Impact of ethnicity on the accuracy of measurements of oxygen saturations: A retrospective observational cohort study
Summary: Background: Pulse oximeters are routinely used in community and hospital settings worldwide as a rapid, non-invasive, and readily available bedside tool to approximate blood oxygenation. Potential racial biases in peripheral oxygen saturation (SpO2) measurements may influence the accuracy...
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| Format: | Article |
| Language: | English |
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Elsevier
2022-06-01
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| Series: | EClinicalMedicine |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2589537022001584 |
| _version_ | 1811237509675352064 |
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| author | Mansoor N. Bangash James Hodson Felicity Evison Jaimin M. Patel Andrew McD Johnston Suzy Gallier Elizabeth Sapey Dhruv Parekh |
| author_facet | Mansoor N. Bangash James Hodson Felicity Evison Jaimin M. Patel Andrew McD Johnston Suzy Gallier Elizabeth Sapey Dhruv Parekh |
| author_sort | Mansoor N. Bangash |
| collection | DOAJ |
| description | Summary: Background: Pulse oximeters are routinely used in community and hospital settings worldwide as a rapid, non-invasive, and readily available bedside tool to approximate blood oxygenation. Potential racial biases in peripheral oxygen saturation (SpO2) measurements may influence the accuracy of pulse oximetry readings and impact clinical decision making. We aimed to assess whether the accuracy of oxygen saturation measured by SpO2, relative to arterial blood gas (SaO2), varies by ethnicity. Methods: In this large retrospective observational cohort study covering four NHS Hospitals serving a large urban population in Birmingham, United Kingdom, consecutive pairs of SpO2 and SaO2 measurements taken on the same patient within an interval of less than 20 min were identified from electronic patient records. Where multiple pairs of measurements were recorded in a spell, only the first was included in the analysis. The differences between SpO2 and SaO2 measurements were compared across groups of self-identified ethnicity. These differences were subsequently adjusted for age, sex, bilirubin, systolic blood pressure, carboxyhaemaglobin saturations and the time interval between SpO2 and SaO2 measurements. Findings: Paired O2 saturation measurements from 16,818 inpatient spells between 1st January 2017 and 18th February 2021 were analysed. The cohort self-identified as being of White (81.2%), Asian (11.7%), Black (4.0%), or Other (3.2%) ethnicities. Across the cohort, SpO2 was statistically significantly higher than SaO2 (p < 0.0001), with medians of 98% (interquartile range [IQR]: 95–100%) vs. 97% (IQR: 96–99%), and a median difference of 0.5% points (pps; 95% confidence interval [CI]: 0.5–0.6). However, the size of this difference varied considerably with the magnitude of SaO2, with SpO2 overestimating by a median by 3.8pp (IQR: 0.4, 8.8) for SaO2 values <90% but underestimating by a median of 0.4pp (IQR: -2.0, 1.4) for an SaO2 of 95%. The differences between SpO2 and SaO2 were also found to vary by ethnicity, with this difference being 0.8pp (95% CI: 0.6–1.0, p < 0.0001) greater in those of Black vs. White ethnicity. These differences resulted in 8.7% vs. 6.1% of Black vs. White patients who were classified as normoxic on SpO2 actually being hypoxic on the gold standard SaO2 (odds ratio: 1.47, 95% CI: 1.09–1.98, p = 0.012). Interpretation: Pulse oximetry may overestimate O2 saturation, and this is possibly more pronounced in patients of Black ethnicity. Prospective studies are urgently warranted to assess the impact of ethnicity on the accuracy of pulse oximetry, to ensure care is optimised for all. Funding: PIONEER, the Health Data Research UK (HDR-UK) Health Data Research Hub in acute care. |
| first_indexed | 2024-04-12T12:24:44Z |
| format | Article |
| id | doaj.art-b09210f5ee98420c9673b8bcd884784d |
| institution | Directory Open Access Journal |
| issn | 2589-5370 |
| language | English |
| last_indexed | 2024-04-12T12:24:44Z |
| publishDate | 2022-06-01 |
| publisher | Elsevier |
| record_format | Article |
| series | EClinicalMedicine |
| spelling | doaj.art-b09210f5ee98420c9673b8bcd884784d2022-12-22T03:33:12ZengElsevierEClinicalMedicine2589-53702022-06-0148101428Impact of ethnicity on the accuracy of measurements of oxygen saturations: A retrospective observational cohort studyMansoor N. Bangash0James Hodson1Felicity Evison2Jaimin M. Patel3Andrew McD Johnston4Suzy Gallier5Elizabeth Sapey6Dhruv Parekh7Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, New Queen Elizabeth Hospital, University of Birmingham, 1st Floor, Mindelsohn Way, Birmingham B15 2WB, United Kingdom; Department of Critical Care, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United KingdomDepartment of Health Informatics, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom; PIONEER: Health Data Research UK (HDRUK) Health Data Research Hub for Acute Care, United KingdomDepartment of Health Informatics, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom; PIONEER: Health Data Research UK (HDRUK) Health Data Research Hub for Acute Care, United KingdomBirmingham Acute Care Research Group, Institute of Inflammation and Ageing, New Queen Elizabeth Hospital, University of Birmingham, 1st Floor, Mindelsohn Way, Birmingham B15 2WB, United Kingdom; Department of Critical Care, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United KingdomBirmingham