Predictors of Contrast Extravasation in the Emergency Department: A Case-Control Multi-Center Retrospective Study

Intravenous (IV) contrast extravasation (IVCE) is a rare but potentially serious complication that can lead to tissue necrosis, compartment syndrome, prolonged emergency department (ED) length of stays, and the diversion of resources to monitoring extravasation injury. However, studies on IVCE in the ED are limited.

This study aims to identify risk factors associated with IVCE in ED patients undergoing contrast-enhanced computed tomography scans.

We performed a multicenter retrospective 1- to 2-case-control matching study of ED patients from January 2016 to October 2023 by reviewing the institutions' adverse event reporting system. Adult patients with IVCE were identified and matched to controls based on demographics and department environmental factors that may have introduced unmeasurable variability in the risk of IVCE. Multivariable logistic regression was performed to assess clinical factors related to IVCE.

We identified 141 IVCE cases and matched them with 266 controls. The mean (±standard deviation) age was 58 years (±14.5), with 59% of patients being female. Common comorbidities included substance abuse (18.4%), heart failure (13.3%), and chronic kidney disease (10.3%). The most common catheter size was 20-gauge (76.7%). IVCE patients had a significantly longer ED stay compared to controls (653 vs. 525 min, p < 0.001). Ultrasound-guided peripheral IV (USGIV) placement (OR 3.67, 95% CI 2.21-6.09, p < 0.001), and substance abuse (OR 1.86, 95% CI 1.04-3.31, p = 0.036) were associated with increased risk of IVCE.

USGIV placement was associated with increased odds of IVCE in the ED. Further prospective studies are needed to confirm these findings and explore additional risk factors.