Impact of ethnicity on the accuracy of measurements of oxygen saturations: A retrospective observational cohort study

Bangash, Mansoor N.; Hodson, James; Evison, Felicity; Patel, Jaimin; Johnston, Andrew M.; Gallier, Suzy; Sapey, Elizabeth; Parekh, Dhruv

doi:10.1016/j.eclinm.2022.101428

Cited by 14 publications

(15 citation statements)

References 26 publications

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“…The inaccuracies in Black patients mostly result in SaO2, particularly at lower oxygen saturations (such as at SaO2 < 90% 9 ) . This is supported by emerging evidence from the UK 19 . However, the magnitudes of these inaccuracies are relatively small, such as a median difference in SaO2 of 0.6% between Black and White patients with an SpO2 of 90% (the threshold for making a diagnosis of hypoxaemia) 3 .…”

Section: Literature On Pulse Oximetry and Skin Pigmentationmentioning

confidence: 57%

Inaccuracy of pulse oximetry with dark skin pigmentation: clinical implications and need for improvement

Kyriacou

Charlton

Al-Halawani

et al. 2023

British Journal of Anaesthesia

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Section: Literature On Pulse Oximetry and Skin Pigmentationmentioning

confidence: 57%

Inaccuracy of pulse oximetry with dark skin pigmentation: clinical implications and need for improvement

Kyriacou

Charlton

Al-Halawani

et al. 2023

British Journal of Anaesthesia

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“…The criteria for initiating supplemental oxygen will need to be standardized in the clinical trial, and, if based on the 6MWD results, there needs to be recognition of factors that might impact the measurement of desaturation via pulse oximetry, including the speed of the walk and skin pigmentation. 45 , 46 Patient reported outcomes (PRO) . Accounting for the patients’ perspective when designing a clinical study is needed to provide direct feedback on whether the magnitude of the outcomes seen with the selected primary endpoint translate into benefits that the patient experiences and perceives.…”

Section: Ild‐ph Clinical Trial Endpointsmentioning

confidence: 99%

Section: Ild‐ph Clinical Trial Endpointsmentioning

confidence: 99%

“…This might be best suited to studies of patients with early disease who are oxygen‐independent, since the initiation of supplemental oxygen is more meaningful than increasing oxygen needs in patients who already are on supplemental oxygen. The criteria for initiating supplemental oxygen will need to be standardized in the clinical trial, and, if based on the 6MWD results, there needs to be recognition of factors that might impact the measurement of desaturation via pulse oximetry, including the speed of the walk and skin pigmentation 45,46 Patient reported outcomes (PRO) .…”

Section: Ild‐ph Clinical Trial Endpointsmentioning

confidence: 99%

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Pulmonary hypertension in interstitial lung disease: Clinical trial design and endpoints: A consensus statement from the Pulmonary Vascular Research Institute's Innovative Drug Development Initiative—Group 3 Pulmonary Hypertension

et al. 2022

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Pulmonary hypertension (PH) associated with interstitial lung disease (ILD) is an attractive target for clinical trials of PH medications. There are many factors that need to be considered to prime such studies for success. The patient phenotype most likely to respond to the intervention requires weighing the extent of the parenchymal lung disease against the severity of the hemodynamic impairment. The inclusion criteria should not be too restrictive, thus enabling recruitment. The trial should be of sufficient duration to meet the chosen endpoint which should reflect how the patient feels, functions, or survives. This paper summarizes prior studies in PH‐ILD and provides a framework of the type of studies to be considered. Inclusion criteria, clinical trial endpoints, and pharmacovigilance in the context of PH‐ILD trials are also addressed. Through lessons learnt from prior studies, suggestions and guidance for future clinical trials in PH‐ILD are also provided.

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“…Since pulse oximetry is based on light passing through the skin, this technology is affected by multiple factors including skin pigmentation. Many have raised questions about the validity of pulse oximeter measurements in patients of varied races and skin colors (1)(2)(3)(4)(5)(6)(7)(8)(9). In fact, the U.S. Food and Drug Administration (FDA) has issued a communication to make patients and healthcare providers aware of the accuracy and limitations of pulse oximetry (10).…”

mentioning

confidence: 99%

Pulse Oximetry and Arterial Saturation Difference in Pediatric COVID-19 Patients: Retrospective Analysis by Race*

Savorgnan

Hassan

Borges

et al. 2023

Pediatric Critical Care Medicine

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Objectives: Pulse oximetry (Spo2) may overestimate arterial oxygen saturation (Sao2) in blood laboratory testing. This study aimed to assess Spo2–Sao2 difference in relation to race (i.e., patient self-reporting as Black or White), occult hypoxemia, and length of stay (LOS) in pediatric patients with COVID-19. Design: Single-center retrospective study in pediatric COVID-19 patients. We used multivariable linear regressions to examine the association between race and oximetry measurements and between occult hypoxemia and LOS. Oximetry bias was defined using Spo2 and Sao2 data according to approved comparisons. Occult hypoxemia was defined as Spo2 greater than 92% and Sao2 less than 88%. Setting: Quaternary pediatric hospital. Patients: Pediatric COVID-19 patients admitted to Texas Children’s Hospital between May 2020 and December 2021. Interventions: None. Measurements and Main Results: There were 2713 patients with complete physiological data in the analysis. Of the total, 61% were Black, and 39% were White. Oximetry bias was greater in Black compared with White patients (p < 0.001), and this bias increased as the oxygen saturations decreased (p < 0.001). Black and White patients had a 12% and 4% prevalence of occult hypoxemia, respectively (p < 0.001). LOS was not associated with oximetry bias or occult hypoxemia once controlled for the level of support (intensive care, respiratory, circulatory). Conclusions: We found an oximetry bias in the measurement of Spo2 with respect to Sao2 in symptomatic hospitalized pediatric patients with the diagnosis of COVID-19. Furthermore, race is related to an increased oximetry bias. However, we did not find a relationship between oximetry bias and the LOS in the hospital in this cohort of patients.

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Impact of ethnicity on the accuracy of measurements of oxygen saturations: A retrospective observational cohort study

Cited by 14 publications

References 26 publications

Inaccuracy of pulse oximetry with dark skin pigmentation: clinical implications and need for improvement

Inaccuracy of pulse oximetry with dark skin pigmentation: clinical implications and need for improvement

Pulmonary hypertension in interstitial lung disease: Clinical trial design and endpoints: A consensus statement from the Pulmonary Vascular Research Institute's Innovative Drug Development Initiative—Group 3 Pulmonary Hypertension

Pulse Oximetry and Arterial Saturation Difference in Pediatric COVID-19 Patients: Retrospective Analysis by Race*

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