Related Experiment Video
Updated: May 9, 2025
Handheld Metal Detector Screening for Metallic Foreign Body Ingestion in Children
Published on: September 11, 2018
Emergency Department Evaluation of Pediatric Patients With Abdominal Pain and Trauma During the National Intravenous
Lauren Klein1, Cornelia Muntean1, Adam Mei1
1Departments of Emergency Medicine.
Insights
During the 2022 iodinated contrast media (ICM) shortage, pediatric CT scans decreased significantly. Importantly, no clinically significant diagnoses were missed in emergency department patients, suggesting non-contrast CT is often sufficient.
Area of Science:
- Radiology
- Pediatric Imaging
- Emergency Medicine
Background:
- Limited research exists on the impact of the 2022 national iodinated contrast media (ICM) shortage on pediatric emergency department patients.
- The study addresses the need to understand diagnostic outcomes during ICM scarcity.
Purpose of the Study:
- To evaluate pediatric patients undergoing abdominal/pelvic CT during the 2022 ICM shortage.
- To identify missed abdominal diagnoses or increased CT scans due to ICM unavailability.
- To test the hypothesis of decreased ICM utilization without increased missed diagnoses.
Main Methods:
- Multi-center retrospective chart review of pediatric patients (<18 years) undergoing abdominal/pelvic CT in the ED.
- Inclusion during the ICM shortage (May-June 2022) and a control period (March-May 2022).
- Primary outcome: rate of missed clinically significant diagnoses after non-contrast CT.
Main Results:
- 446 patients included; ICM utilization decreased by 55% in abdominal pain and 41% in trauma cohorts during the shortage.
- No clinically significant missed diagnoses were identified in either cohort.
- A slight, non-significant increase in repeat CT scans was observed in the abdominal pain cohort, none contrast-enhanced.
Conclusions:
- The 2022 ICM shortage did not lead to missed diagnoses in pediatric emergency patients.
- This data supports the potential for reduced reliance on intravenous contrast in computed tomography imaging when necessary.
- Further research can explore the necessity of ICM in specific pediatric CT scenarios.
Introduction:
Research on the effects of the 2022 national intravenous iodinated contrast media (ICM) shortage on the pediatric population in the emergency department is limited. The purpose of this study was to evaluate pediatric patients who had a computed tomography (CT) of the abdomen/pelvis during the 2022 ICM shortage, and to identify whether any important abdominal diagnoses were missed or if additional CT scans were obtained to accommodate for a lack of available ICM. We hypothesized a decrease in ICM utilization without any increased incidence in missed diagnoses.
Methods:
This is a multi-center retrospective chart review of pediatric patients (<18 years old) who had a CT of the abdomen/pelvis in the emergency department for any indication (abdominal pain or trauma) during the ICM shortage (May 12, 2022-June 29, 2022). A control group from March 22, 2022 to May 11, 2022 was included. The primary outcome was the rate of missed clinically significant diagnoses after initial non-contrast CT.
Results:
There were 446 patients included; 403 patients presented for abdominal pain (224 controls) and 43 patients presented due to trauma (23 controls). ICM utilization decreased significantly during the shortage period: for the abdominal pain cohort, ICM utilization decreased by 55% (95% CI: 47-63), for trauma patients ICM utilization decreased by 41% (95% CI: 17-64). There were no cases of clinically significant missed diagnoses due to noncontrast studies during the shortage period, in both abdominal pain and trauma cohorts. In the abdominal pain cohort, there were 3 (1.7%) repeat CT scans during the shortage period and 1 (0.5%) during the control period (difference: 1.2%, 95% CI: -0.9% to 3.2%). None of these additional studies were contrast-enhanced after an initial noncontrast study. There were no repeat CT scans in the trauma cohort.
Conclusion:
Despite the decrease in IV contrast CT scans ordered, our study did not identify any patients with missed diagnoses in the setting of the ICM shortage. We believe this data adds to the body of literature exploring the necessity of intravenous contrast when it is not utilized or unable to be utilized in computed tomography imaging.
Related Concept Videos
01:30Radiological Investigation I: X-ray and CT
01:14Imaging Studies I: CT and MRI
Description of the Procedures
Computed Tomography (CT) scan:
Computed Tomography (CT) scans use X-ray technology to generate detailed images of bones, organs, and tissues. During the scan, the patient lies on a moving table...
01:23Lower GI Series: Barium Enema
Procedure Details
The examination begins by inserting a lubricated rectal tube into the patient's rectum to administer a radiopaque barium solution. The barium flow is carefully...
01:26Endoscopic Procedures V: ERCP
Patient...
01:13Radiological Investigation III: Pulmonary Angiogram and PET Scan
Pulmonary Angiogram
A Pulmonary Angiogram is an invasive procedure involving injecting a contrast medium through a catheter threaded into the pulmonary artery or the right side of the heart to visualize the pulmonary vasculature. Computed Tomography (CT) scans have mainly replaced this...
01:29Appendicitis-II: Diagnostic Studies and Management
Diagnosing Appendicitis
It requires a multifaceted approach, starting with a detailed physical examination to pinpoint the location and nature of the pain and identify any associated symptoms. Laboratory tests play a crucial role. A complete Blood Count (CBC) typically reveals leukocytosis (an increased number of...