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León-Valladares D, Barrio-Mateu LA, Cortés-Carmona N, Fuentes-Lizana G, Cabanas AM, Latorre-Progulakis K, Fuentes-Guajardo M, Martín-Escudero P. Determining factors of pulse oximetry accuracy: a literature review. Rev Clin Esp 2024; 224:314-330. [PMID: 38599519 DOI: 10.1016/j.rceng.2024.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 03/17/2024] [Indexed: 04/12/2024]
Abstract
OBJECTIVE Identify and reach consensus on the variables that affect the measurement of oxygen saturation using pulse oximetry. METHODS We applied inclusion and exclusion criteria to select relevant studies in databases such as Ebsco and PubMed. The search strategies, carried out until December 2023, focused on publications that addressed the technology of pulse oximeters and variables that influence their accuracy. We assessed the risk of bias of the included studies and used standardized methods for synthesis of results. RESULTS 23 studies were included. The synthesis of the results highlighted that equipment with tetrapolar technology showed greater precision in oxygen saturation measurements. Increased skin pigmentation, hemoglobinopathies and high skin temperatures can lead to an overestimation of SpO2, while factors such as low perfusion, cold skin temperature, nail polish or tattoos, hypoxemia, anemia and high altitude training, they may underestimate it. On the other hand, motion artifacts, light pollution, frequency >150 beats per minute, electromagnetic interference and location of the sensor can cause distortion of the photoplethymography signal. CONCLUSIONS The synthesis of the results highlighted that skin pigmentation and light interference can lead to an overestimation of SpO2, while other factors such as low perfusion and altitude tend to underestimate it. The studies presented variability and heterogeneity in their designs, evidencing limitations in the consistency and precision of the evidence. Despite these limitations, the results underscore the importance of considering multiple variables when interpreting pulse oximetry measurements to ensure their reliability. The findings have significant implications for clinical practice and future research.
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Affiliation(s)
- D León-Valladares
- Departamento de Ciencias de la Actividad Física y del Deporte, Facultad de Educación y Humanidades, Universidad de Tarapacá, Arica, Chile.
| | - L A Barrio-Mateu
- Departamento de Ciencias de la Actividad Física y del Deporte, Facultad de Educación y Humanidades, Universidad de Tarapacá, Arica, Chile
| | - N Cortés-Carmona
- Estudiante Semillero de Investigación, Departamento de Ciencias de la Actividad Física y del Deporte, Facultad de Educación y Humanidades, Universidad de Tarapacá, Arica, Chile
| | - G Fuentes-Lizana
- Estudiante Semillero de Investigación, Departamento de Ciencias de la Actividad Física y del Deporte, Facultad de Educación y Humanidades, Universidad de Tarapacá, Arica, Chile
| | - A M Cabanas
- Departamento de Física, Facultad de Ciencias, Universidad de Tarapacá, Arica, Chile
| | - K Latorre-Progulakis
- Departamento de Tecnología Médica, Facultad de Ciencias de la Salud, Universidad de Tarapacá, Arica, Chile
| | - M Fuentes-Guajardo
- Departamento de Tecnología Médica, Facultad de Ciencias de la Salud, Universidad de Tarapacá, Arica, Chile
| | - P Martín-Escudero
- Escuela de Medicina del Deporte, Departamento de Radiología, Rehabilitación y Fisioterapia, Facultad de Medicina. UCM
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Kovesi T, Saban J, Haddad JF, Reddy D, Webster R, Udupa S. The Accuracy of Readily Available Consumer-Grade Oxygen Saturation Monitors in Pediatric Patients. Respir Care 2024; 69:387-394. [PMID: 38164568 PMCID: PMC11108112 DOI: 10.4187/respcare.11258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
BACKGROUND Pulse oximetry measurement is ubiquitous in acute health care settings in high-income countries and is familiar to any parent whose child has been treated in such a setting. Oximeters for home use are readily available online and are incorporated in several smartphones and smartwatches. METHODS We wished to determine how accurate are oximeters available online that are designated for adult and pediatric use, and the saturation monitor integrated in a smartphone, when used in children, compared to reference, hospital-grade oximeters. We evaluated a fingertip oximeter marketed for children purchased online; an adult fingertip oximeter purchased online; the oximeter integrated in a smartphone; and reference, hospital-grade oximeters. Participants were < 18 y of age. Bland-Altman charts were generated, and the estimated root mean square error (EARMS) was calculated. Rates of failure to obtain a measurement, relationship between device and time to successful measurement, relationship between age and time to successful measurement, and relationship between error (vs the reference device) and age were evaluated for each consumer-grade device. RESULTS We measured SpO2 in 74 children between 0.1-17.0 y of age. Subjects weighing < 30 kg had a median (interquartile range [IQR]) age of 2 (1.0 month-1.4 y) months, and subjects weighing ≥ 30 kg had a median (IQR) age of 14.3 (11.9-16.2) y. Readings could not be obtained in 7.5, 0, and 38.8% of subjects using the pediatric, adult, and smartphone oximeters, respectively. The time to successful reading had a modest negative correlation with age with the inexpensive adult and pediatric oximeters. The inexpensive pediatric oximeter had an overall negative bias, with a mean difference from the reference device of -4.5% (SD 7.9%) and an error that ranged from > 8% to < 33% the reference device. The EARMS was 7.92%. The inexpensive adult oximeter demonstrated no obvious trend in error in the limited saturation range evaluated of 87-99%. The overall mean difference was -0.7% (SD 2.5%). EARMS was 2.5%. The smartphone oximeter underestimated SpO2 at saturations < 94% and overestimated SpO2 for saturations > 94%. Saturations could read as much as > 4%, or < 17%, than the reference oximeter. The mean difference was -2.9% (SD 5.2%). EARMS was 5.1%. CONCLUSIONS Our findings suggest that the performance of consumer-grade devices varies considerably by both subject age and device. The pediatric fingertip device and smartphone application we tested are poorly suited for use in infants. The adult fingertip device we tested performed quite well in larger children with relatively normal oxygen saturations, and the pediatric fingertip device performed moderately well in subjects > 1 y of age who weighed < 30 kg. Given the vast number of devices available online and ever-changing technology, research to evaluate nonclinical oximeters will continue to be required.
