Pulse oximeter measurements vary across ethnic groups: an observational study in patients with COVID-19
Open accessAbstract
Be aware that pulse oximeters overestimate oxygen saturation measurements in patients with hypoxaemia, and that this error is larger in individuals from black and Asian ethnic groupshttps://bit.ly/3fCeJP7
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In sensitivity analyses without the outlier study of Crooks et al, all pooled Arms values dropped, resulting in inaccurate pulse oximeter SpO2 only for dark skin pigmentation and no group exceeding international thresholds.
“Additionally, in the sensitivity analyses without the outlier study of Crooks et al [48], all pooled Arms values dropped, resulting in inaccurate pulse oximeter SpO2 only for dark skin pigmentation and no group exceeding international thresholds.”
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 [48]
Sensitivity analyses for pulse oximetry SpO2 were performed by removing Crooks et al [48] as an outlier due to substantially large standard error.
“Sensitivity analyses were performed for pulse oximetry SpO2 by removing Crooks et al [48] as an outlier due to substantially large SE (Tables S6 and S7 in Multimedia Appendix 1).”
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 [48]
Pulse oximetry consistently overestimated oxygen saturation, and this overestimation was particularly significant for darker skin.
“It showed that PO, which is used to measure oxygen saturation in the blood, consistently overestimated oxygen levels, and this was particularly significant for darker skin.”
From Effect of skin color on optical properties and the implications for medical optical technologies: a review (2024) · cites this paper as [11]
Black and ethnic minority groups had poorest outcomes from COVID-19 infection and this was compounded by the overestimation of oxygen saturation.
“Black and ethnic minority groups had poorest outcomes from COVID-19 infection and this was compounded by the overestimation of oxygen saturation.11,134”
From Effect of skin color on optical properties and the implications for medical optical technologies: a review (2024) · cites this paper as [11]
Skin pigmentation affects the accuracy of PO.
“A recent flurry in publications identifies that skin pigmentation affects the accuracy of PO.11,134–140”
From Effect of skin color on optical properties and the implications for medical optical technologies: a review (2024) · cites this paper as [11]
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Cites
Updated Guidance on the Reporting of Race and Ethnicity in Medical and Science Journals
Flanagin, A., Frey, T., Christiansen, S. L., & AMA Manual of Style Committee (2021) · JAMA · doi:10.1001/jama.2021.13304 · Cited by 1,615 · cited 1× · see citing works
“Due to the small numbers of individuals labelled as Black, Asian and Mixed ethnic group, a final comparison of these combined categories was compared with the much larger White ethnic group for a final analysis to generate a simple output that can be disseminated to increase clinical awareness of these issues, while c…”
ResultRacial bias in pulse oximetry measurement
Sjoding, M. W., Dickson, R. P., Iwashyna, T. J., Gay, S. E., & Valley, T. S. (2020) · New England Journal of Medicine · doi:10.1056/nejmc2029240 · Cited by 1,114 · see citing works
Ethnicity and clinical outcomes in COVID-19: A systematic review and meta-analysis
Sze, S., Pan, D., Nevill, C. R., Gray, L. J., Martin, C., Nazareth, J., Minhas, J. S., Divall, P., Khunti, K., Abrams, K. R., et al. (2020) · EClinicalMedicine · doi:10.1016/j.eclinm.2020.100630 · Cited by 621 · see citing works
Jubran, A. (2015) · Critical Care · doi:10.1186/s13054-015-0984-8 · Cited by 511 · see citing works
Effects of skin pigmentation on pulse oximeter accuracy at low saturation
Bickler, P. E., Feiner, J. R., & Severinghaus, J. W. (2005) · Anesthesiology · doi:10.1097/00000542-200504000-00004 · Cited by 427 · see citing works
Jubran, A., & Tobin, M. J. (1990) · Chest · doi:10.1378/chest.97.6.1420 · Cited by 296 · see citing works
Crooks, C. J., West, J., Fogarty, A., Morling, J. R., Grainge, M. J., Gonem, S., Simmonds, M., Race, A., Juurlink, I., Briggs, S., et al. (2022) · American Journal of Epidemiology · doi:10.1093/aje/kwac126 · Cited by 13 · see citing works
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Fawzy, A., Wu, T. D., Wang, K., Robinson, M. L., Farha, J., Bradke, A., Golden, S. H., Xu, Y., & Garibaldi, B. T. (2022) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2022.1906 · Cited by 326 · see citing works
Setchfield, K., Gorman, A., Simpson, A. H. R. W., Somekh, M. G., & Wright, A. J. (2024) · Journal of Biomedical Optics · doi:10.1117/1.jbo.29.1.010901 · Cited by 72 · see citing works
Setchfield, K., Gorman, A., Simpson, A. H. R. W., Somekh, M. G., & Wright, A. J. (2023) · Biomedical Optics Express · doi:10.1364/boe.493588 · Cited by 49 · see citing works
Singh, S., Bennett, M. R., Chen, C., Shin, S., Ghanbari, H., & Nelson, B. W. (2024) · Journal of Medical Internet Research · doi:10.2196/62769 · Cited by 36 · see citing works
“Sensitivity analyses were performed for pulse oximetry SpO 2 by removing Crooks et al [48] as an outlier due to substantially large SE (Tables S6 and S7 in Multimedia Appendix 1).”
Influential
- Authors
- Crooks, C. J., West, J., Morling, J. R., Simmonds, M., Juurlink, I., Briggs, S., Cruickshank, S., Hammond-Pears, S., Shaw, D., Card, T. R., & Fogarty, A. W.
- Affiliations
- Nottingham University Hospitals NHS Trust (GB)
- Corresponding author
- Fogarty, Andrew W.
- ORCID
- Venue
- European Respiratory Journal
- Publisher
- European Respiratory Society (ERS)
- Published
- 2022-01-27
- Volume
- 59
- Issue
- 4
- Pages
- 2103246
- ISSN
- 0903-1936 (ISSN-L)
- 1399-3003
- PMC
- PMC8796692
- OpenAlex
- W4210472445
- Cited by
- 68
- References
- 7
- Citations by year
- 2026: 7 · 2025: 10 · 2024: 18 · 2023: 20 · 2022: 12
- FWCI
- 4.36
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- European Respiratory Journal (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Repository@Nottingham (University of Nottingham) (submittedVersion, cc-by-nc)
- Funders
- University of Nottingham
- Nottingham University Hospitals NHS Trust
- Topics
- Physical Sciences › Engineering › Biomedical Engineering › Non-Invasive Vital Sign Monitoring
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Chronic Obstructive Pulmonary Disease (COPD) Research
- Health Sciences › Medicine › Infectious Diseases › COVID-19 Clinical Research Studies
- Keywords
- pulse oximetry, hypoxemia, ethnic differences, COVID-19 pandemic
- MeSH terms
- COVID-19, Ethnicity, Humans, Oximetry, Oxygen
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