flag': False, 'map_low': False}),
  ('equal systolic and diastolic invalid', {'hr': 80, 'sbp': 94, 'dbp': 94}, {'error': 'INVALID_BP'}),
  ('zero diastolic invalid', {'hr': 84, 'sbp': 90, 'dbp': 0}, {'error': 'INVALID_BP'}),
  ('low mean pressure',
   {'hr': 110, 'sbp': 85, 'dbp': 54},
   {'si': 1.29, 'map': 64.33, 'category': 'SHOCK_LIKELY', 'msi_flag': True, 'map_low': True})],
 [('normal haemodynamics',
   {'hr': 75, 'sbp': 125, 'dbp': 80},
   {'si': 0.6, 'map': 95.0, 'category': 'NORMAL', 'msi_flag': False, 'map_low': False}),
  ('shock index just under 0.7',
   {'hr': 69, 'sbp': 100, 'dbp': 65},
   {'si': 0.69, 'map': 76.67, 'category': 'NORMAL', 'msi_flag': False, 'map_low': False}),
  ('shock index exactly 0.7',
   {'hr': 70, 'sbp': 100, 'dbp': 60},
   {'si': 0.7, 'map': 73.33, 'category': 'ELEVATED', 'msi_flag': False, 'map_low': False}),
  ('shock index exactly 1',
   {'hr': 125, 'sbp': 125, 'dbp': 60},
   {'si': 1.0, 'map': 81.67, 'category': 'SHOCK_LIKELY', 'msi_flag': True, 'map_low': False}),
  ('wide pulse pressure mean pressure',
   {'hr': 90, 'sbp': 150, 'dbp': 55},
   {'si': 0.6, 'map': 86.67, 'category': 'NORMAL', 'msi_flag': False, 'map_low': False}),
  ('half-hundredth shock index',
   {'hr': 133, 'sbp': 200, 'dbp': 95},
   {'si': 0.67, 'map': 130.0, 'category': 'NORMAL', 'msi_flag': False, 'map_low': False}),
  ('equal systolic and diastolic invalid', {'hr': 80, 'sbp': 95, 'dbp': 95}, {'error': 'INVALID_BP'}),
  ('zero diastolic invalid', {'hr': 85, 'sbp': 90, 'dbp': 0}, {'error': 'INVALID_BP'}),
  ('low mean pressure',
   {'hr': 110, 'sbp': 85, 'dbp': 55},
   {'si': 1.29, 'map': 65.0, 'category': 'SHOCK_LIKELY', 'msi_flag': True, 'map_low': False})]]
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 fixture	Actual	Expected	Outcome
normal haemodynamics	`{'category': 'NORMAL', 'map': 95.0, 'map_low': False, 'msi_flag': False, 'si': 0.57}`	`{'category': 'NORMAL', 'map': 95.0, 'map_low': False, 'msi_flag': False, 'si': 0.57}`	Passed
shock index just under 0.7	`{'category': 'NORMAL', 'map': 74.0, 'map_low': False, 'msi_flag': False, 'si': 0.69}`	`{'category': 'NORMAL', 'map': 74.0, 'map_low': False, 'msi_flag': False, 'si': 0.69}`	Passed
shock index exactly 0.7	`{'category': 'ELEVATED', 'map': 70.67, 'map_low': False, 'msi_flag': False, 'si': 0.7}`	`{'category': 'ELEVATED', 'map': 70.67, 'map_low': False, 'msi_flag': False, 'si': 0.7}`	Passed
shock index exactly 1	`{'category': 'SHOCK_LIKELY', 'map': 75.0, 'map_low': False, 'msi_flag': True, 'si': 1.0}`	`{'category': 'SHOCK_LIKELY', 'map': 75.0, 'map_low': False, 'msi_flag': True, 'si': 1.0}`	Passed
wide pulse pressure mean pressure	`{'category': 'NORMAL', 'map': 84.0, 'map_low': False, 'msi_flag': False, 'si': 0.6}`	`{'category': 'NORMAL', 'map': 84.0, 'map_low': False, 'msi_flag': False, 'si': 0.6}`	Passed
half-hundredth shock index	`{'category': 'NORMAL', 'map': 127.33, 'map_low': False, 'msi_flag': False, 'si': 0.67}`	`{'category': 'NORMAL', 'map': 127.33, 'map_low': False, 'msi_flag': False, 'si': 0.67}`	Passed
equal systolic and diastolic invalid	`{'error': 'INVALID_BP'}`	`{'error': 'INVALID_BP'}`	Passed
zero diastolic invalid	`{'error': 'INVALID_BP'}`	`{'error': 'INVALID_BP'}`	Passed
low mean pressure	`{'category': 'SHOCK_LIKELY', 'map': 62.33, 'map_low': True, 'msi_flag': True, 'si': 1.29}`	`{'category': 'SHOCK_LIKELY', 'map': 62.33, 'map_low': True, 'msi_flag': True, 'si': 1.29}`	Passed

SHA-256 / 72043d4d1542d365c3c170d06eda45b674fa3336e9d824af4923053e0fe42710

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 2026-09-29T14:47:26.754262+00:00.

Case digest / 4fa8f8817b6742cea396a2f8c82669cbf43ac22202603e05658aefe7176d1f6f