Authors:
, , , , , , , , , , , , , , , , , and
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-
1.
GBD 2017 Lower Respiratory Infections Collaborators , 2020. Quantifying risks and interventions that have affected the burden of lower respiratory infections among children younger than 5 years: An analysis for the Global Burden of Disease Study 2017. Lancet Infect Dis 20: 60–79.
-
2.
Lazzerini M , Sonego M , Pellegrin MC , 2015. Hypoxaemia as a mortality risk factor in acute lower respiratory infections in children in low and middle-income countries: Systematic review and meta-analysis. PLoS One 10: e0136166.
-
3.
Hooli S et al., 2023. In-hospital mortality risk stratification in children aged under 5 years with pneumonia with or without pulse oximetry: A secondary analysis of the pneumonia research partnership to assess WHO REcommendations (PREPARE) dataset. Int J Infect Dis 129: 240–250.
-
4.
Ginsburg AS , Van Cleve WC , Thompson MIW , English M , 2012. Oxygen and pulse oximetry in childhood pneumonia: A survey of healthcare providers in resource-limited settings. J Trop Pediatr 58: 389–393.
-
5.
Simkovich SM et al., 2022. Resources and geographic access to care for severe pediatric pneumonia in four resource-limited settings. Am J Respir Crit Care Med 205: 183–197.
-
6.
Enoch AJ , English M , McGivern G , Shepperd S , 2019. Variability in the use of pulse oximeters with children in Kenyan hospitals: A mixed-methods analysis. PLoS Med 16: e1002987.
-
7.
Rahman AE , Hossain AT , Nair H , Chisti MJ , Dockrell D , Arifeen SE , Campbell H , 2022. Prevalence of hypoxaemia in children with pneumonia in low-income and middle-income countries: A systematic review and meta-analysis. Lancet Glob Health 10: e348–e359.
-
8.
McCollum ED et al., 2016. Pulse oximetry for children with pneumonia treated as outpatients in rural Malawi. Bull World Health Organ 94: 893–902.
-
9.
McCollum ED , Ahmed S , Roy AD , Islam AA , Schuh HB , King C , Hooli S , Quaiyum MA , Ginsburg AS , Checkley W , Baqui AH , Colbourn T. , 2023. Risk and accuracy of outpatient-identified hypoxaemia for death among suspected child pneumonia cases in rural Bangladesh: A multifacility prospective cohort study. Lancet Respir Med 11: 769–781.
-
10.
Hooli S et al., 2020. The epidemiology of hypoxemic pneumonia among young infants in Malawi. Am J Trop Med Hyg 102: 676–683.
-
11.
Hooli S , Colbourn T , Lufesi N , Costello A , Nambiar B , Thammasitboon S , Makwenda C , Mwansambo C , McCollum ED , King C , 2016. Predicting hospitalised paediatric pneumonia mortality risk: An external validation of RISC and mRISC, and local tool development (RISC-Malawi) from Malawi. PLoS One 11: e0168126.
-
12.
Gallagher KE et al., 2020. The predictive performance of a pneumonia severity score in human immunodeficiency virus-negative children presenting to hospital in 7 low- and middle-income countries. Clin Infect Dis 70: 1050–1057.
-
13.
Fouzas S , Priftis KN , Anthracopoulos MB , 2011. Pulse oximetry in pediatric practice. Pediatrics 128: 740–752.
-
14.
Henry NR , Hanson AC , Schulte PJ , Warner NS , Manento MN , Weister TJ , Warner MA , 2022. Disparities in hypoxemia detection by pulse oximetry across self-identified racial groups and associations with clinical outcomes. Crit Care Med 50: 204–211.
-
15.
Valbuena VSM , Seelye S , Sjoding MW , Valley TS , Dickson RP , Gay SE , Claar D , Prescott HC , Iwashyna TJ , 2022. Racial bias and reproducibility in pulse oximetry among medical and surgical inpatients in general care in the Veterans Health Administration 2013–19: Multicenter, retrospective cohort study. BMJ 378: e069775.
-
16.
Sjoding MW , Dickson RP , Iwashyna TJ , Gay SE , Valley TS , 2020. Racial bias in pulse oximetry measurement. N Engl J Med 383: 2477–2478.
-
17.
Shi C et al., 2022. The accuracy of pulse oximetry in measuring oxygen saturation by levels of skin pigmentation: A systematic review and meta-analysis. BMC Med 20: 267.
