Inaccurate pulse oximeter readings may have led to less supplemental oxygen for darker-skinned ICU patients

Inaccurate pulse oximeter readings tied to less supplemental oxygen for darker-skinned ICU patients The new research adds to the evidence that the faulty pulse oximeter readings in darker-skinned patients can affect their care and may be a factor in racial disparities. Usha Lee McFarling STAT

atients with darker skin who received less accurate readings of their oxygen levels using pulse oximeters — the ubiquitous devices clamped on hospitalized patients’ fingers — also received less supplemental oxygen during ICU stays, according to a study published Monday.

The new research in the journal JAMA Internal Medicine adds to the evidence that the faulty readings in darker-skinned patients can affect their care and may be one factor explaining racial disparities, such as higher rates of limb loss and death for Black and Hispanic ICU patients.

Meanwhile, a different study published last week in the BMJ suggests that imperfect readings from pulse oximeters may impact care of Black patients broadly, not merely those who are critically ill. An analysis of medical records of tens of thousands of general and surgical patients in Veterans Health Administration medical centers showed that Black patients were more likely than white patients to have hidden hypoxia — undetected low oxygen levels linked to higher rates of death and organ failure.

Both studies were conducted using databases of hospital patient data collected through 2019, meaning neither study involved Covid-19 patients. It’s been known for decades that the devices are less accurate in patients with darker skin and those wearing nail polish, but new interest and a stream of research about potential racial bias in the devices has been sparked by the racial disparities seen in Covid deaths and treatment. The measurement of oxygen levels using the devices has played a critical role in determining which Covid patients are admitted to the hospital and given supplemental oxygen and other therapies. The devices, invented in the 1970s, were tested on largely white populations.

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