Racial bias and reproducibility in pulse oximetry among medical and surgical inpatients in general care in the Veterans Health Administration 2013-19: multicenter, retrospective cohort study

OBJECTIVES: To evaluate measurement discrepancies by race between pulse oximetry and arterial oxygen saturation (as measured in arterial blood gas) among inpatients not in intensive care. DESIGN: Multicenter, retrospective cohort study using electronic medical records from general care medical and s...

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Autores principales: Valbuena, Valeria S M, Seelye, Sarah, Sjoding, Michael W, Valley, Thomas S, Dickson, Robert P, Gay, Steven E, Claar, Dru, Prescott, Hallie C, Iwashyna, Theodore J
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group Ltd. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9254870/
https://www.ncbi.nlm.nih.gov/pubmed/35793817
http://dx.doi.org/10.1136/bmj-2021-069775
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author Valbuena, Valeria S M
Seelye, Sarah
Sjoding, Michael W
Valley, Thomas S
Dickson, Robert P
Gay, Steven E
Claar, Dru
Prescott, Hallie C
Iwashyna, Theodore J
author_facet Valbuena, Valeria S M
Seelye, Sarah
Sjoding, Michael W
Valley, Thomas S
Dickson, Robert P
Gay, Steven E
Claar, Dru
Prescott, Hallie C
Iwashyna, Theodore J
author_sort Valbuena, Valeria S M
collection PubMed
description OBJECTIVES: To evaluate measurement discrepancies by race between pulse oximetry and arterial oxygen saturation (as measured in arterial blood gas) among inpatients not in intensive care. DESIGN: Multicenter, retrospective cohort study using electronic medical records from general care medical and surgical inpatients. SETTING: Veteran Health Administration, a national and racially diverse integrated health system in the United States, from 2013 to 2019. PARTICIPANTS: Adult inpatients in general care (medical and surgical), in Veteran Health Administration medical centers. MAIN OUTCOMES MEASURES: Occult hypoxemia (defined as arterial blood oxygen saturation (SaO(2)) of <88% despite a pulse oximetry (SpO(2)) reading of ≥92%), and whether rates of occult hypoxemia varied by race and ethnic origin. RESULTS: A total of 30 039 pairs of SpO(2)-SaO(2) readings made within 10 minutes of each other were identified during the study. These pairs were predominantly among non-Hispanic white (21 918 (73.0%)) patients; non-Hispanic black patients and Hispanic or Latino patients accounted for 6498 (21.6%) and 1623 (5.4%) pairs in the sample, respectively. Among SpO(2) values greater or equal to 92%, unadjusted probabilities of occult hypoxemia were 15.6% (95% confidence interval 15.0% to 16.1%) in white patients, 19.6% (18.6% to 20.6%) in black patients (P<0.001 v white patients, with similar P values in adjusted models), and 16.2% (14.4% to 18.1%) in Hispanic or Latino patients (P=0.53 v white patients, P<0.05 in adjusted models). This result was consistent in SpO(2)-SaO(2) pairs restricted to occur within 5 minutes and 2 minutes. In white patients, an initial SpO(2)-SaO(2) pair with little difference in saturation was associated with a 2.7% (95% confidence interval −0.1% to 5.5%) probability of SaO(2) <88% on a later paired SpO(2)-SaO(2) reading showing an SpO(2) of 92%, but black patients had a higher probability (12.9% (−3.3% to 29.0%)). CONCLUSIONS: In general care inpatient settings across the Veterans Health Administration where paired readings of arterial blood gas (SaO(2)) and pulse oximetry (SpO(2)) were obtained, black patients had higher odds than white patients of having occult hypoxemia noted on arterial blood gas but not detected by pulse oximetry. This difference could limit access to supplemental oxygen and other more intensive support and treatments for black patients.
