Skin Pigmentation Influence on Pulse Oximetry Accuracy: A Systematic Review and Bibliometric Analysis

Abstract

Nowadays, pulse oximetry has become the standard in primary and intensive care units, especially as a triage tool during the current COVID-19 pandemic. Hence, a deeper understanding of the measurement errors that can affect precise readings is a key element in clinical decision-making. Several factors may influence the accuracy of pulse oximetry, such as skin color, body temperature, altitude, or patient movement. The skin pigmentation effect on pulse oximetry accuracy has long been studied reporting some contradictory conclusions. Recent studies have shown a positive bias in oxygen saturation measurements in patients with darkly pigmented skin, particularly under low saturation conditions. This review aims to study the literature that assesses the influence of skin pigmentation on the accuracy of these devices. We employed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement to conduct a systematic review retrospectively since February 2022 using WOS, PubMed, and Scopus databases. We found 99 unique references, of which only 41 satisfied the established inclusion criteria. A bibliometric and scientometrics approach was performed to examine the outcomes of an exhaustive survey of the thematic content and trending topics.

Keywords: accuracy; oxygen saturation; photoplethysmography; pulse oximetry; skin pigmentation.

Figure 2

Risk of bias assessment in individual studies judged according QUADAS−2. The right column shows the qualitative final conclusion reported by the selected studies [17,21,23,30,38,41,42,43,44,45,46,47,48,50,51,53,56,69,70,71,72,75,76,77,78,79,80,81,82,84,87,88,89,93] regarding the existence of inaccuracy related to skin pigmentation.

Figure 1

Flowchart consistent with preferred reporting items for systematic reviews (PRISMA) statement.

Figure 3

Annual publication trend of selected documents retrieved from Scopus, Pubmed and WOS between 1976 and 2022. A blue dashed line denotes the average $\overline{TC}$ per year.

Figure 4

Network map of average co-occurrence citation of the most relevant keywords and dynamic view over time.