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Differential Pulse Oximeter Accuracy, Occult Hypoxemia Prevalence, and Clinical Outcomes by Patient Race/Ethnicity: A Systematic Review

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 Differential Pulse Oximeter Accuracy, Occult Hypoxemia Prevalence, and Clinical Outcomes by Patient Race/Ethnicity: A Systematic Review

Recommended citation:
Parr NJ, Beech EH, Young S. Differential Pulse Oximeter Accuracy, Occult Hypoxemia Prevalence, and Clinical Outcomes by Patient Race/Ethnicity: A Systematic Review. Washington, DC: Evidence Synthesis Program, Health Services Research and Development Service, Office of Research and Development, Department of Veterans Affairs. VA ESP Project #09-199; 2023.



Download PDF: Complete Report, Executive Summary, Report, Appendices

Takeaway

Pulse oximeters likely overestimate Black or African American patients' blood oxygen saturation level, and occult hypoxemia is likely more common among Black or African American patients compared with White patients. Asian, Latino or Hispanic, Native American or Indigenous, or other or mixed race/ethnicity patients may also experience occult hypoxemia more frequently than White patients.

Context

Pulse oximeters are used in many clinical and home care settings, largely because they provide a rapid and noninvasive means of assessing oxygen saturation. Despite this utility, differences in pulse oximeter accuracy by patient race/ethnicity have been observed in clinical settings for several decades. The COVID-19 pandemic has heightened concern that pulse oximeters may routinely be less accurate in patients with darker skin pigmentation, in turn increasing risk of occult hypoxemia and poorer clinical outcomes.

Key Findings

Pulse oximeters likely overestimate Black or African American patients' blood oxygen saturation level, though recent studies in contemporary hospital and health system settings suggest modern pulse oximeters possess some degree of bias and considerable imprecision regardless of patient race/ethnicity. Occult hypoxemia is likely more common among Black or African American patients compared with White patients, and Asian, Latino or Hispanic, Native American or Indigenous, or other or mixed race/ethnicity patients may also experience occult hypoxemia more frequently than White patients. Evidence is insufficient to draw conclusions about clinical outcomes attributable to race/ethnicity biases in occult hypoxemia, but there does appear to be some signal that Black or African American patients with undetected hypoxemia could experience poorer treatment delivery and clinical outcomes compared with White patients with undetected hypoxemia. Although changes to clinical practice to accommodate bias and imprecision in pulse oximeters may help to reduce risk of occult hypoxemia and mitigate harms in the near-term, advancements in noninvasive oximeter technology are needed.

See also

Differential Pulse Oximeter Accuracy, Occult Hypoxemia Prevalence, and Clinical Outcomes by Patient Race/Ethnicity: A Systematic Review (Management Briefs)

Parr NJ, Beech EH, Young S, Valley TS. Racial and Ethnic Disparities in Occult Hypoxemia Prevalence and Clinical Outcomes Among Hospitalized Patients: A Systematic Review and Meta-Analysis. Journal of General Internal Medicine. 2024. DOI: https://doi.org/10.1007/s11606-024-08852-1.


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