Skin color and ear oximetry
Abstract
Measurements of arterial blood oxygen saturation from two ear oximeters were compared with 655 simultaneously drawn arterial blood samples in 187 patients grouped by skin color quantified by the Munsell color system. Technical problems including warning lights and messages with the two ear oximeters were recorded. There were significantly more technical problems in patients with the darkest skin color associated with inability to obtain a reading or warning message indicating poor tissue penetration of the signal (18 and 15 percent vs 1 percent). When readings could be obtained, the ear oximetry readings were found to be slightly less accurate in the darker patient groups. These findings suggest that dark skin color may affect the performance and accuracy of ear oximeters, including the newer type of pulse oximeters.
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Inaccurate PPG heart rate measurements occur up to 15% more frequently in dark skin than in light skin.
“previous research demonstrated that inaccurate PPG HR measurements occur up to 15% more frequently in dark skin as compared to light skin”
From Investigating sources of inaccuracy in wearable optical heart rate sensors (2020) · cites this paper as [27]
Darker skin contains more melanin, which absorbs more green light than lighter skin.
“likely because darker skin contains more melanin which absorbs more green light than lighter skin.”
From Investigating sources of inaccuracy in wearable optical heart rate sensors (2020) · cites this paper as [27]
Darker skin pigmentation may influence PPG-based SpO2 and PR readings.
“Notably, darker skin pigmentation may influence PPG-based SpO2 and PR readings [7-10].”
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 [7]
Objective scales such as the Fitzpatrick Skin Pigmentation (FSP) scale or the Munsell scale were used by 6/37 studies (16.21%) and 4/37 studies (10.81%), respectively.
“We find that objective scales such as the Fitzpatrick Skin Pigmentation (FSP) scale or the Munsell scale were used by 6/37 studies (16.21%) [61,69,70,71,76,77] and 4/37 studies (10.81%) [47,48,74,89], respectively.”
From Skin pigmentation influence on pulse oximetry accuracy: a systematic review and bibliometric analysis (2022) · cites this paper as [89]
Another study in 187 pulmonary patients undergoing a stress test reported technical problems in patients with slightly less accurate readings.
“Besides, another study in 187 pulmonary patients undergoing a stress test reported technical problems in patients with slightly less accurate readings [89].”
From Skin pigmentation influence on pulse oximetry accuracy: a systematic review and bibliometric analysis (2022) · cites this paper as [89]
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- Authors
- Ries, A. L., Prewitt, L. M., & Johnson, J. J.
- Affiliations
- University of California San Diego (US)
- Corresponding author
- Ries, Andrew L.
- ORCID
- Ries, Andrew L.
- Venue
- Chest
- Publisher
- Elsevier BV
- Published
- 1989-08
- Volume
- 96
- Issue
- 2
- Pages
- 287-290
- ISSN
- 0012-3692 (ISSN-L)
- OpenAlex
- W1966473319
- Cited by
- 145
- References
- 10
- Citations by year
- 2026: 6 · 2025: 8 · 2024: 13 · 2023: 7 · 2022: 37 · 2021: 7 · 2020: 6 · 2019: 1 · 2018: 2 · 2017: 1 · 2016: 3 · 2015: 1 · 2014: 1 · 2013: 1 · 2012: 1
- FWCI
- 6.00
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- CHEST Journal (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Center for Research Resources (RR00827)
- Topics
- Physical Sciences › Engineering › Biomedical Engineering › Non-Invasive Vital Sign Monitoring
- Health Sciences › Medicine › Surgery › Hemodynamic Monitoring and Therapy
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Optical Imaging and Spectroscopy Techniques
- Keywords
- ear oximetry, skin color, dark skin pigmentation, arterial oxygen saturation, pulse oximetry, Munsell color system, measurement accuracy, technical errors
- MeSH terms
- Blood Gas Monitoring, Transcutaneous, Ear, External, Exercise Test, Humans, Lung Diseases, Prospective Studies, Skin Pigmentation
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