![]() ![]() Importance Pulse oximetry guides triage and therapy decisions for COVID-19. Meaning The study results suggest that overestimation of arterial oxygen saturation levels by pulse oximetry occurs in patients of racial and ethnic minority groups with COVID-19 and contributes to unrecognized or delayed recognition of eligibility to receive COVID-19 therapies. Separately, among 6673 patients with pulse oximetry measurements and available covariate data, predicted overestimation of arterial oxygen saturation levels by pulse oximetry among 1903 patients was associated with a systematic failure to identify Black and Hispanic patients who were qualified to receive COVID-19 therapy and a statistically significant delay in recognizing the guideline-recommended threshold for initiation of therapy. Question Are there systematic racial and ethnic biases in pulse oximetry among patients with COVID-19, and is there an association between such biases and unrecognized or delayed recognition of eligibility for oxygen threshold–specific therapy?įindings In this retrospective cohort study of 7126 patients with COVID-19, an analysis of 1216 patients with oxygen saturation levels that were concurrently measured by pulse oximetry and arterial blood gas demonstrated that pulse oximetry overestimated arterial oxygen saturation among Asian, Black, and Hispanic patients compared with White patients. Shared Decision Making and Communication.Scientific Discovery and the Future of Medicine.Health Care Economics, Insurance, Payment.Clinical Implications of Basic Neuroscience.Challenges in Clinical Electrocardiography.Absolute and relative treatment eligibility delay by race among 1,452 patients with predicted SaO 2≤94% before SpO 2≤94% or oxygen initiation Proportion of patients with pulse oximetry (SpO 2) ≤94% or initiated oxygen since predicted arterial oxygen saturation (SaO 2) ≤94% among patients diagnosed with COVID-19 among patients ultimately having SpO 2 ≤ 94% or initiated oxygenĮTable 6. Baseline characteristics of patients testing positive for COVID-19 with predicted SaO 2≤94% before SpO 2≤94% or oxygen initiation included in the treatment eligibility delay analysisĮFigure 3. Average absolute differences between SaO 2 and SpO 2 by race stratified by oxygen deviceĮTable 5. ![]() Adjusted parsimonious linear mixed-effects model including significant interactions of race with SpO 2 and oxygen device as fixed effectsĮFigure 2. Average relative marginal effects by race from the adjusted fully specified linear mixed-effects modelĮTable 4. Adjusted fully specified linear mixed-effects model including interactions between race and each covariate as fixed effectsĮFigure 1. Unadjusted linear mixed-effects model evaluating the association of race with SaO 2-SpO 2 for the full cohort and limited to SpO 2 between 88% and 96%ĮTable 3. Pre-defined race categories available in the Johns Hopkins Health System electronic medical recordĮTable 2. ![]()
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