Racial Bias in Pulse Oximetry Measurement Among Patients About to Undergo Extracorporeal Membrane Oxygenation in 2019-2020

The effects of skin pigmentation on the accuracy of pulse oximetry in measuring oxygen saturation: a systematic review and meta-analysis

“…We judged the applicability concern as high for one study,[60] moderate for 13 studies,[33,36,37,40,42,43,47,48,51,56,57,59,62] and low in terms of all three applicability considerations for the remaining 18 studies. Applicability concerns largely resulted from the lack of specifications on pulse oximeters evaluated, CO-oximeter devices used, and/or arterial blood sampling procedures, thus SpO 2 or SaO 2 could not be reproduced.…”

“…Using QUADAS-2, we considered 14/32 studies (43.75%) to be at unclear risk of bias for all four domains or high risk of bias for at least one domain, [34,38,44,47,48,53,54,[56][57][58][59][60][61]63] and the remaining 18 (56.25%) to be at low risk of bias for at least one of the four domains (Figure 2).…”

“…Key limitations in downgrading risk of bias were: (1) for the patient selection domain, where specific sub-populations were inappropriately excluded from a study [61] or there was no explicit exclusion or even inclusion criteria (19 studies); (2) for index test and reference standard domains, where there was no blinding information for either pulse oximetry SpO2 measurements (20 studies) or CO-oximeter SaO2 readings (30 studies); and (3) for the flow and timing domain, where there were sub-optimally long time intervals between SpO2 readings and the arterial blood sampling for SaO2 measurement, [44] or the exclusion of participants (3/25, 12.00%) from study data analysis without rationale. [59] We judged the applicability concern as high for one study, [60] moderate for 13 studies, [33,36,37,40,42,43,47,48,51,56,57,59,62] and low in terms of all three applicability considerations for the remaining 18 studies. Applicability concerns largely resulted from the lack of specifications on pulse oximeters evaluated, CO-oximeter devices used, and/or arterial blood sampling procedures, thus SpO2 or SaO2 could not be reproduced.…”

“…Twenty-two of the 32 studies (4910 participants) described participants by ethnicity rather than level of skin pigmentation [31,33,34,36,38,39,41,[45][46][47][48][49][50][55][56][57][58][59][60][61][62][63] and we included 14 studies (3510 participants) in meta-analyses. [31,33,34,39,[45][46][47]49,50,59,[60][61][62][63].…”

“…Twenty-two of the 32 studies (4910 participants) described participants by ethnicity rather than level of skin pigmentation [31,33,34,36,38,39,41,[45][46][47][48][49][50][55][56][57][58][59][60][61][62][63] and we included 14 studies (3510 participants) in meta-analyses. [31,33,34,39,[45][46][47]49,50,59,[60][61][62][63]. Pooled data are shown in Table 2 (further data are reported in Supporting Information Figures S5-S7 and Table S5).…”