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