-
18.
Centers for Devices and Radiological Health , 2021. Pulse Oximeter Accuracy and Limitations: FDA Safety Communication. Washington, DC: U.S. Food and Drug Administration.
-
19.
Ruppel H , Makeneni S , Faerber JA , Lane-Fall MB , Foglia EE , O’Byrne ML , Bonafide CP , 2023. Evaluating the accuracy of pulse oximetry in children according to race. JAMA Pediatr 177: 540–543.
-
20.
Andrist E , Nuppnau M , Barbaro RP , Valley TS , Sjoding MW , 2022. Association of race with pulse oximetry accuracy in hospitalized children. JAMA Netw Open 5: e224584.
-
21.
Foglia EE , Whyte RK , Chaudhary A , Mott A , Chen J , Propert KJ , Schmidt B , 2017. The effect of skin pigmentation on the accuracy of pulse oximetry in infants with hypoxemia. J Pediatr 182: 375–377.e2.
-
22.
Vesoulis Z , Tims A , Lodhi H , Lalos N , Whitehead H , 2022. Racial discrepancy in pulse oximeter accuracy in preterm infants. J Perinatol 42: 79–85.
-
23.
Polubriaginof FCG , Ryan P , Salmasian H , Shapiro AW , Perotte A , Safford MM , Hripcsak G , Smith S , Tatonetti NP , Vawdrey DK , 2019. Challenges with quality of race and ethnicity data in observational databases. J Am Med Inform Assoc 26: 730–736.
-
24.
Troeger C et al., 2017. Estimates of the global, regional, and national morbidity, mortality, and aetiologies of lower respiratory tract infections in 195 countries: A systematic analysis for the Global Burden of Disease Study 2015. Lancet Infect Dis 17: 1133–1161.
-
25.
Hernández P , Baker K , Kallander K , 2014. Initial Pneumonia Device Short Listing Exercise Report. London, United Kingdom: Malaria Consortium.
-
26.
King C et al., 2018. Opportunities and barriers in paediatric pulse oximetry for pneumonia in low-resource clinical settings: A qualitative evaluation from Malawi and Bangladesh. BMJ Open 8: e019177.
-
27.
Strange B , Sullivan A , 2013. Pneumonia Diagnostics: Current Outlook and Perspectives. Technical Report. Copenhagen, Denmark: UNICEF Supply Division.
-
28.
Hooli S et al., 2023. Pneumonia REsearch Partnership to Assess WHO REcommendations (PREPARE) study group. In-hospital mortality risk stratification in children aged under 5 years with pneumonia with or without pulse oximetry: A secondary analysis of the Pneumonia REsearch Partnership to Assess WHO REcommendations (PREPARE) dataset. Int J Infect Dis 129: 240–250.
| Past two years | Past Year | Past 30 Days | |
|---|---|---|---|
| Abstract Views | 1384 | 1384 | 299 |
| Full Text Views | 68 | 68 | 16 |
| PDF Downloads | 82 | 82 | 18 |
Pulse Oximetry Accuracy in Children with Dark Skin Tones: Relevance to Acute Lower Respiratory Infection Care in Low- and Middle-Income Countries
Shubhada Hooli
hooli@bcm.edu
Shubhada Hooli
Division of Emergency Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, Texas;
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Tim Colbourn
Tim Colbourn
Institute for Global Health, University College London, London, United Kingdom;
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Manish I. Shah
Manish I. Shah
Department of Emergency Medicine, Stanford University School of Medicine, Palo Alto, California;
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Kristy Murray
Kristy Murray
Division of Tropical Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, Texas;
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Anna Mandalakas
Anna Mandalakas
Global Tuberculosis Program, Department of Pediatrics, Baylor College of Medicine, Houston, Texas;
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Eric D. McCollum
Eric D. McCollum
Global Program in Pediatric Respiratory Sciences, Eudowood Division of Pediatric Respiratory Sciences, Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, Maryland;
Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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ABSTRACT.
