Authors: Starnes, Joseph R. et al.
Anesthesiology November 2025 | DOI: 10.1097/ALN.0000000000005738
This study examined how skin tone influences the accuracy of near-infrared spectroscopy (NIRS) readings in children, addressing concerns similar to those previously identified in pulse oximetry. Using the Medtronic INVOS 5100C NIRS system, the research team enrolled 110 pediatric patients under 21 years old undergoing cardiac catheterization. Skin tone was quantified objectively through spectrophotometry using the individual typology angle (ITA). NIRS readings from the forehead were compared against mixed venous oxygen saturation to assess bias and accuracy.
Results revealed that darker skin tones were associated with a significantly greater negative bias in NIRS readings. For patients in ITA categories 5–6 (darker tones), the mean bias was −12.8%, compared to −2.5% in medium tones (ITA 3–4) and 0.3% in lighter tones (ITA 1–2). These differences—up to 13%—were statistically significant (P < 0.001). Multivariable regression confirmed ITA as an independent predictor of NIRS bias (coefficient = 0.173, P < 0.001).
The findings indicate that the INVOS 5100C NIRS device systematically underestimates oxygen saturation in children with darker skin tones, which could lead to misinterpretation of tissue oxygenation and potentially inequitable clinical management. The authors call for improved device calibration and validation standards to ensure equitable accuracy across diverse populations.
What You Should Know
NIRS monitoring, like pulse oximetry, can produce misleadingly low readings in patients with darker skin. These biases may affect treatment decisions and outcomes, underscoring the need for standardized testing and calibration across skin tone ranges in pediatric monitoring devices.
What This Article Tells Us That Is New
When using the Medtronic (USA) INVOS 5100C system in children, darker skin tone is associated with worse NIRS performance and lower NIRS values compared to mixed venous saturation
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