The pulse oximeter is a ubiquitous clinical tool used to estimate blood oxygen concentrations. However, decreased accuracy of pulse oximetry in patients with dark skin tones has been demonstrated since as early as 1985.
Most commonly, pulse oximeters may overestimate the true oxygen saturation in individuals with dark skin tones, leading to higher rates of occult hypoxemia (i.e., clinically unrecognized low blood oxygen saturation). Overestimation of oxygen saturation in patients with dark skin tones has serious clinical implications, as these patients may receive insufficiently rigorous medical care when pulse oximeter measurements suggest that their oxygen saturation is higher than the true value.
Recent studies have linked pulse oximeter inaccuracy to worse clinical outcomes, suggesting that pulse oximeter inaccuracy contributes to known racial health disparities. The magnitude of device inaccuracy varies by pulse oximeter manufacturer, sensor type, and arterial oxygen saturation. The underlying reasons for decreased pulse oximeter accuracy for individuals with dark skin tones may be related to failure to control for increased absorption of red light by melanin during device development and insufficient inclusion of individuals with dark skin tones during device calibration.
Inadequate regulatory standards for device approval may also play a role in decreased accuracy. Awareness of potential pulse oximeter limitations is an important step for providers and may encourage the consideration of additional clinical information for management decisions. Ultimately, stricter regulatory requirements for oximeter approval and increased manufacturer transparency regarding device performance are required to mitigate this racial bias.
Pulmonologists, critical care specialists, translational researchers, and clinicians
After reading this journal article, learners will be able to:
- Recognize that race may be inadequate as a proxy for skin tone in pulse oximetry validation studies.
- List types of validation data that are important for demonstrating the accuracy of pulse oximeters.
- Obtain additional data when caring for a patient with dark skin whose SpO2 is close to a cutoff point that changes management according to clinical guidelines.
1.00 AMA PRA Category 1 Credit
Credit Expires: December 05, 2024
The American Thoracic Society is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
|Credit Type||Credit/Points||Credit Designation Statement|
|AMA PRA Category 1 Credit™||1.00||The American Thoracic Society designates this Journal for a maximum of 1.00 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.|
Article Authorship Disclosures (as submitted to the ATS prior to article publication date)
Haya Jamali, M.D., Ph.D. (Massachusetts General Hospital, Boston, MA, USA) reported no relevant financial relationships.
Lauren T. Castillo, B.S.N., R.N. (VA Puget Sound Health Care System, Seattle, WA, USA) reported no relevant financial relationships.
Chelsea Cosby Morgan, M.D. (Veterans Affairs Bay Pines Health Care System, Bay Pines, FL, USA) reported no relevant financial relationships.
Jason Coult, Ph.D. (University of Washington, Seattle, WA, USA) reported no relevant financial relationships.
Janice L. Muhammad, M.S., B.S.N., R.N., C.N.M. (VA Puget Sound Health Care System, Seattle, WA, USA) reported no relevant financial relationships.
Oyinkansola O. Osobamiro, M.D. (University of Washington, Seattle, WA, USA) reported no relevant financial relationships.
Elizabeth C. Parsons, M.D. (VA Puget Sound Health Care System, Seattle, WA, USA) reported no relevant financial relationships.
Rosemary Adamson, M.B., B.S. (VA Puget Sound Health Care System, Seattle, WA, USA) reported no relevant financial relationships.
Off-Label Usage Disclosure
Disclosures of AnnalsATS CME Planners
The Annals of the American Thoracic Society (AnnalsATS) original research, commentaries, reviews, and educational content of interest to clinicians and clinical investigators in pediatric and adult pulmonary and sleep medicine and medical critical care. The scope of the journal encompasses content that is applicable to clinical practice, the formative and continuing education of clinical specialists, and the advancement of public health.
The publication of articles that meet these goals by itself is only one step in a multi-step process for the translation of evidence-based improvements in are to clinical practice. Testing for CME credit is designed to function as a next step in the process. This is accomplished through a series of questions written by the author(s) to test that readers have the tools needed to translate recommendations for diagnostic and therapeutic clinical care into clinical practice. Members of the AnnalsATS editorial board review these questions and edit these questions for clarity, educational content, and the quality of the evidence supporting the response to the question.
AnnalsATS CME Planners
Silpa Krefft, M.D., M.P.H. (Chair)
Video Editor, AnnalsATS
Dr. Krefft reported payments for medicolegal consulting on the evaluation of exposure–related lung disease and from Oakstone Medical Reviews (podcast reviews of published articles).
Bernie Sunwoo, M.B. B.S.
Section Editor, AnnalsATS
Dr. Sunwoo reported no relevant financial relationships with ineligible companies.
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