Objectives To evaluate measurement discrepancies by race between pulse oximetry and arterial oxygen saturation (as measured in arterial blood gas) among inpatients not in intensive care. Design Multicenter, retrospective cohort study using electronic medical records from general care medical and surgical inpatients. Setting Veteran Health Administration, a national and racially diverse integrated health system in the United States, from 2013 to 2019. Participants Adult inpatients in general care (medical and surgical), in Veteran Health Administration medical centers. Main outcomes measures Occult hypoxemia (defined as arterial blood oxygen saturation (SaO2) of <88% despite a pulse oximetry (SpO2) reading of ≥92%), and whether rates of occult hypoxemia varied by race and ethnic origin. Results A total of 30 039 pairs of SpO2-SaO2 readings made within 10 minutes of each other were identified during the study. These pairs were predominantly among non-Hispanic white (21 918 (73.0%)) patients; non-Hispanic black patients and Hispanic or Latino patients accounted for 6498 (21.6%) and 1623 (5.4%) pairs in the sample, respectively. Among SpO2 values greater or equal to 92%, unadjusted probabilities of occult hypoxemia were 15.6% (95% confidence interval 15.0% to 16.1%) in white patients, 19.6% (18.6% to 20.6%) in black patients (P<0.001 v white patients, with similar P values in adjusted models), and 16.2% (14.4% to 18.1%) in Hispanic or Latino patients (P=0.53 v white patients, P<0.05 in adjusted models). This result was consistent in SpO2-SaO2 pairs restricted to occur within 5 minutes and 2 minutes. In white patients, an initial SpO2-SaO2 pair with little difference in saturation was associated with a 2.7% (95% confidence interval −0.1% to 5.5%) probability of SaO2 <88% on a later paired SpO2-SaO2 reading showing an SpO2 of 92%, but black patients had a higher probability (12.9% (−3.3% to 29.0%)). Conclusions In general care inpatient settings across the Veterans Health Administration where paired readings of arterial blood gas (SaO2) and pulse oximetry (SpO2) were obtained, black patients had higher odds than white patients of having occult hypoxemia noted on arterial blood gas but not detected by pulse oximetry. This difference could limit access to supplemental oxygen and other more intensive support and treatments for black patients. Technical appendix and statistical code are available in appendix 2 and on GitHub. The dataset used for this analysis is not publicly available.

中文翻译：

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退伍军人健康管理局 2013-19 年普通护理内科和外科住院患者脉搏血氧饱和度的种族偏见和可重复性：多中心、回顾性队列研究

目的 评估非重症监护住院患者脉搏血氧饱和度和动脉血氧饱和度（通过动脉血气测量）之间的测量差异。使用普通护理医疗和外科住院患者的电子病历设计多中心、回顾性队列研究。背景 2013 年至 2019 年，退伍军人健康管理局是美国一个全国性的、种族多元化的综合卫生系统。参与者是在退伍军人健康管理局医疗中心接受一般护理（内科和外科手术）的成年住院患者。主要结果衡量隐匿性低氧血症（定义为动脉血氧饱和度 (SaO2) <88%，尽管脉搏血氧饱和度 (SpO2) 读数≥92%），以及隐匿性低氧血症的发生率是否因种族和民族血统而异。结果 在研究期间，总共识别出 30 039 对 SpO2-SaO2 读数，这些读数在 10 分钟内彼此相隔。这些对主要是非西班牙裔白人 (21 918 (73.0%)) 患者；非西班牙裔黑人患者和西班牙裔或拉丁裔患者分别占样本中的 6498 (21.6%) 和 1623 (5.4%) 对。在 SpO2 值大于或等于 92% 的情况下，白人患者隐匿性低氧血症的未调整概率为 15.6%（95% 置信区间 15.0% 至 16.1%），黑人患者为 19.6%（18.6% 至 20.6%）（P<0.001 v白人患者，在调整后的模型中具有相似的 P 值），在西班牙裔或拉丁裔患者中为 16.2%（14.4% 至 18.1%）（P=0.53 v 白人患者，在调整后的模型中 P<0.05）。该结果在限制在 5 分钟和 2 分钟内发生的 SpO2-SaO2 对中是一致的。在白人患者中，饱和度差异很小的初始 SpO2-SaO2 对与 2.7%（95% 置信区间 -0.1% 至 5.5%）相关，在后来配对的 SpO2-SaO2 读数显示 SpO2 为 92% 时，SaO2 <88% 的概率，但黑人患者的概率更高（12.9%（-3.3% 至 29.0%））。结论 在获得动脉血气 (SaO2) 和脉搏血氧饱和度 (SpO2) 成对读数的退伍军人健康管理局的一般护理住院环境中，黑人患者比白人患者更容易出现动脉血气上发现但未检测到的隐匿性低氧血症通过脉搏血氧仪。这种差异可能会限制黑人患者获得补充氧气和其他更强化的支持和治疗。附录 2 和 GitHub 上提供了技术附录和统计代码。