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Pulse Oximetry Accuracy in Children with Dark Skin Tones: Relevance to Acute Lower Respiratory Infection Care in Low- and Middle-Income Countries
Shubhada Hooli
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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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.
| Past two years | Past Year | Past 30 Days | |
|---|---|---|---|
| Abstract Views | 211 | 211 | 68 |
| Full Text Views | 17 | 17 | 6 |
| PDF Downloads | 19 | 19 | 5 |