UK Calls for Action on Racial Bias in Oximeters

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ChicagoGranny
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UK Calls for Action on Racial Bias in Oximeters

Post by ChicagoGranny » Mon Nov 22, 2021 11:34 am

LONDON (Reuters) -Britain called on Sunday for international action on the issue of medical devices such as oximeters that work better on people with lighter skin, saying the disparities may have cost lives of ethnic minority patients during the COVID-19 pandemic.

Full article: https://www.usnews.com/news/world/artic ... al-devices

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Julie
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Re: UK Calls for Action on Racial Bias in Oximeters

Post by Julie » Mon Nov 22, 2021 12:06 pm

I would so love to know the science behind the claims - it sounds like nonsense except that if there are actual physiologic differences in certain ethnicities (there are definitely some - I've just never heard of them being color coded) I would like to know what they're based on... e.g. people of Medittaranean background/origin are prone to certain hematologic problems, but I've never heard that the shade of their skin is relevant, never mind how an 02 monitor knows the difference.

But PLEASE do not infer the wrong thing from the above - not, not, not arguing for e.g. white vs black or vice versa! The thing as it stands tho' is unclear to say the least - or else the story's so badly written it sounds like gibberish.

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Re: UK Calls for Action on Racial Bias in Oximeters

Post by Pugsy » Mon Nov 22, 2021 12:43 pm

Julie wrote:
Mon Nov 22, 2021 12:06 pm
the story's so badly written
Well....while not horribly written it does what most newspaper articles do and that is start out with a grain of truth and either blow it out of proportion of insert grains of non truths or conspiracy theory crap.

It's been known for a long time that pulse oximeters aren't always reliable in terms of accuracy when it comes to people with darker skin tones. So this isn't really something newly found and an earth shattering new discovery at all. I read about it over 5 years ago I think.

Think of just how pulse oximeters work....
. It does so by sending infrared light into capillaries in your finger, toe, or earlobe. Then it measures how much light is reflected off the gases.
For the same reason we are told not to use nail polish when using the pulse oximeter as it can impact the light used readings and thus the accuracy of the readings....skin tone can also affect the readings.

There are many, many documented scientific studies about this occurrence.
I have no idea what is being done about the skin tone problem ...but I am fairly sure someone somewhere is working on it.
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Re: UK Calls for Action on Racial Bias in Oximeters

Post by ChicagoGranny » Mon Nov 22, 2021 1:29 pm

Julie wrote:
Mon Nov 22, 2021 12:06 pm
it sounds like nonsense
Good grief, it's unpredictable what will set you off.
Julie wrote:
Mon Nov 22, 2021 12:06 pm
I would so love to know the science behind the claims
It's easily found with a browser and an internet connection.

From the New England Journal of Medicine:
... Black patients had nearly three times the frequency of occult hypoxemia that was not detected by pulse oximetry as White patients. ... Our results suggest that reliance on pulse oximetry to triage patients and adjust supplemental oxygen levels may place Black patients at increased risk for hypoxemia. ...

https://www.nejm.org/doi/full/10.1056/nejmc2029240

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Re: UK Calls for Action on Racial Bias in Oximeters

Post by Julie » Mon Nov 22, 2021 1:42 pm

Well, learned something new! No idea that PO's used those methods to work, so I guess there's more to this than I thought.

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Re: UK Calls for Action on Racial Bias in Oximeters

Post by chunkyfrog » Mon Nov 22, 2021 2:01 pm

It seems possible that the skin tone problem could be alleviated with an
adjustment in programming or an increase in sensitivity.
One size certainly does NOT fit all!
It is high time race or gender cease to be obstacles to proper health care.
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Re: UK Calls for Action on Racial Bias in Oximeters

Post by rdfry » Wed Nov 24, 2021 11:46 pm

I asked my wife who was an RN for 45 years working in hospitals with patients of all races and she told me she never saw any bias with oximiters in her entire career.
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Re: UK Calls for Action on Racial Bias in Oximeters

Post by ChicagoGranny » Thu Nov 25, 2021 8:40 am

rdfry wrote:
Wed Nov 24, 2021 11:46 pm
I asked my wife who was an RN for 45 years working in hospitals with patients of all races and she told me she never saw any bias with oximiters in her entire career.
How would she know? She couldn't know without running experiments.

