Professors at the University of Manitoba are making headlines around the world for a recent discovery that a frequently used health care device provides inaccurate results for people of color, leading doctors to take potentially harmful actions.
In July, Dr. Barrett Rush, assistant professor of critical care, and Dr. Jennifer Zielger, critical care fellow, both in the department of internal medicine at the University of Manitoba (UM) Max Rady School of Medicine, formed a study showing that black, Asian, and Hispanic patients receive less supplemental oxygen than white patients.
The study, called Evaluation of racial and ethnic differences in oxygen supplementation among patients in the Intensive Care Unitthen it was released this month in JAMA Internal Medicine and was led by Dr. Eric Raphael Gottlieb and Dr. Leo Celi of Harvard Medical School and the Massachusetts Institute of Technology, respectively.
In a press release sent out by UM on August 3, they said they found the discrepancy was associated with a design flaw in the fingertip device used to measure blood oxygen. The oxygen level in a patient’s blood is measured by the device that produces a beam of light through the finger once it is attached to the finger.
The device was previously known to give inaccurate readings due to pigmentation, be it skin color or nail polish. However, the study by Dr. Rush and Dr. Ziegler is the first to compile evidence on its effect on patient care.
The release even states that there have been “several studies that have shown that pulse oximeters overestimate the oxygen levels of non-white patients.”
“This shows that systemic racism is embedded in the technology we use and affects health care outcomes for minorities,” says Rush. “Not only is our medical technology giving us biased and incorrect information, but doctors are also using that inaccurate information to make clinical decisions that cause harm.”
Elements of the study included reviewing anonymous data from more than 3,000 critically ill patients who were admitted to the intensive care unit of a hospital in Boston, Massachusetts, between 2008 and 2019. Dr. Rush and Dr. Ziegler found that pulse oximeters overestimated Black, Asian, and Hispanic oxygen levels and that the patients received less oxygen than they should.
It was this discovery that allowed the two doctors to further their studies.
The history of oximeters is that they were created in the 1970s and the tests of the device were used on mostly healthy white male patients. Dr. Rush focuses his research on health disparities in critical care and suggests that a recalibration of the medical device is needed.
“The technology is supposed to be objective. But we found that it still has biases toward nonwhite patients and that it’s contributing to worse overall outcomes for nonwhite patients,” he says. “Our ultimate goal is to identify barriers and improve outcomes for these patients.”
Patient data included pulse oximeter and laboratory test results, and the research team compared the results of both procedures by measuring blood samples. The result was that people of color received less supplemental oxygen for a given oxygen saturation level, likely due to faulty oximeter readings.
“Pulse oximeters are found in every hospital room, clinic, and emergency room,” says Dr. Ziegler, who focuses her research on epidemiology and the use of “big data” in health care. “They are contributing to worse outcomes in non-white patients. That’s something that should change.”
Next steps include Dr. Rush and Dr. Ziegler, along with their Boston colleagues, consulting with bioengineers in the US to discuss solving the problem of racial bias in pulse oximeter technologies.
This discovery has resulted in the attraction of media around the world, concluding CNN, BBC, NPR, Reuters, Good morning america and more than 100 other media.
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