Racial Bias in Pulse Oximetry Measurement: NEJM
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Oxygen is among the most frequently administered medical therapies, with a level that is commonly adjusted according to the reading on a pulse oximeter that measures patient's oxygen saturation.

A study was conducted that involved adult inpatients who were receiving supplemental oxygen and patients in ICU at 178 hospitals. Researchers analyzed paired pulse oximetry measures of oxygen saturation and measures of arterial oxygen saturation in arterial blood gas, with all evaluations performed within 10 minutes of each other.

Researchers analyzed 10,789 pairs of measures of oxygen saturation by pulse oximetry and arterial oxygen saturation in arterial blood gas obtained from 1333 White patients and 276 Black patients in the University of Michigan cohort and 37,308 pairs obtained from 7342 White patients and 1050 Black patients in the multicenter cohort.

In the University of Michigan cohort, among the patients who had an oxygen saturation of 92 to 96% on pulse oximetry, an arterial oxygen saturation of less than 88% was found in 88 of 749 arterial blood gas measurements in Black patients (11.7%) and in 99 of 2778 measurements in White patients (3.6%).

The findings in the adjusted analysis were similar to those in the unadjusted analysis, with an arterial blood gas oxygen saturation of less than 88% in 11.4% of the measurements in Black patients and in 3.6% of those in White patients.

In unadjusted analysis, the area under the receiver-operating-characteristic curve for detecting an arterial blood gas oxygen saturation of less than 88% according to the oxygen saturation on pulse oximetry was 0.84 among Black patients and 0.89 among White patients. In the multicenter cohort, the unadjusted analysis involving patients with an oxygen saturation of 92 to 96% on pulse oximetry showed an arterial blood gas oxygen saturation of less than 88% in 160 of 939 measurements in Black patients (17.0%) and in 546 of 8795 measurements in White patients (6.2%).
Thus, in two large cohorts, Black patients had nearly three times the frequency of occult hypoxemia that was not detected by pulse oximetry as White patients.

These results suggest that reliance on pulse oximetry to triage patients and adjust supplemental oxygen levels may place Black patients at increased risk for hypoxemia. It is important to note that not all Black patients who had a pulse oximetry value of 92 to 96% had occult hypoxemia. However, the variation in risk according to race necessitates the integration of pulse oximetry with other clinical and patient-reported data.

Source: https://www.nejm.org/doi/full/10.1056/NEJMc2029240
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