Several patient specific factors can impact the reliability and accuracy of a pulse oximetry reading. Which patient population is most impacted by this lack of reliability and accuracy?
Patients in racial and ethnic minority groups, particularly Black patients, are most impacted by the unreliability and inaccuracy of pulse oximetry readings. In a recent study in adult patients in Veteran Health Administration medical centers, Black patients (19.6%, 95% CI: 18.6%-20.6%) were more likely than non-Hispanic White patients (15.6%, 95% CI: 15%-16.1%) to have hypoxemia (Sa-O2 <88%) despite a normal pulse oximetry (Sp-O2 at least 92%) in general care settings (p < 0.001, NNH = 25). This study did not find a significant difference in pulse oximetry accuracy or reliability in Hispanic or Latino patients (16.2%, 95% CI: 14.4%-18.1%) compared to White patients (p = 0.53). However, after adjusting for age, male sex, comorbidities, and diagnoses, and allowing for non-linear interactions between race and ethnic origin and pulse oximetry, the authors report a difference of 2.5% (95% CI: 0.04%-5%, p <0.05) between White and Hispanic or Latino patients (NNH = 40).
Additional studies have shown that this difference can exacerbate racial and ethnic disparities in patient care, including delayed or unrecognized eligibility for COVID-19 therapies in Black and Hispanic patients. End-tidal CO2 or Sv-O2 should be monitored more frequently in Black and Hispanic patients, particularly in suspected presence of a xenobiotic that impacts respiratory rate or drive.
Valbuena VSM et al. Racial bias and reproducibility in pulse oximetry among medical and surgical inpatients in general care in the Veterans Health Administration 2013-19: multicenter, retrospective cohort study. BMJ. 2022; 378:e069775. doi:10.1136/bmj-2021-069775
https://www.bmj.com/content/378/bmj-2021-069775
Fawzy A et al. Racial and ethnic discrepancy in pulse oximetry and delayed identification of treatment eligibility among patients with COVID-19. JAMA Intern Med. 2022; 182(7):730–738. doi:10.1001/jamainternmed.2022.1906
https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2792653
Contributed by: Willie Eggleston, PharmD