Thread by @WesElyMD

1/🧵 Race & Medicine - #COVID

Dark-skinned people who get #COVID, or any disease lowering O2 levels, are more likely vs whites to suffer undetected hypoxemia (missed ⬇️ O2 levels).

Pulse oximeters are affected by skin color & read falsely high in Blacks.

Does it matter?

2/ It matters because undetected hypoxemia tripled the odds of DEATH 💀
 
This study of >128k measurements from 26,000 pts confirmed these inaccuracies that we’ve known about for 30 years.

Black, Asian & Am Indians were all included. #Disparity
 
bit.ly/3KaNAAj

3/ It’s not lost on me that this study comes at a time when we’re trying to get RID of false distinctions of race in medicine.

MYTHS generated by #racism about Blacks having different lung or kidney function are bogus.

But the Pulse Ox must addressed: bit.ly/3uZIrEG

4/ Knowledge about racial differences in occult hypoxemia could erode trust in the healthcare system among some in the Black community, a racial group that has historically experienced unfair & biased treatment by the medical community
 
bit.ly/35GZMts

5/ The authors offer 2 examples of how to approach this:
 
Eg, order a arterial blood gas (ABG) (by drawing blood) on a semi-arousable Black patient who had a recent appendectomy and is coughing w Pulse Ox sat of 94% while getting oxygen via a nasal canula.

6/ Similarly, one might consider ordering an ABG panel on a Black patient admitted to the ICU with #COVID receiving O2 supplementation w high-flow nasal cannula who is able to speak but is mildly short of breath who has a Pulse Ox sat of 95%.

7/ In this @JAMA_current study, 21.1% of Black children experienced arterial hypoxemia despite a normal SpO2 reading

bit.ly/3JqdoY9

8/fin
Pulse ox doesn’t invoke racial bias in a social sense.

Differences in occult hypoxemia by race are consequences of measurement bias.
 
Let’s add this to the list of #RacialDisparities & get companies to ⬆️ precision & calibration across skin color.

bit.ly/3KeOOum