Association Between Race and Pulse Oximetry Calibration in Children With Congenital Heart Disease

Tuesday, March 24, 2026

8:45 AM - 9:45 AM Central Time

Location: Connections Central - RST 07

AF

Alexandra Fountaine, DO (she/her/hers)

Ohio

Disclosure(s): No relevant financial relationship(s) to disclose.
JP

Jonathan Pelletier, MD, MS

Pediatric Critical Care Attending
Akron Children's Hospital

Disclosure information not submitted.
TK

Tara Karamlou, MD, MSc

Cardiothoracic Surgeon
Akron Children's Hospital

Disclosure information not submitted.
CH

Claire Hanson, MD

Pediatric Intensivist
Akron Children's Hospital

Disclosure information not submitted.
PR

Patricia Raimer, MD

Pediatric Intensivist
Akron Children's Hospital

Disclosure information not submitted.
DG

David Gannon, N/A

Lab Analyst
Akron Children's Hospital

Disclosure information not submitted.
MF

Michael Forbes, MD

Chief Academic Officer
Akron Children's Hospital

Disclosure information not submitted.
SR

Sarah Rush, MD

VP Medical Informatics
Akron Children's Hospital

Disclosure information not submitted.

Introduction: Management of children with congenital heart disease depends on accurate estimation of arterial oxygen saturation (SaO2). Two small single-center studies have suggested that pulse oximetry is less accurate in hypoxemic children of black race. We sought to confirm this relationship in a multicenter database.

Methods: This retrospective cohort analysis extracted data from Cosmos, an Epic-specific database including over 1,700 hospitals. We included simultaneous arterial saturation (SaO2) and pulse oximetry (SpO2) readings within 2 minutes from encounters for children < 18 years old of black or white race (based on EHR demographics) with a cardiovascular complex chronic condition since 1/1/2020. To prevent misclassification of venous blood gases as arterial, we used the SaO2 with the smallest absolute SpO2-SaO2 for a given time point and excluded values where SaO2 was < 70%. We excluded children with multiple races, and those with only a patent ductus arteriosus. The cohort was described with summary statistics. SpO2-SaO2 differences were reported. Differences in SpO2-SaO2 by race were reported using Wilcoxon rank-sum tests and chi-square tests.

Results: There were 22,512 included simultaneous SpO2/SaO2 readings across 9,301 encounters among 8,908 patients. The median (IQR) age was 3 (0-39) months. 9,812/22,512 (43.6%) of readings were on female patients, and 5,878/22,512 (24.8%) were on patients of black race. The median SaO2 readings were similar between black and white patients (96.0% [90.7%-98.8%] vs. 96.2% [91.0-98.7%], p = 0.83). SpO2-SaO2 differences increased with progressive hypoxemia. The median SpO2-SaO2 difference for SaO2 readings >=95% was 0.0% (-1.3%, 1.0%). The median SpO2-SaO2 difference for SaO2 readings 80-84% was 8.0% (2.7%, 12.0%). Racial differences also increased with progressive hypoxemia; among SaO2 readings >=95%, 5.1% of white patients and 4.6% of black patients had SpO2-SaO2 differences >=5% (p = 0.32). However, among SaO2 readings 80-84%, 50.6% of white patients and 60.0% of black patients had SpO2-SaO2 differences >=5% (p < 0.001).

Conclusions: Pulse oximetry bias and racial disparities increased with progressive hypoxemia. Clinicians should interpret pulse oximetry with caution in cyanotic congenital heart disease.