University of Manitoba professors are making headlines around the world for a recent discovery that a frequently used medical care device provides inaccurate results for people of colour, leading doctors to perform possibly damaging actions.
In July, Dr. Barret Rush, assistant professor of critical care, and Dr. Jennifer Zielger, critical care fellow, both in the department of internal medicine in the Max Rady College of Medicine at the University of Manitoba (UM) formed a study that shows Black, Asian and Hispanic patients receive less supplemental oxygen than white patients.
The study, called Assessment of Racial and Ethnic Differences in Oxygen Supplementation Among Patients in the Intensive Care Unit, was then released this month in JAMA Internal Medicine and was led by Dr. Eric Raphael Gottlieb and Dr. Leo Celi from Harvard Medical School and Massachusetts Institute of Technology, respectively.
In a media release sent out by the UM on August 3, it is said that they found the discrepancy to be associated with a flaw in the design of the fingertip device used to measure oxygen in the blood. A patient's oxygen level in their blood is measured by the device producing a beam of light through the finger once it is clamped onto the finger.
The device is previously known to provide inaccurate readings due to pigmentation, whether it is skin colour or nail polish. However, the study by Dr. Rush and Dr. Ziegler is the first to gather evidence on its effect on patient care.
The release even states that there have been "several studies that have shown that pulse oximeters overestimate the oxygen levels of non-white patients."
"This shows that systemic racism is built into the technology we use and affects health-care outcomes for minorities," says Rush. "Not only is our medical technology giving us biased and incorrect information, but clinicians also use that inaccurate information to make clinical decisions that cause harm."
Elements of the study included reviewing anonymous data for more than 3,000 seriously ill patients who were placed in a hospital intensive care unit in Boston, Massachusetts, from 2008 to 2019. Dr. Rush and Dr. Ziegler found that pulse oximeters overestimated oxygen levels of Black, Asian and Hispanic patients and that the patients received less oxygen than they should have.
It was this discovery that allowed the two doctors to progress with their studies.
The history of the oximeters is that they were created in the 1970s and trials of the device were used on mostly healthy white male patients. Dr. Rush focuses his research on health disparities in critical care and suggests that a recalibration of the medical device is in order.
"Technology is supposed to be objective. But we found that it still has biases towards non-white patients and that it's contributing to overall worse outcomes for non-white patients," he says. "Our ultimate goal is to identify barriers and improve the outcomes for these patients."
Patient data included results from both pulse oximeters and lab tests and the research team compared results from both procedures, by measuring blood samples. The result was that people of colour received less supplemental oxygen for a given oxygen saturation level, likely due to faulty oximeter readings.
"Pulse oximeters are in every hospital ward, clinic and emergency room," says Dr. Ziegler, who focuses her research on epidemiology and using "big data" in health care. "They're contributing to worse outcomes in non-white patients. That's something that should change."
The next steps include Dr. Rush and Dr. Ziegler, along with their Boston colleagues, consulting with bioengineers in the U.S., to discuss the solution to the issue of racial bias in pulse oximeter technologies.
This discovery has resulted in media attraction from all across the world, concluding CNN, BBC, NPR, Reuters, Good Morning America and over 100 more news outlets.