Abstract

There are anecdotal reports that the recognition of cyanosis is difficult for some color-deficient observers. The chromaticity changes of blood with oxygenation in vitro lie close to the dichromatic confusion lines. The chromaticity changes of lips and nail beds measured in vivo are also generally aligned in the same way. Experiments involving visual assessment of cyanosis in vivo are fraught with technical and ethical difficulties A single lower face image of a healthy individual was digitally altered to produce levels of simulated cyanosis. The color change is essentially one of saturation. Some images with other color changes were also included to ensure that there was no propensity to identify those as cyanosed. The images were assessed for reality by a panel of four instructors from the NSW Ambulance Service training section. The images were displayed singly and the observer was required to identify if the person was cyanosed or not. Color normal subjects comprised 32 experienced ambulance officers and 27 new recruits. Twenty-seven color deficient subjects (non-NSW Ambulance Service) were examined. The recruits were less accurate and slower at identifying the cyanosed images and the color vision deficient were less accurate and slower still. The identification of cyanosis is a skill that improves with training and is adversely affected in color deficient observers.

© 2014 Optical Society of America

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References

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  2. S. Raza and A. Kumar, “Blue fingers and lips on an acute medical take,” N. Z. Med. J. 122, 65–66 (2009).
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    [CrossRef]
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    [CrossRef]
  5. O. W. Van Assendelft, Spectrophotometry of Haemoglobin Derivatives (Royal Vancorum, 1970).
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  7. , “Interior lighting Part 2.5 hospital and medical tasks,” Sydney: Standards Australia/Standards New Zealand, 1997.
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    [CrossRef]
  9. J. A. Spalding, “The doctor with an inherited defect of colour vision: effect on clinical skills,” Br. J. Gen. Practice 43, 32–33 (1993).
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    [CrossRef]
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    [CrossRef]
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2013

R. D. Branson and J. A. Johannigman, “Pre-hospital oxygen therapy,” Respir. Care 58, 86–97 (2013).
[CrossRef]

2010

R. McNamara, C. M. Taylor, D. K. McKenzie, M. T. Coroneo, and S. J. Dain, “Colour change in cyanosis and the confusions of congenital colour vision deficient observers,” Ophthalmic Physiol. Opt. 30, 699–704 (2010).
[CrossRef]

2009

S. Raza and A. Kumar, “Blue fingers and lips on an acute medical take,” N. Z. Med. J. 122, 65–66 (2009).

2006

A. New, “Oxygen: kill or cure? Prehospital hyperoxia in the COPD patient,” Emerg. Med. J. 23, 144–146 (2006).
[CrossRef]

2004

J. A. Spalding, “Confessions of a colour blind physician,” Clin. Exp. Optometry 87, 344–349 (2004).

1998

S. J. Dain, J. W. Hood, S. Montano, and C. Arali, “A method for evaluating the acceptability of light sources for clinical visual evaluation of cyanosis,” Color Res. Appl. 23, 4–17 (1998).
[CrossRef]

S. J. Dain and J. W. Hood, “Lighting for cyanosis identification,” Lighting 65, 18–24 (1998).

S. J. Dain, J. W. Hood, S. Montano, and C. Arali, “A method for evaluating the acceptability of light sources for clinical visual evaluation of cyanosis,” Color Res. Appl. 23, 4–17 (1998).
[CrossRef]

1997

1993

J. A. Spalding, “The doctor with an inherited defect of colour vision: effect on clinical skills,” Br. J. Gen. Practice 43, 32–33 (1993).

1991

P. A. Lovett, M. B. Halstead, and A. R. Hill, “The effect on clinical judgements of new types of fluorescent lamps. II. Colour measurement and statistical analysis,” Lighting Res. Technol. 23, 53–67 (1991).
[CrossRef]

P. A. Lovett, M. B. Halstead, and A. R. Hill, “The effect on clinical judgements of new types of fluorescent lamps: further statistical analysis leading to a new specification for lamps,” Lighting Res. Technol. 23, 69–80 (1991).
[CrossRef]

P. A. Lovett, M. B. Halstead, A. R. Hill, D. A. Palmer, T. S. Sonnex, and M. R. Pointer, “The effect on clinical judgements of new types of fluorescent lamps. I. Experimental arrangements and clinical results,” Lighting Res. Technol. 23, 35–51 (1991).
[CrossRef]

Arali, C.

