Emergency Department Evaluation of Pediatric Patients With Abdominal Pain and Trauma During the National Intravenous Iodinated Contrast Media Shortage.

Abstract

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.