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The potential for unnecessary medical interventions due to inaccurate pulse oximetry measurements

Published:September 30, 2022DOI:https://doi.org/10.1016/j.hrtlng.2022.09.016
      In a recent study, Fawzy and colleagues describe discrepancies in pulse oximetry readings secondary to race and ethnicity.
      • Fawzy A.
      • Wu T.D.
      • Wang K.
      • et al.
      Racial and ethnic discrepancy in pulse oximetry and delayed identification of treatment eligibility among patients with COVID-19.
      The authors highlight their findings from a retrospective cohort analysis showing greater occult hypoxemia in Asian, Black, and non-Black Hispanic patients, presumably secondary to skin pigmentation, which has been reported previously.
      • Jubran A.
      Pulse oximetry.
      • Sjoding M.W.
      • Dickson R.P.
      • Iwashyna T.J.
      • Gay S.E.
      • Valley T.S.
      Racial bias in pulse oximetry measurement [published correction appears in N Engl J Med. 2021 Dec 23;385(26):2496].
      • Wong A.I.
      • Charpignon M.
      • Kim H.
      • et al.
      Analysis of discrepancies between pulse oximetry and arterial oxygen saturation measurements by race and ethnicity and association with organ dysfunction and mortality [published correction appears in JAMA Netw Open. 2022 Feb 1;5(2):e221210].
      However, while the authors briefly acknowledge that pulse oximetry may inaccurately estimate arterial blood oxygen saturation levels for physiologic, pathologic, technical, and iatrogenic reasons, the contribution of these potential variables was not assessed in the study. Furthermore, while important for diversity, equity, and inclusion studies, the use of self-identified race and ethnicity as a surrogate for skin pigmentation may not accurately represent actual skin type, as it does not provide information regarding the degree of pigmentation; thus, self-reporting may inaccurately estimate the contribution of pigmentation to interference in medical devices. A more effective analysis would be formal assessment and classification of individual skin type to ensure accurate conclusions regarding the effect of pigmentation and any possible interference. Skin classification systems are used to phototype skin based on its response to sun/ultraviolet light exposure.
      • Gupta V.
      • Sharma V.K.
      Skin typing: fitzpatrick grading and others.
      Various skin classification schemes exist, including the Fitzpatrick classification system, which is generally considered to be the gold standard and the most widely accepted, though other systems and modifications have been utilized.
      • Gupta V.
      • Sharma V.K.
      Skin typing: fitzpatrick grading and others.
      ,
      • Roberts W.E.
      Skin type classification systems old and new.
      Regardless of the specific system, incorporating a more objective skin classification versus self-reporting is a critical element to the methodology for this type of study.

      Keywords

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      1. US Food & Drug Administration. Pulse oximeter accuracy and limitations: fda safety communication. https://www.fda.gov/medical-devices/safety-communications/pulse-oximeter-accuracy-and-limitations-fda-safety-communication. Published June 21, 2022. Accessed July 12, 2022.