In a recent study, Fawzy and colleagues describe discrepancies in pulse oximetry readings
secondary to race and ethnicity.
1
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.
2
,
3
,
4
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.
- 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].
JAMA Netw Open. 2021; 4e2131674https://doi.org/10.1001/jamanetworkopen.2021.31674
5
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.
5
,6
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.- Roberts W.E.
Skin type classification systems old and new.
Dermatol Clin. 2009; 27 (529-viii)https://doi.org/10.1016/j.det.2009.08.006
Keywords
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References
- Racial and ethnic discrepancy in pulse oximetry and delayed identification of treatment eligibility among patients with COVID-19.JAMA Intern Med. 2022; 182: 730-738https://doi.org/10.1001/jamainternmed.2022.1906
- Pulse oximetry.Crit Care. 2015; 19: 272https://doi.org/10.1186/s13054-015-0984-8
- Racial bias in pulse oximetry measurement [published correction appears in N Engl J Med. 2021 Dec 23;385(26):2496].N Engl J Med. 2020; 383: 2477-2478https://doi.org/10.1056/NEJMc2029240
- 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].JAMA Netw Open. 2021; 4e2131674https://doi.org/10.1001/jamanetworkopen.2021.31674
- Skin typing: fitzpatrick grading and others.Clin Dermatol. 2019; 37: 430-436https://doi.org/10.1016/j.clindermatol.2019.07.010
- Skin type classification systems old and new.Dermatol Clin. 2009; 27 (529-viii)https://doi.org/10.1016/j.det.2009.08.006
- Effects of skin pigmentation on pulse oximeter accuracy at low saturation.Anesthesiology. 2005; 102: 715-719https://doi.org/10.1097/00000542-200504000-00004
- The accuracy of pulse oximetry in measuring oxygen saturation by levels of skin pigmentation: a systematic review and meta-analysis.BMC Med. 2022; 20 (Published 2022 Aug 16): 267https://doi.org/10.1186/s12916-022-02452-8
- The effect of patient ethnicity on the accuracy of peripheral pulse oximetry in patients with COVID-19 pneumonitis: a single-centre, retrospective analysis.Anaesthesia. 2022; 77: 143-152https://doi.org/10.1111/anae.15581
- 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].JAMA Netw Open. 2021; 4 (Published 2021 Nov 1)e2131674https://doi.org/10.1001/jamanetworkopen.2021.31674
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.
Article info
Publication history
Published online: September 30, 2022
Accepted:
September 24,
2022
Received in revised form:
September 22,
2022
Received:
August 22,
2022
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
