Summary of "Skin Pigmentation Effects on Pulse Oximetry Accuracy Need a Prospective Study"

Summary published June 13, 2023

Summary by Jon Beard, MD

Journal of Patient Safety | March 2023

Blike GT, McGrath SP, McGovern K. Skin Pigmentation Effects on Pulse Oximetry Accuracy Need a Prospective Study. J Patient Saf. 2023 Jun 1;19(4):221-222. doi: 10.1097/PTS.0000000000001116. Epub 2023 Mar 8. PMID: 36920293; PMCID: PMC10227932.


  • In this invited commentary, the authors reviewed recent literature on pulse oximetry measurements in patients with increased skin pigmentation.
  • The authors included 11 studies that reported results by patient race as a proxy for skin pigmentation. Compared to White patients, 8 studies showed higher errors rates among Black patients. Two studies reported error rates in Asian patients compared to both Black and White patients. And one study found no difference in error rates among racial groups.
  • The magnitude of measurement error differed between studies and fell within Food and Drug Administration regulatory requirements in some and measured <1% in others.
  • Limitations of the included studies were cited, including issues like lack of synchronization between SpO2 and arterial measurements, failure to account for device manufacturer variations, absence of standard device calibration, documentation errors, and failure to control for confounding patient characteristics. Other sources of measurement errors, such as motion, ambient light, and low perfusion, were also mentioned.
  • The authors noted that using self-identified race as a marker for skin pigmentation could contribute to analytical inaccuracy, as race encompasses a wide range of pigmentations.
  • The authors agree that further studies are needed to address the real issue of SpO2 errors in individuals with darkly pigmented skin. They propose suggestions to improve understanding, including access to manufacturer calibration study data, prospective studies using best practices (e.g., synchronization of SpO2 and arterial measurements), and the use of better standards for assessing skin pigmentation (e.g., colorimetric/spectrophotometric methods).
  • In conclusion, the authors emphasize the importance of conducting additional studies promptly to ensure the safety of all patients.