Overestimation of Oxygen Saturation Leads to Delayed COVID-19 Treatment

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Patients with unrecognized need for COVID-19 therapy appear to have higher odds of readmission, regardless of race

By Elana Gotkine HealthDay Reporter

THURSDAY, Aug. 31, 2023 (HealthDay News) — Overestimation of oxygen saturation by pulse oximetry leads to delayed delivery of COVID-19 therapy, according to a study published online Aug. 24 in JAMA Network Open.

Ashraf Fawzy, M.D., M.P.H., from Johns Hopkins University School of Medicine in Baltimore, and colleagues examined the effect of overestimation of oxygen saturation by pulse oximetry in a cohort study including patients hospitalized for COVID-19 at 186 U.S. acute care facilities with at least one functional arterial oxygen saturation (SaO2) measurement. A subset of patients were admitted without immediate need for COVID-19 therapy based on pulse oximeter saturation (SpO2 levels of 94 percent or higher without supplemental oxygen). A total of 24,504 patients had concurrent SpO2 and SaO2 measurements.

The researchers found that pulse oximetry overestimated SaO2 for Black, Hispanic, and other patients versus White patients (adjusted mean differences, 0.93, 0.49, and 0.53 percentage points, respectively). In a subset of 8,635 patients with a concurrent SpO2-SaO2 pair without immediate need for COVID-19 therapy, Black patients were more likely than White patients to have pulse oximetry values that masked an indication for COVID-19 therapy (adjusted odds ratio [aOR], 1.65; 95 percent confidence interval [CI], 1.33 to 2.03). The likelihood of receiving COVID-19 therapy was lower for patients with an unrecognized need for COVID-19 therapy (aOR, 0.90; 95 percent CI, 0.83 to 0.97), and these patients had higher odds of readmission, regardless of race (aOR, 2.41; 95 percent CI, 1.39 to 4.18). Unrecognized need for COVID-19 therapy was not associated with in-hospital mortality or length of stay.

“Improved accuracy of pulse oximeters, which play an important role in triage and treatment decisions, is critical to delivery of timely and equitable care to patients with COVID-19,” the authors write.

Several authors disclosed ties to the pharmaceutical industry.

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