Pulse Oximetry and Arterial Saturation Difference in Pediatric COVID-19 Patients: Retrospective Analysis by Race* : Pediatric Critical Care Medicine

Journal Logo

Feature Articles

Pulse Oximetry and Arterial Saturation Difference in Pediatric COVID-19 Patients: Retrospective Analysis by Race*

Savorgnan, Fabio MD1; Hassan, Adel BS2; Borges, Nirica MD1; Acosta, Sebastian PhD3

Author Information
Pediatric Critical Care Medicine 24(6):p 458-462, June 2023. | DOI: 10.1097/PCC.0000000000003208



Pulse oximetry (Spo2) may overestimate arterial oxygen saturation (Sao2) in blood laboratory testing. This study aimed to assess Spo2–Sao2 difference in relation to race (i.e., patient self-reporting as Black or White), occult hypoxemia, and length of stay (LOS) in pediatric patients with COVID-19.


Single-center retrospective study in pediatric COVID-19 patients. We used multivariable linear regressions to examine the association between race and oximetry measurements and between occult hypoxemia and LOS. Oximetry bias was defined using Spo2 and Sao2 data according to approved comparisons. Occult hypoxemia was defined as Spo2 greater than 92% and Sao2 less than 88%.


Quaternary pediatric hospital.


Pediatric COVID-19 patients admitted to Texas Children’s Hospital between May 2020 and December 2021.



Measurements and Main Results: 

There were 2713 patients with complete physiological data in the analysis. Of the total, 61% were Black, and 39% were White. Oximetry bias was greater in Black compared with White patients (p < 0.001), and this bias increased as the oxygen saturations decreased (p < 0.001). Black and White patients had a 12% and 4% prevalence of occult hypoxemia, respectively (p < 0.001). LOS was not associated with oximetry bias or occult hypoxemia once controlled for the level of support (intensive care, respiratory, circulatory).


We found an oximetry bias in the measurement of Spo2 with respect to Sao2 in symptomatic hospitalized pediatric patients with the diagnosis of COVID-19. Furthermore, race is related to an increased oximetry bias. However, we did not find a relationship between oximetry bias and the LOS in the hospital in this cohort of patients.

Copyright © 2023 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies

Full Text Access for Subscribers:

You can read the full text of this article if you:

Access through Ovid