Assessing Clinical Deterioration in Children With Dark-Coloured Skin: A Scoping Review.
Chelsea Kelly, Gavin D Leslie, Pamela Laird and 2 others
PMID 40801333WHAT IT FOUND
Assessing clinical deterioration in children with dark skin remains difficult due to a lack of high-quality evidence.
Transcutaneous bilirubin and pulse oximetry may overestimate levels in this group, but clinical impacts are unclear. Guidance for assessing mottling and capillary refill is missing.
Key findings
01Transcutaneous bilirubin measurements may overestimate levels in babies with dark-coloured skin, though the clinical implications of this error are not clearly established.
02Pulse oximetry may overestimate oxygen saturation in infants with dark-coloured skin, potentially masking hypoxia, although the difference was not statistically significant in one study.
03There is a complete lack of evidence or guidance on how to assess mottling, capillary refill time, or skin colour for APGAR scoring in children with dark skin.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The review included a high proportion of low-level evidence (expert opinion and non-systematic reviews). Skin colour classification in the included studies was often subjective or relied on race/ethnicity as a proxy, which is inaccurate. The search was limited to English-language documents. Critical appraisal of the included studies was omitted due to the scoping review methodology.
Declared interests
None reported.
The easy way to misread this
Do not assume that normal pulse oximetry or transcutaneous bilirubin readings are accurate in children with dark skin. The evidence suggests these devices may overestimate oxygen saturation and bilirubin levels in this group, potentially leading to missed hypoxia or untreated jaundice. Furthermore, do not rely on visual checks for mottling or capillary refill time, as there is no guidance on how to assess these in dark skin.