Effect of Iodinated Contrast Media Shortage on Utilization of Abdominal Computed Tomography in the Emergency Department

Objectives: The purpose of this study is to describe trends in utilization and efficiency of abdominal computed tomography (CT) imaging obtained in the emergency department (ED) during an international iodinated contrast media (ICM) shortage in 2022. This study examines abdominal CT ordering frequency, ICM usage in abdominal CT, and CT time-to-performance.

Background: CT of the abdomen enhanced by ICM is frequently utilized in diagnosis and management of abdominal pathology in the ED. A worldwide ICM shortage in April 2022 prompted hospitals in the United States and abroad to ration their existing ICM supplies.

Methods: This is a retrospective observational cohort study of patients receiving abdominal CT imaging in an urban, tertiary medical center ED in the United States. The ICM shortage at the medical center was defined as April 30-June 3, 2022. Pre- and post-shortage control groups were defined as January 1-March 31, 2022 and July 1-October 31, 2022, respectively. Data was collected from the electronic medical record. Key operational metrics, including time from order to first CT, were determined. In addition, a random sample of charts was reviewed to assess for quality metrics. Descriptive statistics, including median and interquartile range (IQR) were determined. Hypothesis testing was performed using Chi-square, Wilcoxon Rank Sum Test, and T-test.

Results: During the ICM contrast shortage, CT imaging of the abdomen was obtained in 12.2% of total patients (607 of 4981), compared to 14.2% (1612 of 11378, p< 0.001) and 12.7% (2304 of 18176, p=0.35) in the pre- and post-shortage groups, respectively. ICM use decreased significantly during the study period, with only 31.1% (189 of 607) of abdominal CT studies utilizing contrast, compared to 86.7% (1397 of 1612) and 86.1% (1984 of 2304) in the pre- and post-shortage groups, respectively (p < 0.001). Median time from order to performance of CT decreased during the study period (shortage 75 min [IQR 44-127 min], pre-shortage 121 min [IQR 70-179 min, p< 0.001], post-shortage 132 min [IQR 77-199 min, p< 0.001]). This finding held true for both contrast-enhanced and non-contrast CT studies (though with smaller effect size for non-contrast imaging).

Conclusions: During the global ICM shortage, utilization of abdominal CT imaging decreased overall and the utilization of ICM for abdominal CT in particular decreased significantly at the study site. Reduced use of ICM appears to be associated with significant operational improvements in time to abdominal CT in the ED, including reduced time from order to performance of CT. These findings are limited by single center observational and retrospective study design. Further study is required to assess the effect of these changes on diagnostic accuracy and patient safety.

References (Optional): Cavallo JJ, Pahade JK. Practice Management Strategies for Imaging Facilities Facing an Acute Iodinated Contrast Media Shortage. AJR Am J Roentgenol. 2022 Oct;219(4):666-670. doi: 10.2214/AJR.22.27969. Epub 2022 May 13. PMID: 35549445.

Funding (Optional): N/A