The Impact of Skin Tone on Pulse Oximetry Accuracy in Pediatric Patients

Researchers at Vanderbilt University Medical Center recently found that pulse oximetry in pediatric patients with darker skin tones may overvalue oxygen saturation, which can lead to undertreatment of hypoxemia.

Findings from the Pulse Oximetry and Skin Tone in Children (POSTer-Child) study were published in a letter to the editor of The New England Journal of Medicine. First author Joseph Starnes, MD, MPH, is a fellow in Pediatric Cardiology at VUMC.

A press release on the study said, “The study reviewed oxygen saturation determined by two commonly used pulse oximetry devices in 320 patients under age 21 who underwent cardiac catheterization at VUMC in 2024.

“One of the devices failed to detect low oxygen levels, a situation known as ‘occult hypoxemia,’ in 7% of patients with the darkest skin tone, compared to zero percent of those with the lightest skin tone.”

Starnes and his colleagues concluded that current FDA guidelines are inadequate to ensure the accuracy of pulse oximetry, and that additional research is needed. New guidelines are currently under consideration.