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spelling pubmed-92548702022-07-20 Racial bias and reproducibility in pulse oximetry among medical and surgical inpatients in general care in the Veterans Health Administration 2013-19: multicenter, retrospective cohort study Valbuena, Valeria S M Seelye, Sarah Sjoding, Michael W Valley, Thomas S Dickson, Robert P Gay, Steven E Claar, Dru Prescott, Hallie C Iwashyna, Theodore J BMJ Research OBJECTIVES: To evaluate measurement discrepancies by race between pulse oximetry and arterial oxygen saturation (as measured in arterial blood gas) among inpatients not in intensive care. DESIGN: Multicenter, retrospective cohort study using electronic medical records from general care medical and surgical inpatients. SETTING: Veteran Health Administration, a national and racially diverse integrated health system in the United States, from 2013 to 2019. PARTICIPANTS: Adult inpatients in general care (medical and surgical), in Veteran Health Administration medical centers. MAIN OUTCOMES MEASURES: Occult hypoxemia (defined as arterial blood oxygen saturation (SaO(2)) of <88% despite a pulse oximetry (SpO(2)) reading of ≥92%), and whether rates of occult hypoxemia varied by race and ethnic origin. RESULTS: A total of 30 039 pairs of SpO(2)-SaO(2) readings made within 10 minutes of each other were identified during the study. These pairs were predominantly among non-Hispanic white (21 918 (73.0%)) patients; non-Hispanic black patients and Hispanic or Latino patients accounted for 6498 (21.6%) and 1623 (5.4%) pairs in the sample, respectively. Among SpO(2) values greater or equal to 92%, unadjusted probabilities of occult hypoxemia were 15.6% (95% confidence interval 15.0% to 16.1%) in white patients, 19.6% (18.6% to 20.6%) in black patients (P<0.001 v white patients, with similar P values in adjusted models), and 16.2% (14.4% to 18.1%) in Hispanic or Latino patients (P=0.53 v white patients, P<0.05 in adjusted models). This result was consistent in SpO(2)-SaO(2) pairs restricted to occur within 5 minutes and 2 minutes. In white patients, an initial SpO(2)-SaO(2) pair with little difference in saturation was associated with a 2.7% (95% confidence interval −0.1% to 5.5%) probability of SaO(2) <88% on a later paired SpO(2)-SaO(2) reading showing an SpO(2) of 92%, but black patients had a higher probability (12.9% (−3.3% to 29.0%)). CONCLUSIONS: In general care inpatient settings across the Veterans Health Administration where paired readings of arterial blood gas (SaO(2)) and pulse oximetry (SpO(2)) were obtained, black patients had higher odds than white patients of having occult hypoxemia noted on arterial blood gas but not detected by pulse oximetry. This difference could limit access to supplemental oxygen and other more intensive support and treatments for black patients. BMJ Publishing Group Ltd. 2022-07-06 /pmc/articles/PMC9254870/ /pubmed/35793817 http://dx.doi.org/10.1136/bmj-2021-069775 Text en © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY. No commercial re-use. See rights and permissions. Published by BMJ. https://creativecommons.org/licenses/by/4.0/This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Research
Valbuena, Valeria S M
Seelye, Sarah
Sjoding, Michael W
Valley, Thomas S
Dickson, Robert P
Gay, Steven E
Claar, Dru
Prescott, Hallie C
Iwashyna, Theodore J
Racial bias and reproducibility in pulse oximetry among medical and surgical inpatients in general care in the Veterans Health Administration 2013-19: multicenter, retrospective cohort study
title Racial bias and reproducibility in pulse oximetry among medical and surgical inpatients in general care in the Veterans Health Administration 2013-19: multicenter, retrospective cohort study
title_full Racial bias and reproducibility in pulse oximetry among medical and surgical inpatients in general care in the Veterans Health Administration 2013-19: multicenter, retrospective cohort study
title_fullStr Racial bias and reproducibility in pulse oximetry among medical and surgical inpatients in general care in the Veterans Health Administration 2013-19: multicenter, retrospective cohort study
title_full_unstemmed Racial bias and reproducibility in pulse oximetry among medical and surgical inpatients in general care in the Veterans Health Administration 2013-19: multicenter, retrospective cohort study
title_short Racial bias and reproducibility in pulse oximetry among medical and surgical inpatients in general care in the Veterans Health Administration 2013-19: multicenter, retrospective cohort study
title_sort racial bias and reproducibility in pulse oximetry among medical and surgical inpatients in general care in the veterans health administration 2013-19: multicenter, retrospective cohort study
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9254870/
https://www.ncbi.nlm.nih.gov/pubmed/35793817
http://dx.doi.org/10.1136/bmj-2021-069775
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