Pulse oximetry bias led to less treatment for non-White COVID patients

A retrospective study yesterday in JAMA Internal Medicine shows that pulse oximetry overestimated arterial oxygen saturation in racial and ethnic minority COVID-19 patients, leading clinicians to believe they weren't ill enough to be eligible for appropriate treatments.A team led by Johns Hopkins University researchers conducted two analyses using data from five referral centers and community hospitals.

They analyzed the oxygen saturation of 1,216 COVID-19 patients monitored by pulse oximetry and arterial blood gas measurement and also assessed 6,673 patients with both pulse oximetry and covariate data.Overestimation in 30% of racial minoritiesOf the 1,216 patients, 41.7% were women, 39.3% were Black, 37.8% were White, 17.7% were Hispanic, and 5.2% were Asian.

Occult low oxygen saturation was identified in 30.2% of Asian, 29.8% of Hispanic, and 28.5% of Black patients, compared with 17.2% of their White peers.Pulse oximetry overestimated oxygen saturation by, on average, 1.7% (95% confidence interval [CI], 0.5% to 3.0%) in Asian, 1.2% (95% CI, 0.6% to 1.9%) in Black, and 1.1% (95% CI, 0.3% to 1.9%) in Hispanic patients.Of the 1,903 patients with predicted oxygen saturation levels of 94% or less before a pulse oximetry measurement of 94% or less or the initiation of supplemental oxygen, Black patients had 29% lower odds (hazard ratio [HR], 0.71; 95% CI, 0.63 to 0.80), and Hispanic patients had 23% lower odds (HR, 0.77; 95% CI, 0.66 to 0.89) of recognition of treatment eligibility relative to their White counterparts.Overall, 23.7% of these patients—54.8% of whom were Black—never received the therapy for which they were eligible.