The Compensatory Reserve Index Following Injury: Results of a Prospective Clinical Trial

Camille L. Stewart, Jane Mulligan, Greg Z. Grudic, Mark E. Talley, Gregory Jurkovich, Steven L. Moulton

Research output: Contribution to journalArticlepeer-review

20 Scopus citations


Introduction: Humans are able to compensate for significant blood loss with little change in traditional vital signs. We hypothesized that an algorithm, which recognizes compensatory changes in photoplethysmogram (PPG) waveforms, could detect active bleeding and ongoing volume loss in injured patients. Methods: Injured adults were prospectively enrolled at a level I trauma center. PPG data collection was conducted using a custom-made pulse oximeter. Waveform data were post-processed by an algorithm to calculate the compensatory reserve index (CRI), measured on a scale of 1 to 0, with 1 indicating fully compensated and 0 indicating no reserve, or decompensation. CRI was compared to clinical findings. Results: Fifty patients were enrolled in the study; 3 had incomplete data, 3 had indeterminate bleeding, 12 were actively bleeding, and 32 were not bleeding. The mean initial CRI of bleeding patients was significantly lower compared with the non-bleeding patients (CRI 0.17, 95% CI = 0.13-0.22 vs. CRI 0.56, 95% CI = 0.49-0.62, P < 0.001). Using a cut-off of 0.21 had a sensitivity of 0.97 and specificity of 0.83 for identifying bleeding patients. CRI had a higher sensitivity than heart rate (75%), systolic blood pressure (63%), shock index (27%), base deficit (29%), lactate (80%), hemoglobin (50%), and hematocrit (50%). During ongoing bleeding, CRI decreased following fluid resuscitation, and conversely increased for patients who were not bleeding. Conclusions: A novel computational algorithm that recognizes subtle changes in PPG waveforms can quickly and noninvasively discern which patients are actively bleeding and continuing to bleed with high sensitivity and specificity in acutely injured patients.

Original languageEnglish (US)
Pages (from-to)61-67
Number of pages7
Issue number3S
StatePublished - Sep 1 2016
Externally publishedYes


  • Compensatory reserve index
  • hemorrhage
  • shock
  • trauma surgery
  • vital signs

ASJC Scopus subject areas

  • Emergency Medicine
  • Critical Care and Intensive Care Medicine


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