tetano
Editor, Senior Moderator
Am J Epidemiol
. 2022 Sep 29;kwac164.
doi: 10.1093/aje/kwac164. Online ahead of print.
Racial Disparities in Pulse Oximeter Device Inaccuracy and Estimated Clinical Impact on COVID-19 Treatment Course
Sylvia E K Sudat[SUP] 1 2 [/SUP], Paul Wesson[SUP] 3 [/SUP], Kim F Rhoads[SUP] 4 5 [/SUP], Stephanie Brown[SUP] 1 6 7 [/SUP], Noha Aboelata[SUP] 8 9 [/SUP], Alice R Pressman[SUP] 1 3 [/SUP], Aravind Mani[SUP] 10 11 [/SUP], Kristen M J Azar[SUP] 1 3 12 [/SUP]
Affiliations
Abstract
Arterial blood oxygen saturation measured by pulse oximetry (SpO2) may be differentially less accurate for people with darker skin pigmentation, which could potentially affect COVID-19 treatment course. We analyzed pulse oximeter accuracy and association with COVID-19 treatment outcomes using electronic health record (EHR) data from Sutter Health, a large, mixed-payer, integrated healthcare delivery system in northern California, United States (US). We analyzed two cohorts: (1) 43,753 concurrent arterial blood gas (ABG) oxygen saturation (SaO2)/SpO2 measurement pairs taken January 2020-February 2021 for Non-Hispanic white (NHW) or Non-Hispanic Black/African American (NHB) adults, and (2) 8,735 adults who went to the emergency department (ED) with COVID-19 July 2020-February 2021. Pulse oximetry systematically overestimated blood oxygenation by 1% more in NHB individuals than in NHW individuals. For people with COVID-19, this was associated with lower admission probability (-3.1 percentage-points), dexamethasone treatment (-3.1 percentage-points), and supplemental oxygen treatment (-4.5 percentage-points), as well as increased time-to-treatment: +37.2 minutes before dexamethasone initiation and +278.5 minutes before initiation of supplemental oxygen. These results call for additional investigation of pulse oximeters, and suggest that current guidelines for development, testing, and calibration of these devices should be revisited, investigated, and revised.
Keywords: arterial blood gas; blood oxygenation; coronavirus; electronic health record; health equity; real-world data.
. 2022 Sep 29;kwac164.
doi: 10.1093/aje/kwac164. Online ahead of print.
Racial Disparities in Pulse Oximeter Device Inaccuracy and Estimated Clinical Impact on COVID-19 Treatment Course
Sylvia E K Sudat[SUP] 1 2 [/SUP], Paul Wesson[SUP] 3 [/SUP], Kim F Rhoads[SUP] 4 5 [/SUP], Stephanie Brown[SUP] 1 6 7 [/SUP], Noha Aboelata[SUP] 8 9 [/SUP], Alice R Pressman[SUP] 1 3 [/SUP], Aravind Mani[SUP] 10 11 [/SUP], Kristen M J Azar[SUP] 1 3 12 [/SUP]
Affiliations
- PMID: 36173743
- DOI: 10.1093/aje/kwac164
Abstract
Arterial blood oxygen saturation measured by pulse oximetry (SpO2) may be differentially less accurate for people with darker skin pigmentation, which could potentially affect COVID-19 treatment course. We analyzed pulse oximeter accuracy and association with COVID-19 treatment outcomes using electronic health record (EHR) data from Sutter Health, a large, mixed-payer, integrated healthcare delivery system in northern California, United States (US). We analyzed two cohorts: (1) 43,753 concurrent arterial blood gas (ABG) oxygen saturation (SaO2)/SpO2 measurement pairs taken January 2020-February 2021 for Non-Hispanic white (NHW) or Non-Hispanic Black/African American (NHB) adults, and (2) 8,735 adults who went to the emergency department (ED) with COVID-19 July 2020-February 2021. Pulse oximetry systematically overestimated blood oxygenation by 1% more in NHB individuals than in NHW individuals. For people with COVID-19, this was associated with lower admission probability (-3.1 percentage-points), dexamethasone treatment (-3.1 percentage-points), and supplemental oxygen treatment (-4.5 percentage-points), as well as increased time-to-treatment: +37.2 minutes before dexamethasone initiation and +278.5 minutes before initiation of supplemental oxygen. These results call for additional investigation of pulse oximeters, and suggest that current guidelines for development, testing, and calibration of these devices should be revisited, investigated, and revised.
Keywords: arterial blood gas; blood oxygenation; coronavirus; electronic health record; health equity; real-world data.