Acute Care Research Group, Institute of Inflammation and Ageing, New Queen Elizabeth Hospital, University of Birmingham, 1st Floor, Mindelsohn Way, Birmingham B15 2WB, United Kingdom; Department of Critical Care, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Department of Acute Medicine Acute Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United KingdomDepartment of Health Informatics, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom; PIONEER: Health Data Research UK (HDRUK) Health Data Research Hub for Acute Care, United KingdomBirmingham Acute Care Research Group, Institute of Inflammation and Ageing, New Queen Elizabeth Hospital, University of Birmingham, 1st Floor, Mindelsohn Way, Birmingham B15 2WB, United Kingdom; PIONEER: Health Data Research UK (HDRUK) Health Data Research Hub for Acute Care, United Kingdom; Department of Acute Medicine Acute Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United KingdomBirmingham Acute Care Research Group, Institute of Inflammation and Ageing, New Queen Elizabeth Hospital, University of Birmingham, 1st Floor, Mindelsohn Way, Birmingham B15 2WB, United Kingdom; Department of Critical Care, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Corresponding author at: Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, New Queen Elizabeth Hospital, University of Birmingham, 1st Floor, Mindelsohn Way, Birmingham B15 2WB, United Kingdom.Summary: Background: Pulse oximeters are routinely used in community and hospital settings worldwide as a rapid, non-invasive, and readily available bedside tool to approximate blood oxygenation. Potential racial biases in peripheral oxygen saturation (SpO2) measurements may influence the accuracy of pulse oximetry readings and impact clinical decision making. We aimed to assess whether the accuracy of oxygen saturation measured by SpO2, relative to arterial blood gas (SaO2), varies by ethnicity. Methods: In this large retrospective observational cohort study covering four NHS Hospitals serving a large urban population in Birmingham, United Kingdom, consecutive pairs of SpO2 and SaO2 measurements taken on the same patient within an interval of less than 20 min were identified from electronic patient records. Where multiple pairs of measurements were recorded in a spell, only the first was included in the analysis. The differences between SpO2 and SaO2 measurements were compared across groups of self-identified ethnicity. These differences were subsequently adjusted for age, sex, bilirubin, systolic blood pressure, carboxyhaemaglobin saturations and the time interval between SpO2 and SaO2 measurements. Findings: Paired O2 saturation measurements from 16,818 inpatient spells between 1st January 2017 and 18th February 2021 were analysed. The cohort self-identified as being of White (81.2%), Asian (11.7%), Black (4.0%), or Other (3.2%) ethnicities. Across the cohort, SpO2 was statistically significantly higher than SaO2 (p < 0.0001), with medians of 98% (interquartile range [IQR]: 95–100%) vs. 97% (IQR: 96–99%), and a median difference of 0.5% points (pps; 95% confidence interval [CI]: 0.5–0.6). However, the size of this difference varied considerably with the magnitude of SaO2, with SpO2 overestimating by a median by 3.8pp (IQR: 0.4, 8.8) for SaO2 values <90% but underestimating by a median of 0.4pp (IQR: -2.0, 1.4) for an SaO2 of 95%. The differences between SpO2 and SaO2 were also found to vary by ethnicity, with this difference being 0.8pp (95% CI: 0.6–1.0, p < 0.0001) greater in those of Black vs. White ethnicity. These differences resulted in 8.7% vs. 6.1% of Black vs. White patients who were classified as normoxic on SpO2 actually being hypoxic on the gold standard SaO2 (odds ratio: 1.47, 95% CI: 1.09–1.98, p = 0.012). Interpretation: Pulse oximetry may overestimate O2 saturation, and this is possibly more pronounced in patients of Black ethnicity. Prospective studies are urgently warranted to assess the impact of ethnicity on the accuracy of pulse oximetry, to ensure care is optimised for all. Funding: PIONEER, the Health Data Research UK (HDR-UK) Health Data Research Hub in acute care.http://www.sciencedirect.com/science/article/pii/S2589537022001584InequalitiesEthnicityOxygen saturations |
| spellingShingle | Mansoor N. Bangash James Hodson Felicity Evison Jaimin M. Patel Andrew McD Johnston Suzy Gallier Elizabeth Sapey Dhruv Parekh Impact of ethnicity on the accuracy of measurements of oxygen saturations: A retrospective observational cohort study EClinicalMedicine Inequalities Ethnicity Oxygen saturations |
| title | Impact of ethnicity on the accuracy of measurements of oxygen saturations: A retrospective observational cohort study |
| title_full | Impact of ethnicity on the accuracy of measurements of oxygen saturations: A retrospective observational cohort study |
| title_fullStr | Impact of ethnicity on the accuracy of measurements of oxygen saturations: A retrospective observational cohort study |
| title_full_unstemmed | Impact of ethnicity on the accuracy of measurements of oxygen saturations: A retrospective observational cohort study |
| title_short | Impact of ethnicity on the accuracy of measurements of oxygen saturations: A retrospective observational cohort study |
| title_sort | impact of ethnicity on the accuracy of measurements of oxygen saturations a retrospective observational cohort study |
| topic | Inequalities Ethnicity Oxygen saturations |
| url | http://www.sciencedirect.com/science/article/pii/S2589537022001584 |
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