Disparities in Hypoxemia Detection by Pulse Oximetry Across Self-Identified Racial Groups and Associations With Clinical Outcomes*

Henry, Nicole; Hanson, Andrew C.; Schulte, Phillip J.; Warner, Nafisseh S.; Manento, Megan N.; Weister, Timothy; Warner, Matthew A.

doi:10.1097/ccm.0000000000005394

Cited by 87 publications

(121 citation statements)

References 13 publications

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“…6 9 Our study looks at concerns about possible differential bias being introduced because of the potential interval between SpO 2 and SaO 2 readings. 9 Errors in pulse oximeters could be due to a combination of systematic error or bias, which is reproducible across measurements, as well as random error or noise. 30 Because pulse oximeter error is due to a combination of both processes, the magnitude of pulse oximeter error might not be the same each time a reading is taken.…”

Section: Principal Findingsmentioning

confidence: 99%

Racial bias and reproducibility in pulse oximetry among medical and surgical inpatients in general care in the Veterans Health Administration 2013-19: multicenter, retrospective cohort study

Valbuena

Seelye

Sjoding

et al. 2022

BMJ

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ObjectivesTo evaluate measurement discrepancies by race between pulse oximetry and arterial oxygen saturation (as measured in arterial blood gas) among inpatients not in intensive care.DesignMulticenter, retrospective cohort study using electronic medical records from general care medical and surgical inpatients.SettingVeteran Health Administration, a national and racially diverse integrated health system in the United States, from 2013 to 2019.ParticipantsAdult inpatients in general care (medical and surgical), in Veteran Health Administration medical centers.Main outcomes measuresOccult hypoxemia (defined as arterial blood oxygen saturation (SaO2) of <88% despite a pulse oximetry (SpO2) reading of ≥92%), and whether rates of occult hypoxemia varied by race and ethnic origin.ResultsA total of 30 039 pairs of SpO2-SaO2 readings made within 10 minutes of each other were identified during the study. These pairs were predominantly among non-Hispanic white (21 918 (73.0%)) patients; non-Hispanic black patients and Hispanic or Latino patients accounted for 6498 (21.6%) and 1623 (5.4%) pairs in the sample, respectively. Among SpO2 values greater or equal to 92%, unadjusted probabilities of occult hypoxemia were 15.6% (95% confidence interval 15.0% to 16.1%) in white patients, 19.6% (18.6% to 20.6%) in black patients (P<0.001 v white patients, with similar P values in adjusted models), and 16.2% (14.4% to 18.1%) in Hispanic or Latino patients (P=0.53 v white patients, P<0.05 in adjusted models). This result was consistent in SpO2-SaO2 pairs restricted to occur within 5 minutes and 2 minutes. In white patients, an initial SpO2-SaO2 pair with little difference in saturation was associated with a 2.7% (95% confidence interval −0.1% to 5.5%) probability of SaO2 <88% on a later paired SpO2-SaO2 reading showing an SpO2 of 92%, but black patients had a higher probability (12.9% (−3.3% to 29.0%)).ConclusionsIn general care inpatient settings across the Veterans Health Administration where paired readings of arterial blood gas (SaO2) and pulse oximetry (SpO2) were obtained, black patients had higher odds than white patients of having occult hypoxemia noted on arterial blood gas but not detected by pulse oximetry. This difference could limit access to supplemental oxygen and other more intensive support and treatments for black patients.

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Section: Principal Findingsmentioning

confidence: 99%

Racial bias and reproducibility in pulse oximetry among medical and surgical inpatients in general care in the Veterans Health Administration 2013-19: multicenter, retrospective cohort study

Valbuena

Seelye

Sjoding

et al. 2022

BMJ

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“…Workforce diversity increases the quality of medical research and innovation. Recently, teams of diverse scientists uncovered serious biases in foundational clinical algorithms [26], such as the pulse oximetry algorithm to detect hypoxemia [27][28][29] that originated in the omission of dark skinned people in the primary instrument validation studies. The Foundation for Anesthesia Education and Research has called for 'concerted efforts to develop, support, and amplify [the accomplishments of] physician-scientists from underrepresented groups, and for all scientists to partner with affected communities in designing, completing, and disseminating research' [30].…”

Section: Text Of Reviewmentioning

confidence: 99%

Workforce solutions to address health disparities

Mhyre

Jackson

Lucero

et al. 2022

Current Opinion in Anaesthesiology

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Purpose of reviewThis review focuses on physician workforce racial & ethnic diversity as a solution to improve perioperative and peripartum health equity. Recent findingsBlack, Indigenous, and Hispanic physicians remain underrepresented in medicine (URiM) and anesthesiology, and efforts to expand this workforce have had limited impact. Psychological forces, including implicit bias, aversive racism, outgroup bias, racial attention bias, stereotype threat, and imposter syndrome all act to reinforce structural racism and decrease opportunity for advancement. Evidence based solutions are emerging, but require institutional commitment and widespread engagement of the entire medical community.

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“…Recent evidence has highlighted the racial disparity in pulse oximetry measurement,4 5 but its impact on clinical outcome is unknown. This retrospective observational study compared simultaneous paired measurements of SaO 2 (collected through arterial blood gas sampling) with oxygen saturation (SpO 2 ) obtained by pulse oximetry in adults admitted to intensive care unit or undergoing surgery at three hospitals between May 2018 and December 2020 to assess for occult hypoxaemia (SaO 2 <88% with SpO 2 ≥92%).…”

Section: Disparities In Hypoxemia Detection By Pulse Oximetry Across ...mentioning

confidence: 99%

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et al. 2022

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Disparities in Hypoxemia Detection by Pulse Oximetry Across Self-Identified Racial Groups and Associations With Clinical Outcomes*

Abstract: To assess disparities in hypoxemia detection by pulse oximetry across self-identified racial groups and associations with clinical outcomes.

Cited by 87 publications

References 13 publications

Racial bias and reproducibility in pulse oximetry among medical and surgical inpatients in general care in the Veterans Health Administration 2013-19: multicenter, retrospective cohort study

Racial bias and reproducibility in pulse oximetry among medical and surgical inpatients in general care in the Veterans Health Administration 2013-19: multicenter, retrospective cohort study

Workforce solutions to address health disparities

Journal update monthly top five

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