chart-review-rucam

name	chart-review-rucam
description	Score RUCAM (Roussel Uclaf Causality Assessment Method) for drug-induced liver injury (DILI) from EHR structured data + clinical notes. Triggers on: RUCAM, DILI causality, drug-induced liver injury, hepatotoxicity, R ratio, time to onset, rechallenge, liver injury scoring.

Procedure

RUCAM has 7 scored items whose scores sum to a total that maps to a causality category (highly probable / probable / possible / unlikely / excluded).

You do NOT score the items. You extract the small components each item is built from; the platform derives every item score, the total, and the category deterministically from your components. Never call set_field_assessment on an item_*, rucam_total_score, or rucam_causality_category field — those are computed. list_criteria shows you exactly the component (leaf) fields to answer.

Several components/items depend on injury type (hepatocellular / cholestatic / mixed) from the R ratio (ALT/ULN ÷ ALP/ULN) — extract that first.

Per-item logic (which component values map to which score) lives in references/scoring/item-N-*.md — consult it for context, but commit the components, not the score.

Tools

• Structured data (RUCAM plugin): get_patient_summary, get_suspect_drug, get_medications, get_drug_episodes (45-day-gap merge), get_lft_series, get_lab_extremum, get_serology, get_conditions, get_hepatotoxicity_category, compute_r_ratio. The patient (person_id) and data dir are pre-bound — call these WITHOUT person_id/data_dir.
• Notes: list_notes / read_note (platform MCP, faithfulness-gated).
• Write: one set_field_assessment per component below (with a brief rationale + evidence); set_review_status when every applicable component is done.

Components to extract

Read each field's criterion (read_criterion / list_criteria) for its exact allowed values and evidence rules, then commit it. Grouped by the item it feeds:

Injury type (feeds items 1–3)

• injury_track — from compute_r_ratio (hepatocellular / cholestatic / mixed).

Item 1 · time to onset

• onset_path — initial_treatment / re_exposure / from_cessation / not_calculable (get_drug_episodes).
• onset_latency_days — integer days (drug-start→injury for path A; stop→injury for path B).

Item 2 · course after stopping

• dechallenge_outcome — the anchor lab's course after the drug stopped (get_lab_extremum).

Item 3 · risk factors

• rf_alcohol, rf_pregnancy, rf_age_ge_55 — each yes / no.

Item 4 · concomitant drugs

• concomitant_worst_timing — suggestive / compatible / incompatible / none.
• concomitant_worst_hepatotoxic — yes / no (get_hepatotoxicity_category on the worst co-drug).
• concomitant_attribution — yes / no (is a co-drug clearly the cause?).

Item 5 · exclusion of other causes — one flag per cause, yes only if ruled out by a negative test or an explicit note exclusion (per references/scoring/item-5-exclusion.md):

• Group I (6): g1_hav_ruled_out, g1_hbv_ruled_out, g1_hcv_ruled_out, g1_biliary_obstruction_ruled_out, g1_alcoholism_ruled_out, g1_ischemia_ruled_out.
• Group II (5): g2_autoimmune_ruled_out, g2_sepsis_ruled_out, g2_chronic_hbv_hcv_ruled_out, g2_pbc_psc_ruled_out, g2_cmv_ebv_hsv_ruled_out.
• alt_cause_explains — yes / no (does a non-drug cause sufficiently explain the injury? the −3 override).

Item 6 · prior hepatotoxicity

• hepatotoxicity_class — labeled / probable / none (get_hepatotoxicity_category on the suspect drug).

Item 7 · rechallenge

• rechallenge_result — positive_alone / positive_with_codrug / below_uln / none_or_insufficient.

Steps

1. Read references/scoring/item-0-setup.md; call compute_r_ratio and commit injury_track.
2. Work through the components above, gathering evidence with the tools (+ notes) and committing each via set_field_assessment. Answer every applicable component — for the Group I/II exclusion flags, that means one flag per cause even when a cause was not assessed (no), because a missing flag leaves item 5 Pending.
3. set_review_status when done. The item scores, total, and category compute automatically from your components.