Racial and Ethnic Disparities in Identification of Cyanosis in ICU Settings

Cyanosis is a discoloration of the skin arising from deoxygenated hemoglobin in the blood, caused by heart, lung, and blood diseases and treated with interventions including supplemental oxygen therapy. Cyanosis presents as a bluish discoloration in light-skinned patients, but as a gray or white discoloration in dark-skinned patients. While prior work hints at the under-identification of cyanosis for people with black and brown skin, in this study, we quantify differences in cyanosis identification rates and associated clinical treatments by race/ethnicity. Leveraging EHR datasets from two hospital systems, we extract cyanosis mentions from clinical notes and compare cyanosis documentation rates by documented race/ethnicity. Cyanosis documentation was significantly less frequent for Black patients than White patients after adjusting for confounders. We measure impacts of cyanosis identification on provision of oxygen, vasopressors, and fluids. Adjusting for severity of a patient's condition, documentation of cyanosis was associated with faster provision of oxygen.