S. J. Dain, J. W. Hood, S. Montano, and C. Arali, “A method for evaluating the acceptability of light sources for clinical visual evaluation of cyanosis,” Color Res. Appl. 23, 4–17 (1998).
[CrossRef]

S. J. Dain, J. W. Hood, S. Montano, and C. Arali, “A method for evaluating the acceptability of light sources for clinical visual evaluation of cyanosis,” Color Res. Appl. 23, 4–17 (1998).
[CrossRef]

Branson, R. D.

R. D. Branson and J. A. Johannigman, “Pre-hospital oxygen therapy,” Respir. Care 58, 86–97 (2013).
[CrossRef]

Brettel, H.

Casolin, A.

S. J. Dain, A. Casolin, J. Long, and M. R. Hilmi, “Colour vision and the railways: 1. The Railway LED Lantern Test,” Optom. Vis. Sci. (submitted).

Coroneo, M. T.

R. McNamara, C. M. Taylor, D. K. McKenzie, M. T. Coroneo, and S. J. Dain, “Colour change in cyanosis and the confusions of congenital colour vision deficient observers,” Ophthalmic Physiol. Opt. 30, 699–704 (2010).
[CrossRef]

Dain, S. J.

R. McNamara, C. M. Taylor, D. K. McKenzie, M. T. Coroneo, and S. J. Dain, “Colour change in cyanosis and the confusions of congenital colour vision deficient observers,” Ophthalmic Physiol. Opt. 30, 699–704 (2010).
[CrossRef]

S. J. Dain, J. W. Hood, S. Montano, and C. Arali, “A method for evaluating the acceptability of light sources for clinical visual evaluation of cyanosis,” Color Res. Appl. 23, 4–17 (1998).
[CrossRef]

S. J. Dain, J. W. Hood, S. Montano, and C. Arali, “A method for evaluating the acceptability of light sources for clinical visual evaluation of cyanosis,” Color Res. Appl. 23, 4–17 (1998).
[CrossRef]

S. J. Dain and J. W. Hood, “Lighting for cyanosis identification,” Lighting 65, 18–24 (1998).

S. J. Dain, A. Casolin, J. Long, and M. R. Hilmi, “Colour vision and the railways: 1. The Railway LED Lantern Test,” Optom. Vis. Sci. (submitted).

Halstead, M. B.

P. A. Lovett, M. B. Halstead, A. R. Hill, D. A. Palmer, T. S. Sonnex, and M. R. Pointer, “The effect on clinical judgements of new types of fluorescent lamps. I. Experimental arrangements and clinical results,” Lighting Res. Technol. 23, 35–51 (1991).
[CrossRef]

P. A. Lovett, M. B. Halstead, and A. R. Hill, “The effect on clinical judgements of new types of fluorescent lamps: further statistical analysis leading to a new specification for lamps,” Lighting Res. Technol. 23, 69–80 (1991).
[CrossRef]

P. A. Lovett, M. B. Halstead, and A. R. Hill, “The effect on clinical judgements of new types of fluorescent lamps. II. Colour measurement and statistical analysis,” Lighting Res. Technol. 23, 53–67 (1991).
[CrossRef]

Hill, A. R.

P. A. Lovett, M. B. Halstead, and A. R. Hill, “The effect on clinical judgements of new types of fluorescent lamps. II. Colour measurement and statistical analysis,” Lighting Res. Technol. 23, 53–67 (1991).
[CrossRef]

P. A. Lovett, M. B. Halstead, and A. R. Hill, “The effect on clinical judgements of new types of fluorescent lamps: further statistical analysis leading to a new specification for lamps,” Lighting Res. Technol. 23, 69–80 (1991).
[CrossRef]

P. A. Lovett, M. B. Halstead, A. R. Hill, D. A. Palmer, T. S. Sonnex, and M. R. Pointer, “The effect on clinical judgements of new types of fluorescent lamps. I. Experimental arrangements and clinical results,” Lighting Res. Technol. 23, 35–51 (1991).
[CrossRef]

Hilmi, M. R.

S. J. Dain, A. Casolin, J. Long, and M. R. Hilmi, “Colour vision and the railways: 1. The Railway LED Lantern Test,” Optom. Vis. Sci. (submitted).

Hood, J. W.

S. J. Dain, J. W. Hood, S. Montano, and C. Arali, “A method for evaluating the acceptability of light sources for clinical visual evaluation of cyanosis,” Color Res. Appl. 23, 4–17 (1998).
[CrossRef]

S. J. Dain, J. W. Hood, S. Montano, and C. Arali, “A method for evaluating the acceptability of light sources for clinical visual evaluation of cyanosis,” Color Res. Appl. 23, 4–17 (1998).
[CrossRef]

S. J. Dain and J. W. Hood, “Lighting for cyanosis identification,” Lighting 65, 18–24 (1998).

Johannigman, J. A.

