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Critically ill patients in emergency department may be characterized by low amplitude and high variability of amplitude of pulse photoplethysmography

Jussi Pirneskoski1*, Veli-Pekka Harjola2, Petri Jeskanen3, Lari Linnamurto3, Simo Saikko3 and Jouni Nurmi1

Author Affiliations

1 Department of Anesthesia and Intensive Care, Helsinki University Central Hospital, Helsinki, Finland

2 Division of Emergency Care, Department of Medicine, Helsinki University Central Hospital, Helsinki, Finland

3 Saimaa University of Applied Sciences, Lappeenranta, Finland

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Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 2013, 21:48  doi:10.1186/1757-7241-21-48

Published: 24 June 2013



The aim of the present pilot study was to determine if pulse photoplethysmography amplitude (PPGA) could be used as an indicator of critical illness and as a predictor of higher need of care in emergency department patients.


This was a prospective observational study. We collected vital signs and one minute of pulse photoplethysmograph signal from 251 consecutive patients admitted to a university hospital emergency department. The patients were divided in two groups regarding to the modified Early Warning Score (mEWS): > 3 (critically ill) and ≤ 3 (non-critically ill). Photoplethysmography characteristics were compared between the groups.


Sufficient data for analysis was acquired from 212 patients (84.5%). Patients in critically ill group more frequently required intubation and invasive hemodynamic monitoring in the ED and received more intravenous fluids. Mean pulse photoplethysmography amplitude (PPGA) was significantly lower in critically ill patients (median 1.105 [95% CI of mean 0.9946-2.302] vs. 2.476 [95% CI of mean 2.239-2.714], P = 0.0257). Higher variability of PPGA significantly correlated with higher amount of fluids received in the ED (r = 0.1501, p = 0.0296).


This pilot study revealed differences in PPGA characteristics between critically ill and non-critically ill patients. Further studies are needed to determine if these easily available parameters could help increase accuracy in triage when used in addition to routine monitoring of vital signs.