This was the problem. Until recently, no one studied the issue. Blissfully unaware.

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Re: UK Calls for Action on Racial Bias in Oximeters

Post by chunkyfrog » Thu Nov 25, 2021 9:12 am

Agreed, Granny!
Side by side tests confirm the disparity--which increases with deeper skin tones,
or interference by nail polish or makeup--a consequence of spectral absorption.
Most clinicians only use the oximeter, while a blood draw is the most reliable test.
Nurses do not have ready access to a comparison, save the occasional fatality.
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Re: UK Calls for Action on Racial Bias in Oximeters

Post by rdfry » Thu Nov 25, 2021 3:39 pm

I've spent over 40 years in critical care nursing. There are multiple parameters to measure oxygen saturation. Visually observing patients over all status is a start. Add 2 or 3 other modalities that correlate gives me the asurrance that the data from monitors is accurate. Pulse oximiters measure capillary perfusion. Hence is not skin color dependent. Most often a simple assertain of deep breathing while on pulse will show if oximeter is working because the results change beat to beat heart rate.
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Re: UK Calls for Action on Racial Bias in Oximeters

Post by chunkyfrog » Thu Nov 25, 2021 4:23 pm

rdfry wrote:
Thu Nov 25, 2021 3:39 pm
I've spent over 40 years in critical care nursing. There are multiple parameters to measure oxygen saturation. Visually observing patients over all status is a start. Add 2 or 3 other modalities that correlate gives me the asurrance that the data from monitors is accurate. Pulse oximiters measure capillary perfusion. Hence is not skin color dependent. Most often a simple assertain of deep breathing while on pulse will show if oximeter is working because the results change beat to beat heart rate.
Your comments are biased.
Pulse oximeters work on the Lambert Beer law according to spectrum absorption of hemoglobin. The absorption of hemoglobin and MELANIN are quite similar,
resulting in inaccuracies in dark-skinned patients.
Nurses are told whatever is needed so their conscience is overridden
by the racism of their bosses.
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Re: UK Calls for Action on Racial Bias in Oximeters

Post by ChicagoGranny » Thu Nov 25, 2021 5:25 pm

Racial bias in pulse oximetry has been well known for more than three decades. Witness this widely referenced study published in Chest medical journal in 1990.
In white patients, we found that a SpO2 target of 92 percent was reliable in predicting a satisfactory level of oxygenation. However, in black patients, such a SpO2 reading was commonly associated with significant hypoxemia (PaO2 as low as 49 mm Hg), and a higher SpO2 target, 95 percent, was required. In addition, inaccurate oximetry readings (ie, >4 percent difference between SpO2 and direct SaO2 measurements) were more common in black (27 percent) than in white patients (11 percent, p>0.05). In conclusion, a SpO2 target of 92 percent was reliable when titrating supplemental O2 in white patients receiving mechanical ventilation; however, in black patients, such a SpO2 reading was commonly associated with significant hypoxemia, and a higher SpO2 target, 95 percent, was required to ensure a satisfactory level of oxygenation.

https://scholar.google.com/scholar?clus ... s_sdt=0,34

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Re: UK Calls for Action on Racial Bias in Oximeters

Post by rdfry » Thu Nov 25, 2021 5:32 pm

How dare you? My wife is the most professional conscientious person during her entire nursing career.
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Re: UK Calls for Action on Racial Bias in Oximeters

Post by rdfry » Thu Nov 25, 2021 6:21 pm

OK I have read further on the home use and that there appears to be a legitimate concern of irregularities. My wife was addressing the use in hospitals where more information is garnered. But you had no business infurring my wife was biased because of race. That was completely uncalled for.
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Re: UK Calls for Action on Racial Bias in Oximeters

Post by chunkyfrog » Thu Nov 25, 2021 7:34 pm

rdfry wrote:
Thu Nov 25, 2021 6:21 pm
OK I have read further on the home use and that there appears to be a legitimate concern of irregularities. My wife was addressing the use in hospitals where more information is garnered. But you had no business infurring my wife was biased because of race. That was completely uncalled for.
But her teachers or parents may have been.
Bias is not always conscious.
Many of us have bias that we do not realize, because it is
so deeply ingrained that it feels OK.
Bias is all around us--but we resist admitting it.
It is hard to face the wrong thoughts inside us-
-but we must, in order to make things right.
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