Recognition of simulated cyanosis by color-vision-normal and color-vision-deficient subjects

There are anecdotal reports that the recognition of cyanosis is difficult for some color-deficient observers. The chromaticity changes of blood with oxygenation in vitro lie close to the dichromatic confusion lines. The chromaticity changes of lips and nail beds measured in vivo are also generally aligned in the same way. Experiments involving visual assessment of cyanosis in vivo are fraught with technical and ethical difficulties A single lower face image of a healthy individual was digitally altered to produce levels of simulated cyanosis. The color change is essentially one of saturation. Some images with other color changes were also included to ensure that there was no propensity to identify those as cyanosed. The images were assessed for reality by a panel of four instructors from the NSW Ambulance Service training section. The images were displayed singly and the observer was required to identify if the person was cyanosed or not. Color normal subjects comprised 32 experienced ambulance officers and 27 new recruits. Twenty-seven color deficient subjects (non-NSW Ambulance Service) were examined. The recruits were less accurate and slower at identifying the cyanosed images and the color vision deficient were less accurate and slower still. The identification of cyanosis is a skill that improves with training and is adversely affected in color deficient observers.