Pulse Oximetry and Arterial Saturation Difference in Pediatric COVID-19 Patients: Retrospective Analysis by Race*

Author:

Savorgnan Fabio1,Hassan Adel2,Borges Nirica1,Acosta Sebastian3

Affiliation:

1. Divisions of Critical Care and Cardiology, Department of Pediatrics, Baylor College of Medicine and Texas Children’s Hospital, Houston, TX.

2. Baylor College of Medicine, Houston, TX.

3. Divisions of Cardiology, Department of Pediatrics, Baylor College of Medicine and Texas Children’s Hospital, Houston, TX.

Abstract

Objectives: Pulse oximetry (Spo 2) may overestimate arterial oxygen saturation (Sao 2) in blood laboratory testing. This study aimed to assess Spo 2–Sao 2 difference in relation to race (i.e., patient self-reporting as Black or White), occult hypoxemia, and length of stay (LOS) in pediatric patients with COVID-19. Design: Single-center retrospective study in pediatric COVID-19 patients. We used multivariable linear regressions to examine the association between race and oximetry measurements and between occult hypoxemia and LOS. Oximetry bias was defined using Spo 2 and Sao 2 data according to approved comparisons. Occult hypoxemia was defined as Spo 2 greater than 92% and Sao 2 less than 88%. Setting: Quaternary pediatric hospital. Patients: Pediatric COVID-19 patients admitted to Texas Children’s Hospital between May 2020 and December 2021. Interventions: None. Measurements and Main Results: There were 2713 patients with complete physiological data in the analysis. Of the total, 61% were Black, and 39% were White. Oximetry bias was greater in Black compared with White patients (p < 0.001), and this bias increased as the oxygen saturations decreased (p < 0.001). Black and White patients had a 12% and 4% prevalence of occult hypoxemia, respectively (p < 0.001). LOS was not associated with oximetry bias or occult hypoxemia once controlled for the level of support (intensive care, respiratory, circulatory). Conclusions: We found an oximetry bias in the measurement of Spo 2 with respect to Sao 2 in symptomatic hospitalized pediatric patients with the diagnosis of COVID-19. Furthermore, race is related to an increased oximetry bias. However, we did not find a relationship between oximetry bias and the LOS in the hospital in this cohort of patients.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Critical Care and Intensive Care Medicine,Pediatrics, Perinatology and Child Health

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