Trends in adverse events after IV administration of contrast media

Data collected from 1985 to 1999 on adverse events after the IV administration of contrast media were evaluated to identify trends.

Data collected on 391 adverse events after 90,473 administrations of iodinated contrast media and 19 events after 28,340 administrations of gadolinium were evaluated. Reactions were graded as mild, moderate, or severe. Data were also collected regarding contrast extravasation.

When only ionic iodinated contrast material was used, the adverse reaction rate was 6-8%. With the selective use of contrast material, the adverse reaction rate was 0.6% and 0.7%, respectively, for ionic and nonionic agents. The rate decreased to 0.2% with the universal use of nonionic agents. More than 90% of adverse reactions were allergic-like. Seven severe reactions (0.05%) and no deaths occurred in the ionic group. During the selective use period, one death occurred in the nonionic group. No severe reactions or deaths occurred during the first 5 years of universal nonionic use. Since then, 10 severe reactions (0.02%) and one death have occurred. Seven reactions occurred in patients after helical CT angiography. The extravasation rate for iodinated contrast material has remained constant at 0.3-0.4% annually. The adverse reaction rate to gadolinium contrast material was 0.06%.

Mild and moderate adverse events are more common with ionic contrast material than with nonionic. Most reactions are allergic-like. Severe reactions are seen equally with ionic and nonionic contrast material but differ in type. The reactions were allergic-like in the ionic group but were predominantly attributable to cardiopulmonary decompensation in the nonionic group. Helical CT angiography may play a role in reactions.