Korean Journal of Radiology

  • 제20권1호
  • /
  • Pages.148-157
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  • 2019
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  • 1229-6929(pISSN)
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  • 2005-8330(eISSN)
대한영상의학회 (The Korean Society of Radiology)
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Management of Adverse Reactions to Iodinated Contrast Media for Computed Tomography in Korean Referral Hospitals: A Survey Investigation

  • Seungchul Han (Department of Radiology, Seoul National University College of Medicine) ;
  • Soon Ho Yoon (Department of Radiology, Seoul National University College of Medicine) ;
  • Whal Lee (Department of Radiology, Seoul National University College of Medicine) ;
  • Young-Hun Choi (Department of Radiology, Seoul National University College of Medicine) ;
  • Dong Yoon Kang (Drug Safety Monitoring Center, Seoul National University Hospital) ;
  • Hye-Ryun Kang (Drug Safety Monitoring Center, Seoul National University Hospital)
  • 투고 : 2017.12.21
  • 심사 : 2018.05.21
  • 발행 : 2019.01.01
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초록

Objective: To evaluate the current status of managing adverse reactions to iodinated contrast media (ICM) for computed tomography in referral hospitals in South Korea compared with hospitals in other countries. Materials and Methods: This survey investigation involved 59 Korean and 15 overseas hospitals using guideline-based questionnaires consisting of 24 items in 7 main categories related to managing adverse reactions to ICM. Results: Informed written consent with risk factor evaluation was appropriately performed in most of the Korean hospitals. There was considerable variability in assessing renal function across the hospitals; serum creatinine level was used as a reference in 76.4% of Korean hospitals. The Korean hospitals preferred a more stringent approach to determining normal renal function (p = 0.01), withholding metformin (p = 0.01), and fasting before ICM exposure (p < 0.001) compared with overseas hospitals. All the Korean hospitals had an emergency protocol and in-hospital system for adverse reactions to ICM. The Korean (87.7%) and overseas hospitals (100%) were similarly equipped with epinephrine (p = 0.332), but only 38.6% of Korean hospitals were equipped with a bronchodilator (p = 0.004). For patients with a previous hypersensitivity reaction to ICM, 62.3% of Korean hospitals pre-medicated with anti-histamine and corticosteroid according to the severity of the previous reaction, and changed the culprit ICM in 52.8%, while skin test was performed in 17%. Conclusion: In general, Korean referral hospitals were well-prepared regarding informed consent, protocol, and an in-hospital system for managing adverse reactions to ICM. Nevertheless, there was considerable variability in details and management, thus requiring standardization by reflecting current guidelines.

키워드

과제정보

This study was supported by a grant (17172MFDS158) from Korea Ministry of Food and Drug Safety in 2017.

