Initial Photoplethysmography Waveform Analysis in Predicting the Need for Life-saving Intervention in Adult Trauma Patients

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Abstract RATIONALE: Trauma continues to account for significant morbidity, mortality, and healthcare expenditures. The identification of trauma patients who are compensating physiologically but need further intervention continues to be a challenge due to our reliance on vital signs and other inadequate markers of abnormal tissue oxygenation. Given significant, sustained abnormalities in these parameters define the end of the compensated phase of shock, it is not surprising they lack sufficient sensitivity and specificity as early predictors of impending hemodynamic compromise. Photoplethysmography (PPG) is a commonly used monitoring modality that can be easily recorded in clinical settings. Evidence from translational (and limited clinical) research suggests the shape of the PPG waveform carries information pertaining to an individual's remaining compensatory reserve in the setting of central hypovolemia. We hypothesized that features of the initial PPG waveform could predict subsequent life-saving interventions (LSI) intended to address central hypovolemia and other factors contributing to progressive shock in trauma patients. METHODS: This is a secondary analysis of a prospectively collected dataset (11/18/2021-11/04/2024) of 2521 adult trauma patients in the pre-hospital setting. Hospital outcome measures were linked to the EMS records through University of Pittsburgh trauma registry. The primary outcome was provision of at least one LSI (e.g., airway, hemorrhage control, blood product administration). Continuous infrared transmissive PPG waveforms were captured at 125 Hz and subsequently visualized, pre-processed, and analyzed using custom MATLAB scripts. Several features of interest were extracted, including half-rise to dicrotic notch (HRDN) and area under the curve (AUC). We then performed logistic regression to assess the relationship between these features (both the mean of their absolute values and the slope of their trajectories over the first 5 minutes) and LSI. RESULTS and CONCLUSION: Only the mean HRDN over the first 5 minutes was correlated with subsequent LSI (OR 2.46, 95% CI 1.16-5.25, p = 0.02), suggesting further research is needed to assess potential clinical value of PPG waveform analysis in identifying compensated shock and predicting subsequent clinical deterioration in adult trauma patients.

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