The Effect of Iodinated Contrast Media Shortage on Repeat Abdominal Computed Tomography and Return Emergency Department Visits

A global iodinated contrast media (ICM) shortage in 2022 due to COVID-19 quarantine related production shutdowns resulted in rationing of ICM in computed tomography (CT) in the emergency department (ED). ICM is routinely used to enhance abdominal CT imaging to help identify potentially dangerous pathology. This study evaluated whether reduced ICM use in abdominal CT during this shortage resulted in a higher rate of ED returns and repeat CT, and whether repeat CT scans revealed intervenable findings.

All patients who presented to a single urban tertiary ED in Boston, MA and had an abdominal CT performed were considered, with a sample of patients (n = 100) in the pre-shortage period (4/2022 – 6/2022) who had ICM enhanced CT were compared to a sample of patients (n = 100) in the post-shortage period (1/2022 – 3/2022) who had CT without ICM. Patient charts were reviewed to determine whether they had a return ED visit and whether a repeat abdominal CT was performed within 72 hours or 7 days. It was also determined whether repeat CT revealed pathology requiring urgent intervention. Analysis included descriptive statistics and statistical testing with Chi-Square and Fischer’s Exact tests.

There was no statistically significant difference in ED return visit frequency between pre- and post-shortage patients, with 7 day return rate of 11% pre-shortage (6 by 72 hours, an additional 5 by day 7) and 8% in the post-shortage group (3 by 72 hours, an additional 5 by day 7), p = .63 (OR 0.55-3.6). There was no difference in overall rate of repeat CT, with repeat CT performed within 7 days in 6% of pre-shortage patients (3 by 72 hours - 3 with ICM, an additional 3 by day 7 – 2 with ICM), and 9% of post-shortage patients (4 by 72 hours – 3 with ICM, an additional 5 by 7 days – 3 with ICM), p=.59 (OR 0.22 to 1.8). There was no statistically significant difference in rate of repeat CT with intervenable findings, with 2% pre-shortage and 3% post-shortage, p>.99 (OR 0.12-3.3).

Comparison of patients receiving abdominal CT pre- and post-shortage revealed no significant difference in rate of repeat ED visit or repeat CT within 7 days, notably with no significant difference in rate of intervenable findings on repeat CT. Operationally, limited ICM use in abdominal CT did not appear to affect the rate of repeat CT scans, although limitations include a single site study and test sample size not powered to detect small differences.