According to a retrospective cohort study, overestimation of oxygen saturation by pulse oximetry resulted in a delay in COVID-19 treatment and an unrecognized need for treatment in black patients.
Among more than 24,000 patients with simultaneous measurements of pulse oximeter saturation (SpO2) and arterial oxygen saturation (SaO2), those with an unidentified need for COVID treatment in the first place were 10% less likely to receive treatment (adjusted HR 0. 90, 95% CI 0. 83-0. 97), regardless of race (P = 0. 45 for interaction), Tianshi David Wu, MD, MHS, of Baylor College of Medicine in Houston, and co-authors reported.
These patients also had higher risks of readmission (adjusted OR 2. 41, 95% CI 1. 39-4. 18), and race also influenced play (P = 0. 14 for interaction), they reported in JAMA Network Open.
However, in a subset of 8,635 patients who did not have an immediate need for COVID treatment, black patients were particularly more likely to have pulse oximetry values that did not imply a need for COVID treatment compared to white patients (adjusted OR 1. 65, 95% CI 1. 33-2. 03).
“Taken together, these findings provide a complementary picture of the effect of pulse oximeter inaccuracy on clinical decision-making and patient outcomes,” the authors wrote.
“Variability in pulse oximeter accuracy has been reported in the past, and its effect on patients of all races underscores the multifactorial nature of pulse oximeter accuracy, which extends beyond skin pigmentation,” they noted.
A study earlier this year also showed that pulse oximetry made SaO2 more expensive in black children versus white children.
It should be noted that in this study, patients who had an initially unidentified need for COVID treatment based on a pulse oximetry error obtained treatment after an average time of 7. 3 hours, compared to 6. 5 hours for those whose need for treatment was immediately identified.
“Although this inaccuracy was more likely to occur in black patients, white and black patients who had this inaccuracy experienced similar delays in receiving COVID-19 medications,” Wu told MedPage Today in an email. “This suggests that racial bias in pulse oximeter accuracy is a key factor in treatment differences between white and black patients in our data. “
“Clinically, our findings emphasize once again that clinicians deserve the ‘cut-off’ values reported through the pulse oximeter and do not articulate vital medical decisions about such numbers,” he added.
William Padula, PhD, of the University of Southern California in Los Angeles, told MedPage Today that while pulse oximeters would likely have worked well in some previous trials, patient samples might not have been as representative of existing populations.
“I think what we’ve learned as a society, specifically when we prioritize fitness equity over other fitness priorities and service delivery, is that the number of patients sampled when calibrating those pulse oximeters are not from underrepresented minority groups, especially in this case. , darker-skinned people,” he said.
These findings “show, through fitness outcomes resulting from a generation of fitness that has proven effective in clinical trials, that once you put it into the genuine global realm and expose it to the variability of genuine patient populations, you see that it doesn’t serve everyone as well,” he continued.
Padula encouraged the use of diagnostic equipment to ensure accurate diagnosis and more equitable care.
“I say sensory generation is amazing, it has made healthcare more efficient. It ensures that we provide the right care to the right patient more regularly,” he said, noting, however, that “health systems want to allocate more resources to ensure that in addition to generation, other knowledge issues are collected for all other people with a disease of serious concern, such as COVID-19.
For this study, Wu and colleagues used insights from HCA Healthcare and Academy for Research Generation’s COVID-19 Consortium on 24,504 hospitalized COVID patients in 186 acute care facilities in the United States with at least one functional measure of SaO2 from March 2020 through October 2021.
The median age was 63. 9%, 41. 9% female, 41. 4% White, 32. 2% Hispanic, 16% Black, and 10. 4% were Asian, American Indian or Alaska Native, Hawaiian, Pacific Islander, or other race or ethnicity. On average, patients on racial and ethnic minority teams were younger than white patients.
SaO2 overestimated by pulse oximetry in black and Hispanic patients, as well as those of other racial identities, compared to white patients:
The researchers stated that other factors, such as hospital staff, availability of cures and practice patterns, may also have affected the time to treatment delivery. The exclusion of patients receiving oxygen treatment because of breathlessness, a possible deviation from rules set by providers, and the use of self-reported race and ethnicity as a replacement for actual skin tone, which would likely vary, would likely have also limited the study’s conclusions, they said.
Elizabeth Short is editor of MedPage Today and covers pulmonology, allergy and immunology. Follow
This study is supported by HCA Healthcare through the COVID-19 Consortium of HCA Healthcare and Academy for Research Generation, Johns Hopkins InHealth (the Johns Hopkins Precision Medicine Initiative), and the John Templeton Foundation.
Wu supported through a grant from the National Heart, Lung, and Blood Institute and the Department of Veterans Affairs, the Veterans Health Administration, the Office of Research and Development, and the Center for Quality, Efficiency, and Safety Innovations.
Co-authors reported relationships with HCA Healthcare, the National Heart, Lung, and Blood Institute, Novalung, Getinge/Maquet, ExThera, Altrazeal, Fresenius, MC3, Janssen Development, Gilead Life Sciences, Atea Pharmaceuticals, the FDA, and the Society for Primary Care Medicine.
Padula reported any conflicts of interest.