A global contrast shortage: a descriptive study exploring IV contrast utilization and outcomes in trauma patients at...

Computed Tomography (CT) with intravenous (IV) contrast is critical to the evaluation of the trauma patient. A pandemic-related lockdown occurred in Spring 2022 in the city where iohexol iodinated contrast media) is manufactured, resulting in a global shortage. We explored the potential impact of this shortage on contrast utilization and patient outcomes.

A retrospective study was performed of all trauma patients who underwent CT between January and December 2022 at a level I trauma center. Pre-contrast conservation (PRE) period was defined as January to April 2022, and post-conservation (POST) as May to December 2022. Demographics, utilization rates (bolus/patient) and outcomes were evaluated. Chi-square tests were performed for categorical variables and Mann-Whitney U tests for continuous variables. Statistical significance was set at p < 0.05.

1,097 patients were included; 509 in the pre-shortage period, 588 post-shortage. 857 CTs with contrast (1.68 contrast bolus/patient) were performed pre-conservation and 979 post-conservation (1.66 contrast bolus/patient) (p = 0.04). Maximum Abbreviated Injury Scale (AIS) head, head/neck, and extremity were higher post-shortage (p < 0.05); however, mortality was higher in the pre-conservation group (p < 0.0012). There were 9 cases of Acute Kidney Injury (AKI, 8 PRE, 1 POST), 22 delayed diagnoses (14 PRE, 8 POST) and 2 missed injuries (PRE 2, POST 0).

Despite a nationwide IV contrast shortage and volume of contrast utilization per patient, we did not observe an increase in delayed diagnoses, missed injuries or AKI although these events remain small with no clear adverse signal. This may reflect the proactive institutional measures deployed to decrease nonurgent contrast use in the inpatient and outpatient settings in order to conserve contrast for more emergent settings. Based on the limited data set and truncated pre-shortage periods we were not able to reach any meaningful conclusions regarding quality of care and impact on outcomes. Next steps may include multi-center analysis to determine the larger clinical impact of this shortage.