Am J Emerg Med. 2019 Jul 15;Epub ahead of print

# The utility of iPhone oximetry apps: A comparison with standard pulse oximetry measurement in the emergency department.

Jordan T, Meyers C, Schrading W, Donnelly J

OBJECTIVES: To determine if a correlation exists between 3 iphone pulse ox applications' measurements and the standard pulse oximetry (SpO2) and whether these applications can accurately determine hypoxia.

METHODS: Three applications reportedly measuring SpO2 were downloaded onto an iPhone 5s. Two of these applications used the onboard light and camera lens "Pulse Oximeter" (Pox) and "Heart Rate and Pulse Oximeter" (Ox) and one used an external device that plugged into the iphone (iOx). Patients in the ED were enrolled with chief complaints of cardiac/pulmonary origin or a SpO2 ≤ 94%. All measurements were compared to controls. Concordance correlation coefficients, sensitivity, and specificity were calculated.

RESULTS: A total of 191 patients were enrolled. The concordance correlation of iOx with control was 0.55 (CI 0.46, 0.63), POx was 0.01 (CI -0.09, 0.11), and Ox was 0.07 (CI -0.02, 0.15). 68/191 patients (35%) were found to have hypoxemia. Sensitivities for detecting hypoxia were 69%, 0%, and 7% for iOx, POx, and Ox, respectively. Specificities were 89%, 100%, and 89%. Even iOx (the most accurate) 21 (11%) were incorrectly classified nonhypoxic, and 22 (12%) were incorrectly classified hypoxic.

CONCLUSIONS: While iOx has modest concordance with control, Ox and POx showed almost none. The iOx device was best in correctly identifying hypoxia patients, but almost 1/4 of patients were incorrectly classified. The three apps provided inaccurate SpO2 measurements and had limited to no ability to accurately detect hypoxia. These apps should not be relied upon to provide accurate SpO2 measurements in emergent, even austere conditions.