Via Research Recognition Day Program VCOM-Carolinas 2025

Clinical Educational Research

Consequences of the 2022 IV Contrast Shortage on Emergency Department Care: A Retrospective Study Lindsay Tjiattas-Saleski DO, Shawna Bellew MD, Daniel Butz OMS-IV, Mandy Stallard OMS-IV, Matt Gallush OMS-IV, Nathan Hudepohl MD, Michael Ramsay MD, Lin Kang PhD, Sabrina Avanzato OMS-II, Constantine Hrysikos OMS-II, Riley Seay OMS-II Introduction Results Results

Discussion

References 1. Kocher KE, Meurer WJ, Fazel R, et al. (2011). National trends in use of computed tomography in the emergency department. Ann Emerg Med. 58(5):452- 62.e3.​ doi: 10.1016/j.annemergmed.2011.05.020.​ 2. Selvarajan SK, Levin DC, Parker L. (2019). The increasing use of emergency department imaging in the united states: Is it appropriate? AJR Am J Roentgenol. 213(4):W180-W184. doi: 10.2214/AJR.19.21386.​ 3. Rogers DC, Tadi P. Intravenous Contrast. [Updated 2023 Mar 13]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK557794/ ​ 4. Davenport MS, Chu P, Szczykutowicz TP, et al. (2022). Comparison of strategies to conserve iodinated intravascular contrast media for computed tomography during a Shortage. JAMA 2;328(5):476-478. doi: 10.1001/jama.2022.9879. 5. Shaish, H., Ream, J., Huang, C., et al. (2023). Diagnostic Accuracy of Unenhanced Computed Tomography for Evaluation of Acute Abdominal Pain in the Emergency Department. JAMA surgery, 158(7), e231112. https://doi.org/10.1001/jamasurg.2023.1112​ Rationing and Hospital Designation:​ • Level 1 trauma centers showed minimal changes in ordering patterns due to higher acuity. ​ Quality Metrics:​ • Time to first room and patient LOS increased for CT scan patients during the shortage, despite reduced ICM use.​ • This could be explained by factors such as bed count, staffing, and COVID-19 cleaning protocols.​ Mortality, Disposition, and Diagnostic Accuracy:​ • Mortality rates and patient dispositions for CT of abdomen/pelvis remained unchanged between periods, possibly due to specific diagnoses. • This contradicts studies showing contrast enhanced imaging (CEI) improves diagnostic accuracy for abdominal/pelvic conditions. 5 • Radiologists may have adjusted their workup and interpretation to maintain accuracy during the shortage.​ Cost- Saving Opportunities:​ • Judicious use of ICM and effective CDS tool implementation can offer cost-saving opportunities. References

Computed tomography (CT) is an essential diagnostic tool in the evaluation of patients presenting to the emergency department (ED) in the United States (US). Between 15-20 percent of patients in the U.S. who present to the ED undergo CT imaging, which has significantly increased the amount of CT scans over past several decades. 1,2 CT imaging, utilizing intravenous contrast media (ICM), improves the imaging detail needed to evaluate and diagnose various pathologies including, generalized abdominal pain, infections, active hemorrhages, and vascular pathologies. 3 In April of 2022, production shut-down in Shanghai, China caused by the COVID-19 pandemic resulted in a global shortage of contrast, forcing many hospitals to limit their usage. 4 This event presented a unique opportunity to examine the consequences of limited contrast utilization on emergency department care and outcomes. The objective of this study was to review the impact associated with the ICM shortage due to the COVID-19 pandemic, specifically on patient outcomes and the operational effectiveness of the emergency department.

• 93% of non-shortage CT scans used contrast, 45% of shortage CT scans used contrast which is statistically sig nificant (Fisher’s Exact Test, p -value < 2.2e-16, Figure 1) • Hillcrest Hospital decreased from 93.7% to 28.1% contrast usage. • Greenville Memorial Hospital decreased from 93.4% to 60.2%. • Chronic kidney disease, diabetes and increased age exhibited a decreased likelihood of ordering a CT with IV contract.

Figure 1: Total CT Orders in Both Periods

Figure 2: CT Proportion by ED

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Methods

Study Overview: • Retrospective study comparing patients at six EDs before (June to July 2019) and during (June to July 2022) the contrast shortage including all adult patients (age 18 and older) • Data from 11,044 patients for two time periods: non-shortage (5,814) and shortage (5,230) periods. Analyzed 16,536 CT imaging procedures, pulling data from

• ED throughput showed no substantial difference between periods. • Time-first-roomed and LOS increases were noted during ICM shortage in most EDs. • Chief complaints of abdominal pain showed no significant difference in contrast usage (Wilcoxon rank sum test, p-value = 4.06e-05).

Figure 10: LOS by Imaging Study

Figure 3: Roomed Time by Imaging Study

electronic medical records including: • Patient demographics: age, sex, race • Chief complaint, diagnosis, disposition • Hospital

• CT ordered: abdomen/pelvis, chest pulmonary angiogram • Initial and follow-up serum creatinine/glomerular filtration rate • Time to CT acquisition, time to room • Mortality within 30 days, return visits within 30 days Statistical Analysis: • Compared patients who received CT with contrast to those who received CT without contrast during pre- and post-shortage periods

2025 Research Recognition Day

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