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SURF PROPOSAL:
MEDICAL INEQUALITY, PULSE OXIMETER USE IN DARK-SKINNED INDIVIDUALS
Madison RackearThe University of North Carolina at Chapel Hill
Background:
Pulse Oximetry
• Measure heart rate and oxygen saturation in area of pulsatile blood flow using light
• Transmission-probed oximeters: light emitter and receptor on opposite sides of body part
• Reflectance-probed oximeters: light emitter and receptor on same side of body part
• Low cost and easy use led to oximeters being widely used in third-world countries, developing medicine
The Problem:
Medical Inequality
• Interferences with light transmission or absorption can cause errors in readings
• Includes sufficiently dark skin pigmentation
• Dark-skinned individuals more likely to experience overestimates of SpO2 at levels <
80% (Feiner et. al. 2007)
• Problem extends overseas into disproportionately large groups of dark-skinned peoples
My Approach:
A Comparative
Study
• Determine if transmission-probed or reflectance-probed oximeters can decrease inaccuracies
• Creation of patient groups at UNC Hospitals
– Patients selected based on likelihood that SpO2
will fall below 80%
– Individuals divided based on skin albedo
• Each receive three oxygen saturation tests:
– Baseline assessment using arterial blood gas
– Transmission-probed oximeter reading
– Reflectance-probed oximeter reading
Variable Correlation
:
Data Analysis
• Determine accuracy of each pulse oximeter for each individual by comparing oximeter readings to arterial blood gas reading
• Use of two groups to view data on large scale:
– Examine data for accuracy across groups based on skin albedo
– Create new categories based on “true” SpO2
readings and compare accuracy data across these groups
• Evaluate statistically significant correlation among variables
Significance:
Dissemination Plan
• Greatly improve health care standards among already marginalized group of people
• Improve many developing countries’ ability to detect and treat diseases in their early stages
• Determine statistically significant differences in accuracy of oxygen saturation readings in two types of oximeters when used on dark-skinned patients
• Write and attempt to publish paper concerning findings
Breakdown:
Budget and Timeline
Budget:
Oximetry & Other Lab Equipment$200
On-Campus Summer Housing$1100
Patient Monetary Incentive $400
Timeline:
Week 1 Identify Patient Groups
Weeks 2 – 4 Collect Patient Data
Weeks 5 – 6 Data Analysis
Weeks 7 – 8 Develop and Finalize Deliverables
Qualifications:
Past Experience &
Interest
• AP Physics Final Thesis, Spring 2015
– Focused on identifying cause of technological issues for tattooed Apple watch users
– Watch utilizes pulse oximetry, interference from tattoo ink was origin of problems
– For final thesis, proposed innovative design to eliminate problems in accuracy
• High Quality Home Therapy Internship, Summer 2015
– Firsthand patient experience
– Patients of all backgrounds, with all medical problems
• Chronic headaches, Alzheimer’s, mental disabilities, physical trauma
– HIPPA trained and certified
References:
• Feiner, J.R., Severinghaus, J.W., Bickler, P.E. (2007). Dark skin decreases the accuracy of pulse oximeters at low oxygen saturation. Anesthesia & Analgesia, 105 (6), S18-23. http://www.ncbi.nlm.nih.gov/pubmed/18048893.
• Korol, B., Bergfeld, G.R., Goldman, H., McLaughlin, J. (1977). Use of the pigmentometer, a new device for measuring skin albedo. The Pavlovian Journal of Biological Science, 12 (1), 19-31. http://www.ncbi.nlm.nih.gov/pubmed/857232.
List of Scholarships and Honors:
• AP Scholar Award
• President’s Award for Educational Excellence
• Mount Holyoke College Book Award
• Yale Physics Olympics Honorable Mention
• National Merit Scholarship Committee Commended Student
• National Honor Society
• Math Honor Society
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