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Cited by 119Non-Invasive Vital Sign MonitoringOptical Imaging and Spectroscopy TechniquesHemodynamic Monitoring and Therapy

A review of the effect of skin pigmentation on pulse oximeter accuracy

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Al-Halawani, Raghda, Charlton, Peter H, Qassem, Meha, Kyriacou, Panayiotis A·2023·Physiological Measurement
DOI 10.1088/1361-6579/acd51aPMC PMC10391744
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Abstract

Objective . Pulse oximetry is a non-invasive optical technique used to measure arterial oxygen saturation (SpO 2 ) in a variety of clinical settings and scenarios. Despite being one the most significant technological advances in health monitoring over the last few decades, there have been reports on its various limitations. Recently due to the Covid-19 pandemic, questions about pulse oximeter technology and its accuracy when used in people with different skin pigmentation have resurfaced, and are to be addressed. Approach . This review presents an introduction to the technique of pulse oximetry including its basic principle of operation, technology, and limitations, with a more in depth focus on skin pigmentation. Relevant literature relating to the performance and accuracy of pulse oximeters in populations with different skin pigmentation are evaluated. Main Results . The majority of the evidence suggests that the accuracy of pulse oximetry differs in subjects of different skin pigmentations to a level that requires particular attention, with decreased accuracy in patients with dark skin. Significance . Some recommendations, both from the literature and contributions from the authors, suggest how future work could address these inaccuracies to potentially improve clinical outcomes. These include the objective quantification of skin pigmentation to replace currently used qualitative methods, and computational modelling for predicting calibration algorithms based on skin colour.

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  • There have been systematic reviews on PPG skin pigmentation bias, but these have been limited to either consumer device PR or pulse oximeter SpO2.

    “There have been systematic reviews on PPG skin pigmentation bias, but these have been limited to either consumer device PR [35] or pulse oximeter SpO2 [36-38].”

    From Impact of skin pigmentation on pulse oximetry blood oxygenation and wearable pulse rate accuracy: systematic review and meta-analysis (2024) · cites this paper as [38]

    The ‘Skin pigmentation as a limitation of pulse oximetry’ section describes a review of studies comparing pulse-oximeter SpO2 with reference SaO2 across skin pigmentation groups, supporting the subject attributed to this source. But the ‘Statistical significance’ section explicitly calls it a narrative review, not a systematic review; the source therefore does not support that classification. (LLM, conf=0.87)

    Experimental — accuracy not yet measured

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Cited by

Sorted by citations

Authors
Al-Halawani, R., Charlton, P. H., Qassem, M., & Kyriacou, P. A.
Affiliations
University of London (GB)
Corresponding author
Al-Halawani, Raghda
ORCID
Venue
Physiological Measurement
Publisher
IOP Publishing
Published
2023-05-01
Volume
44
Issue
5
Pages
05TR01
ISSN
  • 0967-3334 (ISSN-L)
  • 1361-6579
DOI
10.1088/1361-6579/acd51a
PMC
PMC10391744
OpenAlex
W4376272121
Cited by
119
References
18
Citations by year
2026: 34 · 2025: 51 · 2024: 29 · 2023: 5
FWCI
2.67
Type
journal article
Language
en
Open access
Licence
Locations
  • Physiological Measurement (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • City Research Online (City University London) (submittedVersion)
  • Apollo (University of Cambridge) (submittedVersion, cc-by)
Funders
British Heart Foundation (FS/20/20/34626)
Topics
  • Physical Sciences › Engineering › Biomedical Engineering › Non-Invasive Vital Sign Monitoring
  • Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Optical Imaging and Spectroscopy Techniques
  • Health Sciences › Medicine › Surgery › Hemodynamic Monitoring and Therapy
Keywords
pulse oximetry, skin pigmentation, arterial oxygen saturation, measurement accuracy, dark skin, skin colour, calibration algorithm, COVID-19 pandemic
MeSH terms
COVID-19, Humans, Oximetry, Oxygen, Skin Pigmentation, Pandemics

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