The Effect of an Iodinated Contrast Material Shortage on Ordering Patterns in the Emergency Department

Introduction Iodinated contrast media (ICM) is essential to emergency department care in differentiating and delineating life-threatening pathologies. In May 2022, due to the COVID-19 outbreak, there was an unprecedented disruption in the manufacturing of iodinated contrast. The primary goal of this study was to describe the effects of an ICM shortage on the ordering patterns of emergency medicine physicians. Methods This was a retrospective, observational study with a pre-/post-test design. The study included two 28-day periods. All subjects who underwent a CT were included in the study. The subgroup of patients who underwent a repeat CT with ICM contrast within 1-24 hours was identified. Results During the pre- and post-implementation study periods, 4,574 and 3,973 CT studies were performed. The median length of stay (p=0.013) and time to first CT (p<0.001) both decreased during the post-implementation period. During the post-implementation period, more non-contrast CTs were ordered (p<0.001). During the post-implementation period, there was an increase in non-contrast studies followed by a repeat study with contrast (p=0.003). Conclusions A global ICM shortage resulted in a shift in the ordering patterns of Emergency Medicine (EM) physicians. More non-contrast CT scans were ordered. However, there was also an increase in repeat imaging with ICM material.