Abstract
Arterial blood oxygen saturation measured by pulse oximetry (SpO2) may be differentially less accurate for people with darker skin pigmentation, which could potentially affect COVID-19 treatment course. We analyzed pulse oximeter accuracy and association with COVID-19 treatment outcomes using electronic health record (EHR) data from Sutter Health, a large, mixed-payer, integrated healthcare delivery system in northern California, United States (US). We analyzed two cohorts: (1) 43,753 concurrent arterial blood gas (ABG) oxygen saturation (SaO2)/SpO2 measurement pairs taken January 2020-February 2021 for Non-Hispanic white (NHW) or Non-Hispanic Black/African American (NHB) adults, and (2) 8,735 adults who went to the emergency department (ED) with COVID-19 July 2020-February 2021. Pulse oximetry systematically overestimated blood oxygenation by 1% more in NHB individuals than in NHW individuals. For people with COVID-19, this was associated with lower admission probability (-3.1 percentage-points), dexamethasone treatment (-3.1 percentage-points), and supplemental oxygen treatment (-4.5 percentage-points), as well as increased time-to-treatment: +37.2 minutes before dexamethasone initiation and +278.5 minutes before initiation of supplemental oxygen. These results call for additional investigation of pulse oximeters, and suggest that current guidelines for development, testing, and calibration of these devices should be revisited, investigated, and revised.
Keywords: health equity, real-world data, electronic health record, blood oxygenation, coronavirus, arterial blood gas
Contributor Information
Sylvia E K Sudat, Institute for Advancing Health Equity, Sutter Health, Sacramento, California, United States; Center for Health Systems Research, Sutter Health, Walnut Creek, California, United States.
Paul Wesson, Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, United States.
Kim F Rhoads, School of Medicine, University of California San Francisco, San Francisco, California, United States; Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California, United States.
Stephanie Brown, Institute for Advancing Health Equity, Sutter Health, Sacramento, California, United States; Alta Bates Summit Medical Center, Oakland, California, United States; Berkeley Emergency Medical Group, San Ramon, California, United States.
Noha Aboelata, Roots Community Health Center, Oakland, California, United States; Stanford University School of Medicine, Stanford, California, United States.
Alice R Pressman, Institute for Advancing Health Equity, Sutter Health, Sacramento, California, United States; Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, United States.
Aravind Mani, California Pacific Medical Center, San Francisco, California, United States; Pacific Inpatient Medical Group, San Francisco, California, United States.
Kristen M J Azar, Institute for Advancing Health Equity, Sutter Health, Sacramento, California, United States; Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, United States; Center for Health Systems Research, Sutter Health, Palo Alto, California, United States.
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