Acute lower respiratory infections (ALRI) are the leading post-neonatal cause of death in children under 5 years old. There is a high prevalence of pediatric ALRI-related hypoxemia in low- and middle-income countries. The WHO defines clinically meaningful hypoxemia in children as a SpO2 (peripheral oxygen saturation) <90%. Multiple studies put this convention into question and found SpO2 of 90% to 92% to be associated with child ALRI mortality. An evolving body of evidence suggests that pulse oximeters systematically overestimate oxygen saturation in individuals with dark skin tones. We conducted a narrative review of pediatric studies evaluating pulse oximeter accuracy in children without COVID-19. Four studies, one prospective, examined pulse oximeter accuracy in children of varying ages with dark skin tones. All studies had limitations that affect their generalizability. There is evidence that certain pulse oximeters may overestimate oxygen saturation in children with dark skin tones. Further prospective research is urgently needed to identify affected populations and clinical implications. Despite recognized challenges, we strongly urge continued and expanded use of pulse oximetry as its use will save lives.
Author Notes
Current contact information: Tim Colbourn, Institute for Global Health, University College London, London, United Kingdom, E-mail: t.colbourn@ucl.ac.uk. Manish Shah, Department of Emergency Medicine, Stanford University School of Medicine, Stanford, CA, E-mail: mshah5@stanford.edu. Kristy Murray, Division of Tropical Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, TX, E-mail: kmurray@bcm.edu. Anna Mandalakas, Global Tuberculosis Program, Department of Pediatrics, Baylor College of Medicine, Houston, TX, E-mail: anna.mandalakas@bcm.edu. Eric D. McCollum, Global Program in Pediatric Respiratory Sciences, Eudowood Division of Pediatric Respiratory Sciences, Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, MD, E-mail: ericdmccollum@gmail.com.
ProCite
RefWorks
Reference Manager
BibTeX
Zotero
EndNote
-
1.
GBD 2017 Lower Respiratory Infections Collaborators , 2020. Quantifying risks and interventions that have affected the burden of lower respiratory infections among children younger than 5 years: An analysis for the Global Burden of Disease Study 2017. Lancet Infect Dis 20: 60–79.
-
2.
Lazzerini M , Sonego M , Pellegrin MC , 2015. Hypoxaemia as a mortality risk factor in acute lower respiratory infections in children in low and middle-income countries: Systematic review and meta-analysis. PLoS One 10: e0136166.
-
3.
Hooli S et al., 2023. In-hospital mortality risk stratification in children aged under 5 years with pneumonia with or without pulse oximetry: A secondary analysis of the pneumonia research partnership to assess WHO REcommendations (PREPARE) dataset. Int J Infect Dis 129: 240–250.
-
4.
Ginsburg AS , Van Cleve WC , Thompson MIW , English M , 2012. Oxygen and pulse oximetry in childhood pneumonia: A survey of healthcare providers in resource-limited settings. J Trop Pediatr 58: 389–393.
-
5.
Simkovich SM et al., 2022. Resources and geographic access to care for severe pediatric pneumonia in four resource-limited settings. Am J Respir Crit Care Med 205: 183–197.
-
6.
Enoch AJ , English M , McGivern G , Shepperd S , 2019. Variability in the use of pulse oximeters with children in Kenyan hospitals: A mixed-methods analysis. PLoS Med 16: e1002987.
-
7.
Rahman AE , Hossain AT , Nair H , Chisti MJ , Dockrell D , Arifeen SE , Campbell H , 2022. Prevalence of hypoxaemia in children with pneumonia in low-income and middle-income countries: A systematic review and meta-analysis. Lancet Glob Health 10: e348–e359.
-
8.
McCollum ED et al., 2016. Pulse oximetry for children with pneumonia treated as outpatients in rural Malawi. Bull World Health Organ 94: 893–902.
-
9.
McCollum ED , Ahmed S , Roy AD , Islam AA , Schuh HB , King C , Hooli S , Quaiyum MA , Ginsburg AS , Checkley W , Baqui AH , Colbourn T. , 2023. Risk and accuracy of outpatient-identified hypoxaemia for death among suspected child pneumonia cases in rural Bangladesh: A multifacility prospective cohort study. Lancet Respir Med 11: 769–781.
-
10.
Hooli S et al., 2020. The epidemiology of hypoxemic pneumonia among young infants in Malawi. Am J Trop Med Hyg 102: 676–683.
-
11.
Hooli S , Colbourn T , Lufesi N , Costello A , Nambiar B , Thammasitboon S , Makwenda C , Mwansambo C , McCollum ED , King C , 2016. Predicting hospitalised paediatric pneumonia mortality risk: An external validation of RISC and mRISC, and local tool development (RISC-Malawi) from Malawi. PLoS One 11: e0168126.
-
12.
