Utility of skin tone on pulse oximetry in critically ill patients: a prospective cohort study.
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2024-02-27
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IMPORTANCE: Pulse oximetry, a ubiquitous vital sign in modern medicine, has inequitable accuracy that disproportionately affects Black and Hispanic patients, with associated increases in mortality, organ dysfunction, and oxygen therapy. Although the root cause of these clinical performance discrepancies is believed to be skin tone, previous retrospective studies used self-reported race or ethnicity as a surrogate for skin tone. OBJECTIVE: To determine the utility of objectively measured skin tone in explaining pulse oximetry discrepancies. DESIGN SETTING AND PARTICIPANTS: Admitted hospital patients at Duke University Hospital were eligible for this prospective cohort study if they had pulse oximetry recorded up to 5 minutes prior to arterial blood gas (ABG) measurements. Skin tone was measured across sixteen body locations using administered visual scales (Fitzpatrick Skin Type, Monk Skin Tone, and Von Luschan), reflectance colorimetry (Delfin SkinColorCatch [L*, individual typology angle {ITA}, Melanin Index {MI}]), and reflectance spectrophotometry (Konica Minolta CM-700D [L*], Variable Spectro 1 [L*]). MAIN OUTCOMES AND MEASURES: Mean directional bias, variability of bias, and accuracy root mean square (ARMS), comparing pulse oximetry and ABG measurements. Linear mixed-effects models were fitted to estimate mean directional bias while accounting for clinical confounders. RESULTS: 128 patients (57 Black, 56 White) with 521 ABG-pulse oximetry pairs were recruited, none with hidden hypoxemia. Skin tone data was prospectively collected using 6 measurement methods, generating 8 measurements. The collected skin tone measurements were shown to yield differences among each other and overlap with self-reported racial groups, suggesting that skin tone could potentially provide information beyond self-reported race. Among the eight skin tone measurements in this study, and compared to self-reported race, the Monk Scale had the best relationship with differences in pulse oximetry bias (point estimate: -2.40%; 95% CI: -4.32%, -0.48%; p=0.01) when comparing patients with lighter and dark skin tones. CONCLUSIONS AND RELEVANCE: We found clinical performance differences in pulse oximetry, especially in darker skin tones. Additional studies are needed to determine the relative contributions of skin tone measures and other potential factors on pulse oximetry discrepancies.
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Hao, Sicheng, Katelyn Dempsey, João Matos, Christopher E Cox, Veronica Rotemberg, Judy W Gichoya, Warren Kibbe, Chuan Hong, et al. (2024). Utility of skin tone on pulse oximetry in critically ill patients: a prospective cohort study. medRxiv. 10.1101/2024.02.24.24303291 Retrieved from https://hdl.handle.net/10161/30414.
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Christopher Ethan Cox
My work is conducted as a clinician, researcher, teacher, and administrator at Duke University. Currently, I am an Associate Professor of Medicine, the director of Duke’s Medical Intensive Care Unit (MICU), and the Director of the Duke Program to Support People and Enhance Recovery (ProSPER). My clinical work is based in ICUs at Duke University, though I am also a board-certified palliative medicine specialist.
My research focuses on understanding and improving the experience of critical illness and quality of care for patients, their families and loved ones, clinicians, and society in general. To do this, my work addresses topics and methodologies including health services research, behavioral and psychological concerns, communication improvement, technological development, and decision making support—all in the context of critical care and palliative medicine. My extensive training in clinical and health services research methodology and healthcare information technology allows me to do this.
Key interests: Critical care, healthcare information technology, health administration and policy, decision making, health economics, mechanical ventilation, palliative care, chronic critical illness / prolonged mechanical ventilation, critical care echocardiography
Warren Alden Kibbe
Warren A. Kibbe, PhD, is chief for Translational Biomedical Informatics in the Department of Biostatistics and Bioinformatics and Chief Data Officer for the Duke Cancer Institute. He joined the Duke University School of Medicine in August after serving as the acting deputy director of the National Cancer Institute (NCI) and director of the NCI’s Center for Biomedical Informatics and Information Technology where he oversaw 60 federal employees and more than 600 contractors, and served as an acting Deputy Director for NCI. As an acting Deputy Director, Dr. Kibbe was involved in the myriad of activities that NCI oversees as a research organization, as a convening body for cancer research, and as a major funder of cancer research, funding nearly $4B US annually in cancer research throughout the United States.
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