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Affiliation(s)
- Thomas Kovesi
- Drs Kovesi, Saban, and Udupa are affiliated with Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Canada. Dr Haddad is affiliated with University of Calgary, Calgary, Canada. Ms Reddy and Dr Webster are affiliated with Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, Canada.
| | - Jeremy Saban
- Drs Kovesi, Saban, and Udupa are affiliated with Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Canada. Dr Haddad is affiliated with University of Calgary, Calgary, Canada. Ms Reddy and Dr Webster are affiliated with Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, Canada
| | - John Faissal Haddad
- Drs Kovesi, Saban, and Udupa are affiliated with Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Canada. Dr Haddad is affiliated with University of Calgary, Calgary, Canada. Ms Reddy and Dr Webster are affiliated with Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, Canada
| | - Deepti Reddy
- Drs Kovesi, Saban, and Udupa are affiliated with Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Canada. Dr Haddad is affiliated with University of Calgary, Calgary, Canada. Ms Reddy and Dr Webster are affiliated with Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, Canada
| | - Richard Webster
- Drs Kovesi, Saban, and Udupa are affiliated with Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Canada. Dr Haddad is affiliated with University of Calgary, Calgary, Canada. Ms Reddy and Dr Webster are affiliated with Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, Canada
| | - Sharmila Udupa
- Drs Kovesi, Saban, and Udupa are affiliated with Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Canada. Dr Haddad is affiliated with University of Calgary, Calgary, Canada. Ms Reddy and Dr Webster are affiliated with Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, Canada
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Silverston P, Ferrari M, Quaresima V. Pulse oximetry and the pandemic. BMJ 2022; 378:e071474. [PMID: 35798377 DOI: 10.1136/bmj-2022-071474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Paul Silverston
- Faculty of Health, Education, Medicine and Social Care, Anglia Ruskin University, Cambridge, UK
| | - Marco Ferrari
- Department of Life, Health and Environmental Science, University of L'Aquila, L'Aquila, Italy
| | - Valentina Quaresima
- Department of Life, Health and Environmental Science, University of L'Aquila, L'Aquila, Italy
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Cabanas AM, Fuentes-Guajardo M, Latorre K, León D, Martín-Escudero P. Skin Pigmentation Influence on Pulse Oximetry Accuracy: A Systematic Review and Bibliometric Analysis. SENSORS (BASEL, SWITZERLAND) 2022; 22:3402. [PMID: 35591092 PMCID: PMC9102088 DOI: 10.3390/s22093402] [Citation(s) in RCA: 45] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 04/15/2022] [Accepted: 04/20/2022] [Indexed: 02/04/2023]
Abstract
Nowadays, pulse oximetry has become the standard in primary and intensive care units, especially as a triage tool during the current COVID-19 pandemic. Hence, a deeper understanding of the measurement errors that can affect precise readings is a key element in clinical decision-making. Several factors may influence the accuracy of pulse oximetry, such as skin color, body temperature, altitude, or patient movement. The skin pigmentation effect on pulse oximetry accuracy has long been studied reporting some contradictory conclusions. Recent studies have shown a positive bias in oxygen saturation measurements in patients with darkly pigmented skin, particularly under low saturation conditions. This review aims to study the literature that assesses the influence of skin pigmentation on the accuracy of these devices. We employed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement to conduct a systematic review retrospectively since February 2022 using WOS, PubMed, and Scopus databases. We found 99 unique references, of which only 41 satisfied the established inclusion criteria. A bibliometric and scientometrics approach was performed to examine the outcomes of an exhaustive survey of the thematic content and trending topics.
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Affiliation(s)
- Ana M. Cabanas
- Departamento de Física, Universidad de Tarapacá, Arica 1010069, Chile
| | | | - Katina Latorre
- Departamento de Tecnología Médica, Universidad de Tarapacá, Arica 1010069, Chile; (M.F.-G.); (K.L.)
| | - Dayneri León
- Departamento de Educación Física, Universidad de Tarapacá, Arica 1010069, Chile;
| | - Pilar Martín-Escudero
- Medical School of Sport Medicine, Faculty of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain;
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