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Heart rate variability (HRV) measured using electrocardiography waveforms is associated with increased organ dysfunction and clinical deterioration in adult and pediatric patients in the intensive care unit (ICU). Here, we explore the feasibility of using photoplethysmography (PPG)-derived integer pulse rate variability (PRVi) to estimate HRV and determine its association with organ dysfunction in pediatric oncology patients in the ward and pediatric ICU. The advantage of using PPG sensor data over electrocardiography is its higher availability in most healthcare settings and in wearable technology. In a cohort of 38 patients, reduced median daily PRVi was significantly associated with increase in two pediatric organ dysfunction scores after adjusting for confounders (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). PRVi shows promise as a real-time physiologic marker of clinical deterioration using highly-available PPG data, but further research is warranted.<\/jats:p>","DOI":"10.1038\/s41746-018-0038-0","type":"journal-article","created":{"date-parts":[[2018,7,12]],"date-time":"2018-07-12T08:41:12Z","timestamp":1531384872000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["Using photoplethysmography data to estimate heart rate variability and its association with organ dysfunction in pediatric oncology patients"],"prefix":"10.1038","volume":"1","author":[{"given":"Anoop","family":"Mayampurath","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Samuel L","family":"Volchenboum","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7434-6747","authenticated-orcid":false,"given":"L. Nelson","family":"Sanchez-Pinto","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2018,7,25]]},"reference":[{"key":"38_CR1","doi-asserted-by":"publisher","first-page":"1536","DOI":"10.1007\/s00134-014-3389-2","volume":"40","author":"MS Zinter","year":"2014","unstructured":"Zinter, M. S., DuBois, S. G., Spicer, A., Matthay, K. & Sapru, A. Pediatric cancer type predicts infection rate, need for critical care intervention, and mortality in the pediatric intensive care unit. Intensive Care Med. 40, 1536\u20131544 (2014).","journal-title":"Intensive Care Med"},{"key":"38_CR2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0006642","volume":"4","author":"S Ahmad","year":"2009","unstructured":"Ahmad, S. et al. Continuous multi-parameter heart rate variability analysis heralds onset of sepsis in adults. PLoS One. 4, e6642 (2009).","journal-title":"PLoS One"},{"key":"38_CR3","doi-asserted-by":"publisher","first-page":"1070","DOI":"10.1542\/peds.2004-2461","volume":"116","author":"MP Griffin","year":"2005","unstructured":"Griffin, M. P. et al. Heart rate characteristics: novel physiomarkers to predict neonatal infection and death. Pediatrics 116, 1070\u20131074 (2005).","journal-title":"Pediatrics"},{"key":"38_CR4","doi-asserted-by":"publisher","first-page":"885","DOI":"10.1016\/j.jamcollsurg.2007.01.019","volume":"204","author":"JA Morris Jr.","year":"2007","unstructured":"Morris, J. A. Jr. et al. Adrenal insufficiency, heart rate variability, and complex biologic systems: a study of 1,871 critically ill trauma patients. J. Am. Coll. Surg. 204, 885\u2013892 (2007). discussion 892-883.","journal-title":"J. Am. Coll. Surg."},{"key":"38_CR5","doi-asserted-by":"publisher","first-page":"804","DOI":"10.1097\/01.sla.0000219642.92637.fd","volume":"243","author":"PR Norris","year":"2006","unstructured":"Norris, P. R. et al. Cardiac uncoupling and heart rate variability stratify ICU patients by mortality: a study of 2088 trauma patients. Ann. Surg. 243, 804\u2013812 (2006).","journal-title":"Ann. Surg."},{"key":"38_CR6","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1016\/j.ijcard.2012.03.119","volume":"166","author":"A Sch\u00e4fer","year":"2013","unstructured":"Sch\u00e4fer, A. & Vagedes, J. How accurate is pulse rate variability as an estimate of heart rate variability? A review on studies comparing photoplethysmographic technology with an electrocardiogram. Int J. Cardiol. 166, 15\u201329 (2013).","journal-title":"Int J. 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Med Decis. Mak. 19, 399\u2013410 (1999).","journal-title":"Med Decis. Mak."},{"key":"38_CR10","doi-asserted-by":"crossref","unstructured":"Matics, T. J. & Sanchez-Pinto, L. N. Adaptation and validation of a pediatric sequential organ failure assessment score and evaluation of the sepsis-3 definitions in critically ill children. JAMA Pediatr. 171(10), e172352 (2017).","DOI":"10.1001\/jamapediatrics.2017.2352"}],"container-title":["npj Digital Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41746-018-0038-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41746-018-0038-0","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41746-018-0038-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,12,21]],"date-time":"2022-12-21T12:39:34Z","timestamp":1671626374000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41746-018-0038-0"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,7,25]]},"references-count":10,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2018,12]]}},"alternative-id":["38"],"URL":"https:\/\/doi.org\/10.1038\/s41746-018-0038-0","relation":{},"ISSN":["2398-6352"],"issn-type":[{"type":"electronic","value":"2398-6352"}],"subject":[],"published":{"date-parts":[[2018,7,25]]},"assertion":[{"value":"21 March 2018","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"27 June 2018","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"28 June 2018","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"25 July 2018","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare no competing interests.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"29"}}