R. D. Branson and J. A. Johannigman, “Pre-hospital oxygen therapy,” Respir. Care 58, 86–97 (2013).
[CrossRef]

Kumar, A.

S. Raza and A. Kumar, “Blue fingers and lips on an acute medical take,” N. Z. Med. J. 122, 65–66 (2009).

Long, J.

S. J. Dain, A. Casolin, J. Long, and M. R. Hilmi, “Colour vision and the railways: 1. The Railway LED Lantern Test,” Optom. Vis. Sci. (submitted).

Lovett, P. A.

P. A. Lovett, M. B. Halstead, A. R. Hill, D. A. Palmer, T. S. Sonnex, and M. R. Pointer, “The effect on clinical judgements of new types of fluorescent lamps. I. Experimental arrangements and clinical results,” Lighting Res. Technol. 23, 35–51 (1991).
[CrossRef]

P. A. Lovett, M. B. Halstead, and A. R. Hill, “The effect on clinical judgements of new types of fluorescent lamps: further statistical analysis leading to a new specification for lamps,” Lighting Res. Technol. 23, 69–80 (1991).
[CrossRef]

P. A. Lovett, M. B. Halstead, and A. R. Hill, “The effect on clinical judgements of new types of fluorescent lamps. II. Colour measurement and statistical analysis,” Lighting Res. Technol. 23, 53–67 (1991).
[CrossRef]

McKenzie, D. K.

R. McNamara, C. M. Taylor, D. K. McKenzie, M. T. Coroneo, and S. J. Dain, “Colour change in cyanosis and the confusions of congenital colour vision deficient observers,” Ophthalmic Physiol. Opt. 30, 699–704 (2010).
[CrossRef]

McNamara, R.

R. McNamara, C. M. Taylor, D. K. McKenzie, M. T. Coroneo, and S. J. Dain, “Colour change in cyanosis and the confusions of congenital colour vision deficient observers,” Ophthalmic Physiol. Opt. 30, 699–704 (2010).
[CrossRef]

Mollon, J. D.

Montano, S.

S. J. Dain, J. W. Hood, S. Montano, and C. Arali, “A method for evaluating the acceptability of light sources for clinical visual evaluation of cyanosis,” Color Res. Appl. 23, 4–17 (1998).
[CrossRef]

S. J. Dain, J. W. Hood, S. Montano, and C. Arali, “A method for evaluating the acceptability of light sources for clinical visual evaluation of cyanosis,” Color Res. Appl. 23, 4–17 (1998).
[CrossRef]

New, A.

A. New, “Oxygen: kill or cure? Prehospital hyperoxia in the COPD patient,” Emerg. Med. J. 23, 144–146 (2006).
[CrossRef]

Palmer, D. A.

P. A. Lovett, M. B. Halstead, A. R. Hill, D. A. Palmer, T. S. Sonnex, and M. R. Pointer, “The effect on clinical judgements of new types of fluorescent lamps. I. Experimental arrangements and clinical results,” Lighting Res. Technol. 23, 35–51 (1991).
[CrossRef]

Pointer, M. R.

P. A. Lovett, M. B. Halstead, A. R. Hill, D. A. Palmer, T. S. Sonnex, and M. R. Pointer, “The effect on clinical judgements of new types of fluorescent lamps. I. Experimental arrangements and clinical results,” Lighting Res. Technol. 23, 35–51 (1991).
[CrossRef]

Raza, S.

S. Raza and A. Kumar, “Blue fingers and lips on an acute medical take,” N. Z. Med. J. 122, 65–66 (2009).

Sonnex, T. S.

P. A. Lovett, M. B. Halstead, A. R. Hill, D. A. Palmer, T. S. Sonnex, and M. R. Pointer, “The effect on clinical judgements of new types of fluorescent lamps. I. Experimental arrangements and clinical results,” Lighting Res. Technol. 23, 35–51 (1991).
[CrossRef]

Spalding, J. A.

J. A. Spalding, “Confessions of a colour blind physician,” Clin. Exp. Optometry 87, 344–349 (2004).

J. A. Spalding, “The doctor with an inherited defect of colour vision: effect on clinical skills,” Br. J. Gen. Practice 43, 32–33 (1993).

Taylor, C. M.

R. McNamara, C. M. Taylor, D. K. McKenzie, M. T. Coroneo, and S. J. Dain, “Colour change in cyanosis and the confusions of congenital colour vision deficient observers,” Ophthalmic Physiol. Opt. 30, 699–704 (2010).
[CrossRef]

Van Assendelft, O. W.

