Authors: Starnes JR, et al.
Anesthesiology ():10.1097/ALN.0000000000005738, August 29, 2025. doi:10.1097/ALN.0000000000005738
This prospective study evaluated the effect of skin tone on near-infrared spectroscopy (NIRS) performance in children undergoing cardiac catheterization. A total of 110 patients under 21 years old were enrolled, with skin tone quantified using spectrophotometry and categorized by individual typology angle (ITA). Forehead regional oxygen saturation measured by a Medtronic INVOS 5100C NIRS device was compared against mixed venous saturation.
Results showed that NIRS underestimated oxygen saturation more significantly in children with darker skin. Patients in ITA categories 5–6 (darker tones) had a mean bias of -12.8% compared to -2.5% in ITA 3–4 and 0.3% in ITA 1–2. Multivariable regression confirmed ITA as a strong predictor of NIRS bias (p<0.001).
What You Should Know:
NIRS technology, similar to pulse oximetry, demonstrates reduced accuracy in children with darker skin tones, underestimating oxygen saturation compared with mixed venous values. This bias could contribute to disparities in perioperative monitoring and outcomes. The findings highlight the urgent need for device validation standards that ensure equitable performance across diverse skin tones.
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Thank you to Anesthesiology for allowing us to use this article.