GRN-Transformer: Enhancing Motion Artifact Detection in PICU Photoplethysmogram Signals

Photoplethysmogram (PPG) signals, optical measurements of pulsatile blood flow used continuously in intensive care monitoring, are frequently contaminated by motion, low perfusion, or sensor displacement, producing waveform artifacts that propagate into downstream estimates such as SpOtextsubscript2 and trigger spurious clinical alarms. Automated artifact detection is therefore a prerequisite for reliable bedside decision support. Transformer classifiers, which use self-attention to weight contributions from every part of the input pulse, are well suited to learning artifact morphology, but their performance is known to degrade on the small, imbalanced datasets typical of single-center clinical studies. We propose the GRN-Transformer, which integrates a single Gated Residual Network (GRN) block atop a standard Transformer encoder stack, serving as a small-data regularizer. On a labeled Pediatric Intensive Care Unit (PICU) PPG dataset from CHU Sainte-Justine Hospital (CHUSJ), the GRN-Transformer reaches 98% accuracy, 90% precision, 97% recall, and 93% F1-score using only 5% of the annotated pulses, substantially improving recall over the baseline Transformer (+11 points) without sacrificing precision. Cross-validated evaluation indicates that clean-data accuracy gains are modest once fold-to-fold variability is accounted for, but the GRN-Transformer is markedly more robust to realistic signal degradations (noise, baseline wander, sensor dropout), trains approximately 2.7× faster than the baseline, and runs at 6.33~ms p99 latency on a CPU-only consumer laptop. A retrospective simulation suggests the model could meaningfully reduce clinician review burden when used as a pre-filter for PPG-driven alarms. These results support the GRN-Transformer as a deployable artifact-detection component for resource-constrained pediatric clinical settings.