Gallagher KE et al., 2020. The predictive performance of a pneumonia severity score in human immunodeficiency virus-negative children presenting to hospital in 7 low- and middle-income countries. Clin Infect Dis 70: 1050–1057.
-
13.
Fouzas S , Priftis KN , Anthracopoulos MB , 2011. Pulse oximetry in pediatric practice. Pediatrics 128: 740–752.
-
14.
Henry NR , Hanson AC , Schulte PJ , Warner NS , Manento MN , Weister TJ , Warner MA , 2022. Disparities in hypoxemia detection by pulse oximetry across self-identified racial groups and associations with clinical outcomes. Crit Care Med 50: 204–211.
-
15.
Valbuena VSM , Seelye S , Sjoding MW , Valley TS , Dickson RP , Gay SE , Claar D , Prescott HC , Iwashyna TJ , 2022. Racial bias and reproducibility in pulse oximetry among medical and surgical inpatients in general care in the Veterans Health Administration 2013–19: Multicenter, retrospective cohort study. BMJ 378: e069775.
-
16.
Sjoding MW , Dickson RP , Iwashyna TJ , Gay SE , Valley TS , 2020. Racial bias in pulse oximetry measurement. N Engl J Med 383: 2477–2478.
-
17.
Shi C et al., 2022. The accuracy of pulse oximetry in measuring oxygen saturation by levels of skin pigmentation: A systematic review and meta-analysis. BMC Med 20: 267.
-
18.
Centers for Devices and Radiological Health , 2021. Pulse Oximeter Accuracy and Limitations: FDA Safety Communication. Washington, DC: U.S. Food and Drug Administration.
-
19.
Ruppel H , Makeneni S , Faerber JA , Lane-Fall MB , Foglia EE , O’Byrne ML , Bonafide CP , 2023. Evaluating the accuracy of pulse oximetry in children according to race. JAMA Pediatr 177: 540–543.
-
20.
Andrist E , Nuppnau M , Barbaro RP , Valley TS , Sjoding MW , 2022. Association of race with pulse oximetry accuracy in hospitalized children. JAMA Netw Open 5: e224584.
-
21.
Foglia EE , Whyte RK , Chaudhary A , Mott A , Chen J , Propert KJ , Schmidt B , 2017. The effect of skin pigmentation on the accuracy of pulse oximetry in infants with hypoxemia. J Pediatr 182: 375–377.e2.
-
22.
Vesoulis Z , Tims A , Lodhi H , Lalos N , Whitehead H , 2022. Racial discrepancy in pulse oximeter accuracy in preterm infants. J Perinatol 42: 79–85.
-
23.
Polubriaginof FCG , Ryan P , Salmasian H , Shapiro AW , Perotte A , Safford MM , Hripcsak G , Smith S , Tatonetti NP , Vawdrey DK , 2019. Challenges with quality of race and ethnicity data in observational databases. J Am Med Inform Assoc 26: 730–736.
-
24.
Troeger C et al., 2017. Estimates of the global, regional, and national morbidity, mortality, and aetiologies of lower respiratory tract infections in 195 countries: A systematic analysis for the Global Burden of Disease Study 2015. Lancet Infect Dis 17: 1133–1161.
-
25.
Hernández P , Baker K , Kallander K , 2014. Initial Pneumonia Device Short Listing Exercise Report. London, United Kingdom: Malaria Consortium.
-
26.
King C et al., 2018. Opportunities and barriers in paediatric pulse oximetry for pneumonia in low-resource clinical settings: A qualitative evaluation from Malawi and Bangladesh. BMJ Open 8: e019177.
-
27.
Strange B , Sullivan A , 2013. Pneumonia Diagnostics: Current Outlook and Perspectives. Technical Report. Copenhagen, Denmark: UNICEF Supply Division.
-
28.
Hooli S et al., 2023. Pneumonia REsearch Partnership to Assess WHO REcommendations (PREPARE) study group. In-hospital mortality risk stratification in children aged under 5 years with pneumonia with or without pulse oximetry: A secondary analysis of the Pneumonia REsearch Partnership to Assess WHO REcommendations (PREPARE) dataset. Int J Infect Dis 129: 240–250.
| Past two years | Past Year | Past 30 Days | |
|---|---|---|---|
| Abstract Views | 1384 | 1384 | 299 |
| Full Text Views | 68 | 68 | 16 |
| PDF Downloads | 82 | 82 | 18 |