Differential pulse oximetry readings between ethnic groups and delayed transfer to intensive care units

Crooks, Colin J; West, Joe; Morling, Joanne R; Simmonds, Mark; Juurlink, Irene; Briggs, Steve; Cruickshank, Simon; Hammond-Pears, Susan; Shaw, Dominick; Card, Timothy R; Fogarty, Andrew W

Abstract

Summary Background Pulse oximeters are widely used to monitor blood oxygen saturations, although concerns exist that they are less accurate in individuals with pigmented skin. Aims This study aimed to determine if patients with pigmented skin were more severely unwell at the period of transfer to intensive care units than individuals with White skin. Methods Using data from a large teaching hospital, measures of clinical severity at the time of transfer of patients with Covid-19 infection to intensive care units were assessed, and how this varied by ethnic group. Results Data were available on 748 adults. Median pulse oximetry demonstrated similar oxygen saturations at the time of transfer to intensive care units (Kruskal Wallis test, p = 0.51), although median oxygen saturation measurements from arterial blood gases at this time demonstrated lower oxygen saturations in patients classified as Indian/Pakistani ethnicity (91.6%) and Black/Mixed ethnicity (93.0%), compared to those classified as a White ethnicity (94.4%, Kruskal Wallis test, p = 0.005). There were significant differences in mean respiratory rates in these patients (p < 0.0001), ranging from 26 breaths/minute in individuals with White ethnicity to 30 breaths/minute for those classified as Indian/Pakistani ethnicity and 31 for those who were classified as Black/Mixed ethnicity. Conclusions These data are consistent with the hypothesis that differential measurement error for pulse oximeter readings negatively impact on the escalation of clinical care in individuals from other than White ethnic groups. This has implications for healthcare in Africa and South-East Asia, and may contribute to differences in health outcomes across ethnic groups globally.

Citation

Crooks, C. J., West, J., Morling, J. R., Simmonds, M., Juurlink, I., Briggs, S., …Fogarty, A. W. (2023). Differential pulse oximetry readings between ethnic groups and delayed transfer to intensive care units. QJM: An International Journal of Medicine, 116(1), 63-67. https://doi.org/10.1093/qjmed/hcac218

• Journal Article Type: Article
• Acceptance Date: Sep 1, 2022
• Online Publication Date: Sep 6, 2022
• Publication Date: 2023-01
• Deposit Date: Sep 16, 2022
• Publicly Available Date: Sep 7, 2023
• Journal: QJM: An International Journal of Medicine
• Print ISSN: 1460-2725
• Electronic ISSN: 1460-2393
• Publisher: Oxford University Press (OUP)
• Peer Reviewed: Peer Reviewed
• Volume: 116
• Issue: 1
• Pages: 63-67
• DOI: https://doi.org/10.1093/qjmed/hcac218
• Keywords: General Medicine
• Public URL: https://nottingham-repository.worktribe.com/output/11199415
• Publisher URL: https://academic.oup.com/qjmed/advance-article-abstract/doi/10.1093/qjmed/hcac218/6692791?redirectedFrom=fulltext&login=false