Abstract Details

Title Development and Implementation of a Standardized Imaging Protocol for Suspected Acute Stroke Patients With Iodinated Contrast Allergies

Topic Practice, Policy, and Ethics

Presentation(s) P10 - Poster Session 10 (8:00 AM-9:00 AM)

Poster/Presentation
Number 14-009

Objective We aimed to evaluate the efficacy of a standardized protocol we developed to reduce care delays for patients with iodinated contrast allergies who present to the emergency department with acute stroke symptoms.

Background Emergent head and noninvasive vessel imaging are standard of care in the evaluation of patients with stroke symptoms. CT angiography (CTA) is the preferred vessel-imaging modality given ease of acquisition and widespread availability. In patients with iodinated contrast allergies, concern for adverse reactions may prohibit or delay CTA. The American College of Radiology recommends these patients receive pretreatment hours prior to contrast exposure, but this is an unrealistic option for those undergoing evaluation for emergent interventions such as mechanical thrombectomy.

Design/Methods We designed a protocol to guide management of patients with iodinated contrast allergies who present to our emergency department with stroke symptoms using information we gathered from retrospective chart review, literature review, and stakeholder interviews. Our protocol was approved by stakeholders and included a recommendation for pretreatment with intravenous hydrocortisone 200mg and diphenhydramine 50mg. We implemented this protocol at our institution and evaluated its efficacy in reducing time to CTA and in preventing adverse reactions.

Results During the first six months of implementation, there were 10 unique stroke alert encounters involving patients with contrast allergies. Nine patients received pretreatment and CTA. One patient had a reaction after contrast exposure, reported as angioedema; this patient had also received tenecteplase. Neither of the two patients with a history of anaphylaxis to contrast had a reaction following CTA. The average time from completion of CT head to CTA was 12.5 minutes compared to 124 minutes prior to protocol implementation.

Conclusions Emergent pretreatment with hydrocortisone and diphenhydramine prior to CTA is well-tolerated and effective in reducing delays to imaging in patients with contrast allergies that present to the emergency department with acute stroke symptoms.

Authors/Disclosures
Madeline Russell, MD PRESENTER	Dr. Russell has nothing to disclose.
Robin N. Dharia, MD	Dr. Dharia has nothing to disclose.
Alan R. Cherney, MD	Dr. Cherney has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Myself.
Shaista Alam, MD (Jefferson University Hospital)	Dr. Alam has nothing to disclose.
Katherine E. Beard, MD (Thomas Jefferson University Hospital)	Miss Beard has nothing to disclose.
Nicole M. Calautti, MD (Thomas Jefferson University Hospital)	Dr. Calautti has nothing to disclose.
Karyn Ding, MD	Dr. Ding has nothing to disclose.
Audrey A. Del Re, MD (Thomas Jefferson University Hospital)	Dr. Del Re has nothing to disclose.
Kathryn E. Dent, MD (Thomas Jefferson University Hospital)	Dr. Dent has nothing to disclose.
Kathleen D. Graveran-Perez, MD	Dr. Graveran-Perez has nothing to disclose.
Helen Hernandez Lage, MD	Mrs. Hernandez Lage has nothing to disclose.
Elan Miller, MD (Thomas Jefferson Hospital)	Dr. Miller has nothing to disclose.
Danielle Porreca, MD, PhD (Thomas Jefferson University Hospital)	Dr. Porreca has nothing to disclose.
Deborah Steinberg, MD (Thomas Jefferson University Hospital)	Dr. Steinberg has nothing to disclose.
Diana Tzeng, MD (Thomas Jefferson University)	Dr. Tzeng has nothing to disclose.

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