Implications of iodinated contrast media extravasation in the emergency department

• Published in: The American journal of emergency medicine Vol. 36; no. 2; pp. 294 - 296
• Main Authors: Sonis, Jonathan D., Gottumukkala, Ravi V., Glover, McKinley, Yun, Brian J., White, Benjamin A., Kalra, Mannudeep K., Otrakji, Alexi, Raja, Ali S., Prabhakar, Anand M.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.02.2018; Elsevier Limited
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Blistering; Child; Child, Preschool; Cold treatment; Compartment syndrome; Compression; Computed tomography; Consultation; Contrast agents; Contrast extravasation; Contrast media; Contrast Media - adverse effects; Disease Management; Emergency department; Emergency management; Emergency medical care; Emergency medical services; Emergency Service, Hospital; Extravasation; Extravasation of Diagnostic and Therapeutic Materials - epidemiology; Extravasation of Diagnostic and Therapeutic Materials - therapy; Female; Follow-Up Studies; Humans; Length of stay; Male; Medical imaging; Medical records; Middle Aged; Pain; Patients; Perfusion; Radiology; Retrospective Studies; Tomography, X-Ray Computed - adverse effects; Tomography, X-Ray Computed - methods; Young Adult; CT; Contrast extravasation; Emergency department; Computed tomography; ED; Length of stay
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1016/j.ajem.2017.11.012

To characterize the management, outcomes, and emergency department (ED) length of stay (LOS) following iodinated contrast media extravasation events in the ED. All ED patients who developed iodinated contrast media extravasation following contrast-enhanced CT (CECT) from October 2007–December 2016 were retrospectively identified. Medical records were reviewed and management, complications, frequency of surgical consultation, and ED LOS were quantified using descriptive statistics. The Wilcoxon rank sum test was used to compare ED LOS in patients who did and did not receive surgical consultation. A total of 199 contrast extravasation episodes occurred in ED patients during the 9-year study period. Of these, 42 patients underwent surgical consultation to evaluate the contrast extravasation event. No patient developed progressive symptoms, compartment syndrome, or tissue necrosis, and none received treatment beyond supportive care (warm/cold packs, elevation, compression). Median ED LOS for patients who did and did not receive surgical consultation was 11.3h versus 9.0h, respectively (p<0.01). Close observation and supportive care are sufficient for contrast extravasation events in the ED without concerning symptoms (progressive pain/swelling, altered tissue perfusion, sensory changes, or blistering/ulceration). Routine surgical consultation is likely unnecessary in the absence of these symptoms – concordant with the current American College of Radiology guidelines – and may be associated with longer ED LOS without impacting management.