Discrepancy between arterial oxygen saturation and pulse oximetry measurement in a Chinese pediatric patient cohort

Increasing evidence suggest a racial bias in pulse oximetry measurement, but this was under investigated in Asian pediatric populations.

Via the Pediatric Intensive Care database, this retrospective study included pediatric patient records of arterial oxygen saturation (SaO₂) and oxygen saturation on pulse oximetry (SpO₂) measured within 10 min. Discrepancy was examined, and potential predictors of occult hypoxemia (defined as SaO₂ <88% with the paired SpO₂ ≥92%) as well as its association with outcomes were explored by logistic regression.

A total of 390 patients were included with 454 pairs of SaO₂-SpO₂ readings. The study population consisted of Han Chinese (99.0%) and 43.6% were female. Occult hypoxemia was observed in 20.0% of the patients, with a mean SaO₂ of 71.4 ± 15.8%. Potential predictors of occult hypoxemia included female, being first admitted to cardiac ICU, congenital heart disease, increased heart rate, while patients with prior surgery records were less likely to experience occult hypoxemia. Patients with occult hypoxemia had numerically higher in-ICU mortality (16.7% versus 10.9%) and in-hospital mortality (17.9% versus 10.9%), but the associations were not statistically significant.

There was a substantial proportion of hypoxemia that was not detected by pulse oximetry in the Chinese pediatric patients, which might be predicted by several characteristics and seemed to associate with mortality.