Racial disparities in pulse oximetry: measurement bias and clinical implications—a systematic review

Abstract

This review synthesised existing evidence on racial disparities in pulse oximeter accuracy, quantified the degree of bias, evaluated clinical effects, highlighted implications for practice, and identified research priorities needed to achieve equitable device performance. While prior systematic reviews have examined pulse oximeter accuracy across varying skin pigmentation levels, most have focused primarily on aggregate accuracy metrics without integrating downstream clinical consequences or anaesthesiology-specific implications. In contrast, this review synthesises paired SpO₂–SaO₂ comparisons stratified by race or skin tone and explicitly links measurement bias to occult hypoxaemia, treatment escalation thresholds, and perioperative decision-making. By integrating device-level performance characteristics with clinical risk pathways, this review aims to provide actionable insights for anaesthesiologists and critical care clinicians.