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

Barry Hahn1, Jerel Chacko1, Mukund Mohan1

  • 1Emergency Medicine, Staten Island University Hospital, Staten Island, USA.

Cureus
|January 25, 2023
PubMed

Insights

An iodinated contrast media (ICM) shortage shifted emergency medicine physician ordering patterns, leading to more non-contrast CT scans and an increase in repeat imaging with ICM contrast.

Area of Science:

  • Radiology
  • Emergency Medicine
  • Healthcare Supply Chain Management

Background:

  • Iodinated contrast media (ICM) is critical for diagnosing urgent conditions in emergency departments.
  • A global shortage of ICM occurred in May 2022 due to COVID-19 disruptions.
  • This shortage impacted the availability of essential diagnostic tools.

Purpose of the Study:

  • To analyze the impact of an ICM shortage on the diagnostic imaging ordering practices of emergency medicine physicians.
  • To identify changes in computed tomography (CT) ordering patterns during the shortage.
  • To assess the consequences of reduced ICM availability on patient imaging pathways.

Main Methods:

  • Retrospective, observational study with pre-/post-implementation design.
  • Comparison of two 28-day periods before and during the ICM shortage.
  • Analysis of CT ordering patterns, including non-contrast and repeat contrast-enhanced scans.

Main Results:

  • A decrease in median length of stay and time to first CT scan was observed post-shortage.
  • Significant increase in the ordering of non-contrast CT scans during the ICM shortage period (p<0.001).
  • An increase in non-contrast CTs followed by a repeat contrast-enhanced CT within 24 hours was noted (p=0.003).

Conclusions:

  • The ICM shortage prompted a notable shift in emergency medicine physician imaging choices.
  • Physicians increased the use of non-contrast CT scans to conserve ICM.
  • Despite conservation efforts, repeat imaging with ICM also increased, indicating complex adaptation strategies.

Keywords:
computed tomographycontrast materialemeregency medicinegeneral radiologymedication shortage

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