CORTICOSTEROID PROPHYLAXIS FOR PATIENTS WITH INCREASED RISK OF ADVERSE REACTIONS TO INTRAVASCULAR CONTRAST AGENTS - A SURVEY OF CURRENT PRACTICE IN THE UK

There is no definite experimental evidence that prophylactic corticost eroids reduce the frequency or severity of adverse effects from low-os molar contrast agents in patients at increased risk of reaction. There is no consensus in terms of how prophylaxis should be conducted. We h ave studied current radiologists' practice in the UK by sending postal questionnaires to 212 radiologists randomly selected from a list of c urrent consultants who are Fellows of the Royal College of Radiologist s. One hundred and seventy (80.2%) of the 212 questionnaires were comp leted. The majority of radiologists routinely use non-ionic low osmola r contrast media for intravenous administration, only 30 (17.6%) routi nely using conventional ionic agents and six (3.5%) ionic low osmolar agents. All 170 use low osmolar contrast media for those patients perc eived to be at increased risk of adverse reactions. Seventy-six radiol ogists (44.7%) never use steroid cover. There is no consistent practic e amongst the 94 consultants (55.3%) who do use steroid cover. The ind ications for prophylaxis vary, as do the corticosteroid used and the d ose regime employed. The total dose used varied from the equivalent of 7.5 mg to 400 mg of prednisolone, and the duration of prophylaxis var ied from a single dose to a 4 day course. One hundred and forty-two ra diologists (83.5%) would welcome nationally agreed guidelines for the use of steroid cover. The great variation in the use of steroid cover in the UK reflects the lack of clear evidence of its benefit in combin ation with low osmolar contrast media.