Are pulse ox devices racist?

Black communities are already faced with substandard healthcare, so when a medical device that monitors vital signs, such as the pulse ox, is developed without Black and dark-skinned people in mind, it is much more than just a design flaw.

In our last blog post, we went into detail about pulse oximeters and their mechanism of action. As we touched on briefly, blood oxygen measurement varies greatly from person to person since it relies on light passing through tissue, which behaves differently depending on a number of biological factors. This seemingly objective method actually serves as an example of biomedical technology that fails to account for all of these factors.

We couldn’t find a single stock shot of a pulse oximeter being used on someone with dark skin at bigstock.com, we checked.

Low oxygen saturation levels, the type of sensor in the device, gender, and skin color have all been shown to cause errors in pulse oximetry, but the discrepancies relating to skin color may be the most glaring. Studies and extensive anecdotal evidence from clinicians have shown that any errors due to low oxygen saturation were more dramatically skewed in Black patients when compared to their white counterparts. More specifically, at oxygen saturation levels below 80%, pulse oximetry measurements are significantly overestimated in dark-skinned patients

At saturation levels below 80%, patients begin to experience oxygen deprivation to the point of organ failure (hypoxia). So, if a pulse ox reading is overestimated in a dark-skinned patient, a healthcare professional could easily miss the onset of hypoxia. This limitation of the technology is critical especially now, during the COVID-19 pandemic, which is killing Black people at a rate three times higher than that of any other racial group in America. Black communities are already faced with substandard healthcare, so when a medical device that monitors vital signs, such as the pulse ox, is developed without Black and dark-skinned people in mind, it is much more than just a design flaw. 

As engineers, we are taught that device design of any kind cannot be successful unless the product meets all necessary requirements. Just like designing a building requires every environmental condition to be taken into consideration, designing a medical device requires every kind of person to be taken into consideration.

Nevertheless, in the 1980s, when the pulse ox first underwent FDA screening, accuracy and calibration testing was conducted primarily on light-skinned people; this has not changed since then. Despite the major functional disparity, the FDA has yet to require further research and testing dedicated to developing a pulse ox that produces accurate measurements on darker skin.

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