Preparing for severe contrast media reactions in children - results of a national survey, a literature review and a suggested protocol

Abstract

Aim: To identify current practices within paediatric radiology in the UK with regard to the use of prophylactic medication, prior to administering intravenous (IV) radiocontrast medium (RCM). In addition, the pre-injection risk management strategies of the departments questioned was to be evaluated, and using consensus opinion, a protocol for managing patients identified as being at high risk for an adverse reaction to RCM was to be outlined.

Materials and methods: An online survey of paediatric radiology consultants representing all geographic regions of the UK was carried out. The questions asked included an assessment of the risk factors for adverse reactions to RCM, and how such reactions are anticipated and managed. The questionnaire asked about the perceived indications for, and the use of prophylactic medication prior to RCM administration.

Results: A response rate of 51% was achieved. The majority of respondents felt that a history of previous RCM reaction was an indication to administer prophylactic drugs prior to a further dose of RCM. No other risk factor was believed to require prophylactic medication.

Conclusion: Using information obtained from the survey, a literature search was performed to assess the evidence available in support of each practice. A protocol was devised to identify children at risk of an adverse reaction to RCM, and guide the use of prophylactic medication in this group of patients. The survey highlighted considerable variability in the risk-assessment and management practices within paediatric radiology in the UK. The derived protocol may guide radiologists' management of children at risk for an RCM reaction.