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Abstract Pulse oximetry (SpO 2 ) is a critical monitor for assessing oxygenation status and guiding therapy in critically ill patients. Race has been identified as a potential source of SpO 2 error, with consequent bias and inequities in healthcare. This study was designed to evaluate the incidence of occult hypoxemia and accuracy of pulse oximetry associated with the Massey-Martin scale and characterize the relationship between Massey scores and self-identified race. This retrospective single institute study utilized the Massey-Martin scale as a quantitative assessment of skin pigmentation. These values were recorded peri-operatively in patients enrolled in unrelated clinical trials. The electronic medical record was utilized to obtain demographics, arterial blood gas values, and time matched SpO 2 values for each PaO 2 ≤ 125 mmHg recorded throughout their hospitalizations. Differences between SaO 2 and SpO 2 were compared as a function of both Massey score and self-reported race. 4030 paired SaO 2 -SpO 2 values were available from 579 patients. The average error (SaO 2 -SpO 2 ) ± SD was 0.23 ± 2.6%. Statistically significant differences were observed within Massey scores and among races, with average errors that ranged from − 0.39 ± 2.3 to 0.53 ± 2.5 and − 0.55 ± 2.1 to 0.37 ± 2.7, respectively. Skin color varied widely within each self-identified race category. There was no clinically significant association between error rates and Massey-Martin scale grades and no clinically significant difference in accuracy observed between self-reported Black and White patients. In addition, self-reported race is not an appropriate surrogate for skin color.
Marlar et al. (Wed,) studied this question.