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Pulse Oximeters may be racially biased

9th Apr 2021
Pulse Oximeters may be racially biased

(Piqsels Creative Commons)

Hamed Chapman

The independent NHS Race and Health Observatory is calling for further action and research following the publication of a new rapid review of the accuracy of Pulse Oximeters that test the level of oxygen in a person’s blood.

Oximeter readings from Black and minority ethnic people could be seriously misleading, particularly during the Covid-19 pandemic, and need further assessment, the observatory of healthcare experts warned.

The research review dating back to 1990 highlights inaccurate and ambiguous readings when factoring those with darker pigmentation and skin tones from a comprehensive stock-take of available research.

Coming at such a pivotal time, Director of the Race and Health Observatory, Habib Naqvi, said that “we cannot afford to overlook this rapid review and the recommendations for action, which can prevent late hospital admissions and help improve the health of black and minority ethnic people at risk or recovering from Covid-19.”
“This review has stressed the need to ensure healthcare equipment and devices are culturally competent and sensitive, whilst not contributing to the array of current and historic health inequalities.”

Analysis from a recent 2020 Michigan University study found Pulse Oximeter readings of blood oxygen levels were three times more likely to be inaccurate among African-American patients, while there has been limited widescale trials in the UK.

Pulse Oximeters test the level of oxygen in a person’s blood by attaching a clip-like device to a person’s finger, toe, or earlobe, sending a beam of light through the body to measure and diagnose lower than normal blood oxygen levels.

Royal Pharmaceutical Society Director for England, Ravi Sharma, said there was ever-growing evidence from vast reputable studies highlighting the inconsistencies of Pulse Oximeters that “cannot be ignored during a pandemic significantly impacting black and minority ethnic people.”

“This review exposes an area of health inequality where one treatment may yield more effective results for one group of patients over another, this is unacceptable and needs to be urgently addressed,” Sharma said.

He suggested that pharmacists and other healthcare professionals who use Pulse Oximeters in their practice or provide them to the public “take ethnicity into account when considering their effectiveness in users.”

The majority of oximeters have been developed based on studies measuring oxygen levels in Caucasian and light-skinned individuals. General terms such as ‘pale’, ‘blotchy skin’ or skin or lips ‘going ‘blue’, do not typically apply to black and darker-skinned minority ethnic people.

Respiratory Consultant at North Bristol NHS Trust Huzaifa Adamali also said the review was “needed and timely,” adding that “oxygen is probably the commonest drug used in the care of patients who present with medical emergencies.

“Oxygen saturation should be checked in all breathless and acutely ill patients. Healthcare professionals are increasingly reliant on the pulse oximeter to detect early deterioration and inform clinical decision-making, including the start of oxygen therapy,” he said.

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