O. W. Van Assendelft, Spectrophotometry of Haemoglobin Derivatives (Royal Vancorum, 1970).

Viénot, F.

Br. J. Gen. Practice

J. A. Spalding, “The doctor with an inherited defect of colour vision: effect on clinical skills,” Br. J. Gen. Practice 43, 32–33 (1993).

Clin. Exp. Optometry

J. A. Spalding, “Confessions of a colour blind physician,” Clin. Exp. Optometry 87, 344–349 (2004).

Color Res. Appl.

S. J. Dain, J. W. Hood, S. Montano, and C. Arali, “A method for evaluating the acceptability of light sources for clinical visual evaluation of cyanosis,” Color Res. Appl. 23, 4–17 (1998).
[CrossRef]

S. J. Dain, J. W. Hood, S. Montano, and C. Arali, “A method for evaluating the acceptability of light sources for clinical visual evaluation of cyanosis,” Color Res. Appl. 23, 4–17 (1998).
[CrossRef]

Emerg. Med. J.

A. New, “Oxygen: kill or cure? Prehospital hyperoxia in the COPD patient,” Emerg. Med. J. 23, 144–146 (2006).
[CrossRef]

J. Opt. Soc. Am. A

Lighting

S. J. Dain and J. W. Hood, “Lighting for cyanosis identification,” Lighting 65, 18–24 (1998).

Lighting Res. Technol.

P. A. Lovett, M. B. Halstead, and A. R. Hill, “The effect on clinical judgements of new types of fluorescent lamps. II. Colour measurement and statistical analysis,” Lighting Res. Technol. 23, 53–67 (1991).
[CrossRef]

P. A. Lovett, M. B. Halstead, and A. R. Hill, “The effect on clinical judgements of new types of fluorescent lamps: further statistical analysis leading to a new specification for lamps,” Lighting Res. Technol. 23, 69–80 (1991).
[CrossRef]

P. A. Lovett, M. B. Halstead, A. R. Hill, D. A. Palmer, T. S. Sonnex, and M. R. Pointer, “The effect on clinical judgements of new types of fluorescent lamps. I. Experimental arrangements and clinical results,” Lighting Res. Technol. 23, 35–51 (1991).
[CrossRef]

N. Z. Med. J.

S. Raza and A. Kumar, “Blue fingers and lips on an acute medical take,” N. Z. Med. J. 122, 65–66 (2009).

Ophthalmic Physiol. Opt.

R. McNamara, C. M. Taylor, D. K. McKenzie, M. T. Coroneo, and S. J. Dain, “Colour change in cyanosis and the confusions of congenital colour vision deficient observers,” Ophthalmic Physiol. Opt. 30, 699–704 (2010).
[CrossRef]

Respir. Care

R. D. Branson and J. A. Johannigman, “Pre-hospital oxygen therapy,” Respir. Care 58, 86–97 (2013).
[CrossRef]

Other

O. W. Van Assendelft, Spectrophotometry of Haemoglobin Derivatives (Royal Vancorum, 1970).

S. J. Dain, A. Casolin, J. Long, and M. R. Hilmi, “Colour vision and the railways: 1. The Railway LED Lantern Test,” Optom. Vis. Sci. (submitted).

, “Interior lighting Part 2.5 hospital and medical tasks,” Sydney: Standards Australia/Standards New Zealand, 1997.

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Figures (6)

Fig. 1.
Fig. 1.

Twenty digitally altered images. Eighteen to reproduce the color changes in cyanosis and two idiosyncratic images as distractors.

Fig. 2.
Fig. 2.

Images of Fig. 1 rendered as the view of a deuteranope by the Vischeck plug-in for ImageJ (see text). The reduction of chromaticity difference compared with Fig. 1 is clearly evident.

Fig. 3.
Fig. 3.

Identification of cyanosis in the 20 images. Black bars are the images for which the consensus was uncyanosed. The gray bar is the image for which the observers were equally divided. The white bars are the images for which the consensus was cyanosed.

Fig. 4.
Fig. 4.

Color of a patch of lower lip, expressed as CIE a* and b*, as a function of the consensus decision on cyanosis.

Fig. 5.
Fig. 5.

Color of a patch of lower lip, expressed as CIE L* and c*, as a function of the consensus decision on cyanosis.

Fig. 6.
Fig. 6.

Error rates (corrected for guessing) as a function of c* for the three groups of observers.

Tables (1)

Tables Icon

Table 1. Completion Time to Rate 20 Images

Metrics