Racial Disparities Uncovered in Pediatric Pulse Oximetry Readings

March 23, 2023 - In determining the accuracy associated with pulse oximetry readings for children, Black patients were found to be more likely to receive false indications of hypoxemia or lack thereof, according to new research published in JAMA Network Open.

According to the National Cancer Institute (NCI), hypoxemia is a condition that results from a lack of sufficient oxygen levels in the blood.

Researchers who conducted the study described that, in the past, various efforts using EHR data had gathered information indicating that pulse oximetry devices may overestimate blood oxygen levels in Black patients battling hypoxemia.

Inaccurate readings could then impact treatment, as the medical device would lead clinicians to conclude that these patients do not need treatment, they noted.

In the study, researchers aimed to compare arterial blood oxygen saturation and pulse oximetry values among Black and White pediatric patients. They used data from a pediatric cardiac catheterization laboratory in which pulse oximetry values are within one minute of arterial blood oxygen saturation measurements. This duration is critical because most previous EHR-based studies used pulse oximetry values collected within 10 minutes of arterial blood oxygen saturation measurements.

The study included 774 patients from the Children’s Hospital of Philadelphia, all of whom were between 1 and 17 years old. Of the total study population, 26 percent were Black or African American, 74 percent were White, 43 percent were female, and all had undergone a cardiac catheterization between 2016 and 2021.

Among those with true hypoxemia, 12 percent of Black patients had peripheral oxygen saturation levels indicating normoxemia or a healthy amount of oxygen in the blood. In comparison, only 4 percent of White patients experienced this type of false negative.

Among those with peripheral oxygen saturation levels that indicated normoxemia, 5 percent of Black patients had true hypoxemia, higher than the 1 percent of White patients who experienced the same.

These results led researchers to conclude that pulse oximetry overestimated arterial oxygen saturation in Black children. This was likely caused by the light absorption properties of melanin, as Black or African American patients have darker skin with higher melanin levels compared to White patients, they hypothesized.

Thus, research must evaluate the relationship between blood oxygen saturation and pulse oximetry with more advanced measurements of skin pigmentation, the researchers stated.

Racial disparities due to poor pulse oximeter readings are not unprecedented and can lead to inadequate treatment.

Research from July 2022 indicated that many Asian, Black, and Hispanic patients received an incorrect amount of supplemental oxygen due to poor pulse oximeter performance.

Researchers conducted a retrospective cohort study that included data for 3,069 patients, 83 of whom were Asian, 207 were Black, 112 were Hispanic, and 2,667 were White.

They found that patients belonging to a minority race often had higher pulse oximetry levels, which led to them receiving less supplemental oxygen.