The effect of patient ethnicity on the accuracy of peripheral pulse oximetry in patients with COVID-19 pneumonitis: A single-centre, retrospective analysis
Open accessAbstract
Summary Pulse oximetry is used widely to titrate oxygen therapy and for triage in patients who are critically ill. However, there are concerns regarding the accuracy of pulse oximetry in patients with COVID‐19 pneumonitis and in patients who have a greater degree of skin pigmentation. We aimed to determine the impact of patient ethnicity on the accuracy of peripheral pulse oximetry in patients who were critically ill with COVID‐19 pneumonitis by conducting a retrospective observational study comparing paired measurements of arterial oxygen saturation measured by co‐oximetry on arterial blood gas analysis (SaO 2 ) and the corresponding peripheral oxygenation saturation measured by pulse oximetry (S p O 2 ). Bias was calculated as the mean difference between SaO 2 and S p O 2 measurements and limits of agreement were calculated as bias ±1.96 SD. Data from 194 patients (135 White ethnic origin, 34 Asian ethnic origin, 19 Black ethnic origin and 6 other ethnic origin) were analysed consisting of 6216 paired SaO 2 and S p O 2 measurements. Bias (limits of agreement) between SaO 2 and S p O 2 measurements was 0.05% (−2.21–2.30). Patient ethnicity did not alter this to a clinically significant degree: 0.28% (1.79–2.35), −0.33% (−2.47–2.35) and −0.75% (−3.47–1.97) for patients of White, Asian and Black ethnic origin, respectively. In patients with COVID‐19 pneumonitis, S p O 2 measurements showed a level of agreement with SaO 2 values that was in line with previous work, and this was not affected by patient ethnicity.
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Recent studies have shown a positive bias in oxygen saturation measurements in patients with darkly pigmented skin, particularly under low saturation conditions.
“Recent studies have shown a positive bias in oxygen saturation measurements in patients with darkly pigmented skin, particularly under low saturation conditions.”
From Skin pigmentation influence on pulse oximetry accuracy: a systematic review and bibliometric analysis (2022) · cites this paper as [17]
More recent studies have revealed that dark skin pigmentation influences the accuracy and performance of pulse oximeter devices, resulting in overestimations, with increased incidence in the risk for occult hypoxemia (SO2<88% despite normal SpO2>92%).
“More recent studies have also revealed that dark skin pigmentation influences the accuracy and performance of pulse oximeters devices, resulting in overestimations [17,49,50,51,52,53] with increased incidence in the risk for occult hypoxemia (SO2<88% despite normal SpO2>92%) [54,55].”
From Skin pigmentation influence on pulse oximetry accuracy: a systematic review and bibliometric analysis (2022) · cites this paper as [17]
The main reason for the upsurge of publications in 2021 may be attributed to the increase of pulse oximetry for triage in patients because of the COVID-19 pandemic and recent concern about accuracy across all skin types.
“The main reason for this surge may be attributed to the increase of this technique for triage in patients because of the current COVID-19 pandemic [12,13,14,15,16,17], and also because of the recent concern about the accuracy of these devices across all skin types [20,57,58,59,60,61].”
From Skin pigmentation influence on pulse oximetry accuracy: a systematic review and bibliometric analysis (2022) · cites this paper as [17]
Ancestry descriptors were used in 11 studies (29.73%).
“On the other hand, ancestry descriptors were used in 11 studies (29.73%) [17,21,23,24,41,51,53,61,75,82,93]”
From Skin pigmentation influence on pulse oximetry accuracy: a systematic review and bibliometric analysis (2022) · cites this paper as [17]
A study in patients with acute COVID-19 pneumonia found a small bias between arterial blood gas analysis SaO2 and SpO2 measurements of 0.28%, −0.33% and −0.75% for 194 patients of "White" (135), "Asian" (34) and "Black" (19) ethnic origin, respectively.
“Besides, another study was performed in patients with acute COVID-19 pneumonia to find out a relationship between patient ancestry and the accuracy of pulse oximetry found a small bias between arterial blood gas analysis SaO2 and SpO2 measurements of 0.28%, −0.33% and −0.75% for 194 patients of “White” (135), “Asian” (34) and “Black” (19) ethnic origin, respectively, [17].”
From Skin pigmentation influence on pulse oximetry accuracy: a systematic review and bibliometric analysis (2022) · cites this paper as [17]
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- Authors
- Wiles, M. D., El‐Nayal, A., Elton, G., Malaj, M., Winterbottom, J., Gillies, C., Moppett, I. K., & Bauchmuller, K.
- Affiliations
- Sheffield Teaching Hospitals NHS Foundation Trust (GB)
- University of Nottingham (GB)
- Department of Critical Care Sheffield Teaching Hospitals NHS Foundation Trust Sheffield UK
- Corresponding author
- Wiles, M. D.
- Venue
- Anaesthesia
- Publisher
- Wiley
- Published
- 2021-09-20
- Volume
- 77
- Issue
- 2
- Pages
- 143-152
- ISSN
- 0003-2409 (ISSN-L)
- 1365-2044
- PMC
- PMC8653100
- OpenAlex
- W3200483630
- Cited by
- 45
- References
- 13
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 14 · 2023: 8 · 2022: 17 · 2021: 3
- FWCI
- 3.19
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Anaesthesia (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Physical Sciences › Engineering › Biomedical Engineering › Non-Invasive Vital Sign Monitoring
- Health Sciences › Medicine › Infectious Diseases › COVID-19 Clinical Research Studies
- Health Sciences › Medicine › Surgery › Hemodynamic Monitoring and Therapy
- Keywords
- pulse oximetry accuracy, COVID-19 pneumonitis, patient ethnicity, skin pigmentation, arterial oxygen saturation, co-oximetry, arterial blood gases, critically ill patients
- MeSH terms
- COVID-19, SARS-CoV-2, Oxygen Saturation, Critical Care, Ethnicity, Female, Humans, Male, Middle Aged, Oximetry, Oxygen Inhalation Therapy, Retrospective Studies, Reproducibility of Results
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