Impact of ethnicity on the accuracy of measurements of oxygen saturations: A retrospective observational cohort study.
Impact of ethnicity on the accuracy of measurements of oxygen saturations: A retrospective observational cohort study.
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DOI：
10.1016/j.eclinm.2022.101428
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发表时间：
2022-06
影响因子：
15.1
通讯作者：
中科院分区：
文献类型：
--
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脉搏血氧仪作为一种快速、无创且随时可用的床边工具，广泛用于世界各地的社区和医院环境中，以估算血氧含量。外周血氧饱和度（SpO 2）测量中的潜在种族偏倚可能会影响脉搏血氧饱和度读数的准确性，并影响临床决策。我们旨在评估通过SpO 2测量的血氧饱和度相对于动脉血气（SaO 2）的准确性是否因种族而异。在这项大型回顾性观察性队列研究中，涵盖了为英国伯明翰的大量城市人口提供服务的四家NHS医院，从电子患者记录中识别出同一患者在不到20分钟的间隔内进行的连续成对SpO 2和SaO 2测量。当一个咒语中记录了多对测量值时，只有第一对被包括在分析中。在自我认定的种族组之间比较SpO 2和SaO 2测量值之间的差异。随后根据年龄、性别、胆红素、收缩压、一氧化碳血红蛋白饱和度以及SpO 2和SaO 2测量之间的时间间隔对这些差异进行了调整。分析了2017年1月1日至2021年2月18日期间16，818例住院患者的成对O2饱和度测量值。队列自我认定为白色（81.2%）、亚洲（11.7%）、黑人（4.0%）或其他（3.2%）种族。在整个队列中，SpO 2在统计学上显著高于SaO 2（p < 0.0001），中位数为98%（四分位距[IQR]：95-100%）vs. 97%（IQR：96-99%），中位数差异为0.5%（pps; 95%置信区间[CI]：0.5-0.6）。然而，这种差异的大小随SaO 2的大小而变化很大，当SaO 2值<90%时，SpO 2高估中位数3.8pp（IQR：0.4，8.8），但当SaO 2为95%时，低估中位数0.4pp（IQR：-2.0，1.4）。SpO 2和SaO 2之间的差异也因种族而异，黑人与白色种族之间的差异为0.8 pp（95% CI：0.6-1.0，p < 0.0001）。这些差异导致8.7%的黑人患者与6.1%的白色患者在SpO 2时被归类为正常氧含量，而在金标准SaO 2时实际上是缺氧（比值比：1.47，95% CI：1.09-1.98，p = 0.012）。脉搏血氧饱和度可能高估O2饱和度，这在黑人患者中可能更明显。迫切需要进行前瞻性研究，以评估种族对脉搏血氧仪准确性的影响，以确保所有人的护理都得到优化。PIONEER是英国健康数据研究中心（HDR-UK）的健康数据研究中心。
Pulse oximeters are routinely used in community and hospital settings worldwide as a rapid, non-invasive, and readily available bedside tool to approximate blood oxygenation. Potential racial biases in peripheral oxygen saturation (SpO2) measurements may influence the accuracy of pulse oximetry readings and impact clinical decision making. We aimed to assess whether the accuracy of oxygen saturation measured by SpO2, relative to arterial blood gas (SaO2), varies by ethnicity. In this large retrospective observational cohort study covering four NHS Hospitals serving a large urban population in Birmingham, United Kingdom, consecutive pairs of SpO2 and SaO2 measurements taken on the same patient within an interval of less than 20 min were identified from electronic patient records. Where multiple pairs of measurements were recorded in a spell, only the first was included in the analysis. The differences between SpO2 and SaO2 measurements were compared across groups of self-identified ethnicity. These differences were subsequently adjusted for age, sex, bilirubin, systolic blood pressure, carboxyhaemaglobin saturations and the time interval between SpO2 and SaO2 measurements. Paired O2 saturation measurements from 16,818 inpatient spells between 1st January 2017 and 18th February 2021 were analysed. The cohort self-identified as being of White (81.2%), Asian (11.7%), Black (4.0%), or Other (3.2%) ethnicities. Across the cohort, SpO2 was statistically significantly higher than SaO2 (p < 0.0001), with medians of 98% (interquartile range [IQR]: 95–100%) vs. 97% (IQR: 96–99%), and a median difference of 0.5% points (pps; 95% confidence interval [CI]: 0.5–0.6). However, the size of this difference varied considerably with the magnitude of SaO2, with SpO2 overestimating by a median by 3.8pp (IQR: 0.4, 8.8) for SaO2 values <90% but underestimating by a median of 0.4pp (IQR: -2.0, 1.4) for an SaO2 of 95%. The differences between SpO2 and SaO2 were also found to vary by ethnicity, with this difference being 0.8pp (95% CI: 0.6–1.0, p < 0.0001) greater in those of Black vs. White ethnicity. These differences resulted in 8.7% vs. 6.1% of Black vs. White patients who were classified as normoxic on SpO2 actually being hypoxic on the gold standard SaO2 (odds ratio: 1.47, 95% CI: 1.09–1.98, p = 0.012). Pulse oximetry may overestimate O2 saturation, and this is possibly more pronounced in patients of Black ethnicity. Prospective studies are urgently warranted to assess the impact of ethnicity on the accuracy of pulse oximetry, to ensure care is optimised for all. PIONEER, the Health Data Research UK (HDR-UK) Health Data Research Hub in acute care.
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影响因子：
4.1
作者：
Gallier S;Price G;Pandya H;McCarmack G;James C;Ruane B;Forty L;Crosby BL;Atkin C;Evans R;Dunn KW;Marston E;Crawford C;Levermore M;Modhwadia S;Attwood J;Perks S;Doal R;Gkoutos G;Dormer R;Rosser A;Fanning H;Sapey E
通讯作者：
Sapey E
影响因子：
8.8
作者：
Bickler, PE;Feiner, JR;Severinghaus, JW
通讯作者：
Severinghaus, JW
影响因子：
4.1
作者：
Soltan MA;Varney J;Sutton B;Melville CR;Lugg ST;Parekh D;Carroll W;Dosanjh DP;Thickett DR
通讯作者：
Thickett DR
影响因子：
6.5
作者：
Hinkelbein, Jochen;Koehler, Heike;Fiedler, Fritz
通讯作者：
Fiedler, Fritz
DOI：
10.1056/nejmp2028243
发表时间：
2021-02-04
期刊：
The New England journal of medicine
影响因子：
--
作者：
Diao JA;Inker LA;Levey AS;Tighiouart H;Powe NR;Manrai AK
通讯作者：
Manrai AK