참고문헌

  1. Bottinor W, Polkampally P, Jovin I. Adverse reactions to iodinated contrast media. Int J Angiol 2013;22:149-154
  2. Bae K, Lee SM, Ha JY, Jeon KN, Moon JI, Choi BH, et al. Adverse drug reactions to CT contrast media in South Korea: incidence and risk factors. J Korean Soc Radiol 2016;75:41-48
  3. Bata P, Tarnoki AD, Tarnoki DL, Horvath E, Berczi V, Szalay F. Acute severe thrombocytopenia following non-ionic low-osmolarity intravenous contrast medium injection. Korean J Radiol 2012;13:505-509
  4. CT and X-ray contrast guidelines. UCSF Department of Radiology & Biomedical imaging Web site. https://radiology.ucsf.edu/patient-care/patient-safety/contrast/iodinated. Updated July 20, 2017. Accessed September 17, 2017
  5. ACR Committee on Drugs and ContrastMedia. ACR manual on contrast media version 10.3. 2017. Available at: https://www.acr.org/-/media/ACR/Files/Clinical-Resources/Contrast_Media.pdf. Accessed September 17, 2017
  6. Korean Society of Radiology, Korean Academy of Asthma, KIoDSRM. Korean clinical practice guideline on adverse reactions of injectable iodinated contrast agent and gadolinium contrast agent for MRI, 2nd edition. [Published 2016]. Available at: http://www.allergy.or.kr/file/allergic2016.pdf. Accessed September 17, 2017
  7. Drug safety information report trend. Korean Institute of Drug Safety & Risk Management imaging Web site. http://open.drugsafe.or.kr/trend/trend/Read.jsp?ntt_id=2003. Published 2016. Accessed September 17, 2017
  8. ESUR guidelines on contrast media. Version 8.1. European Society of Urogenital Radiology Web site. http://www.esur.org/guidelines/. Published 2013. Accessed September 17, 2017
  9. Lee J, Cho JY, Lee HJ, Jeong YY, Kim CK, Park BK, et al.; Korean Society of Urogenital Radiology (KSUR); Korean Society of Radiology. Contrast-induced nephropathy in patients undergoing intravenous contrast-enhanced computed tomography in Korea: a multi-institutional study in 101487 patients. Korean J Radiol 2014;15:456-463
  10. Davenport MS, Khalatbari S, Cohan RH, Dillman JR, Myles JD, Ellis JH. Contrast material-induced nephrotoxicity and intravenous low-osmolality iodinated contrast material: risk stratification by using estimated glomerular filtration rate. Radiology 2013;268:719-728
  11. Salpeter SR, Greyber E, Pasternak GA, Salpeter EE. Risk of fatal and nonfatal lactic acidosis with metformin use in type 2 diabetes mellitus. Cochrane Database Syst Rev 2010;(4):CD002967
  12. Stang M, Wysowski DK, Butler-Jones D. Incidence of lactic acidosis in metformin users. Diabetes Care 1999;22:925-927
  13. Oowaki K, Saigusa H, Ojiri H, Ariizumi M, Yamagisi J, Fukuda K, et al. [Relationship between oral food intake and nausea caused by intravenous injection of iodinated contrast material]. Nihon Igaku Hoshasen Gakkai Zasshi 1994;54:476-479
  14. Wagner HJ, Evers JP, Hoppe M, Klose KJ. [Must the patient fast before intravascular injection of a non-ionic contrast medium? Results of a controlled study]. Rofo 1997;166:370-375
  15. Webb JA, Stacul F, Thomsen HS, Morcos SK; Members Of The Contrast Media Safety Committee Of The European Society Of Urogenital Radiology. Late adverse reactions to intravascular iodinated contrast media. Eur Radiol 2003;13:181-184
  16. Loh S, Bagheri S, Katzberg RW, Fung MA, Li CS. Delayed adverse reaction to contrast-enhanced CT: a prospective single-center study comparison to control group without enhancement. Radiology 2010;255:764-771
  17. Abe S, Fukuda H, Tobe K, Ibukuro K. Protective effect against repeat adverse reactions to iodinated contrast medium: premedication vs. changing the contrast medium. Eur Radiol 2016;26:2148-2154
  18. Park HJ, Park JW, Yang MS, Kim MY, Kim SH, Jang GC, et al. Re-exposure to low osmolar iodinated contrast media in patients with prior moderate-to-severe hypersensitivity reactions: a multicentre retrospective cohort study. Eur Radiol 2017;27:2886-2893
  19. Lee SY, Yang MS, Choi YH, Park CM, Park HW, Cho SH, et al. Stratified premedication strategy for the prevention of contrast media hypersensitivity in high-risk patients. Ann Allergy Asthma Immunol 2017;118:339-344.e1
  20. Yoon SH, Lee SY, Kang HR, Kim JY, Hahn S, Park CM, et al. Skin tests in patients with hypersensitivity reaction to iodinated contrast media: a meta-analysis. Allergy 2015;70:625-637
  21. Behzadi AH, Zhao Y, Farooq Z, Prince MR. Immediate allergic reactions to gadolinium-based contrast agents: a systematic review and meta-analysis. Radiology 2018;286:471-482
  22. Kanal E, Barkovich AJ, Bell C, Borgstede JP, Bradley WG Jr, Froelich JW, er al.; ACR Blue Ribbon Panel on MR Safety. ACR guidance document for safe MR practices: 2007. AJR Am J Roentgenol 2007;188:1447-1474
  23. Perazella MA. Current status of gadolinium toxicity in patients with kidney disease. Clin J Am Soc Nephrol 2009;4:461-469