Trends in adverse events after IV administration of contrast media

OBJECTIVE. Data collected from 1985 to 1999 on adverse events after the IV administration of contrast media were evaluated to identify trends. MATERIALS AND METHODS. Data collected on 391 adverse events after 90,473 ad ministrations of iodinated contrast media and 19 events after 28,340 admini strations of gadolinium were evaluated. Reactions were graded as mild, mode rate, or severe. Data were also collected regarding contrast extravasation. RESULTS. When only ionic iodinated contrast material was used, the adverse reaction rate was 6-8%. With the selective use of contrast material, the ad verse reaction rate was 0.6% and 0.7%, respectively, for ionic and nonionic agents. The rate decreased to 0.2% with the universal use of nonionic agen ts. More than 90% of adverse reactions were allergic-like. Seven severe rea ctions (0.05%) and no deaths occurred in the ionic group. During the select ive use period, one death occurred in the nonionic group. No severe reactio ns or deaths occurred during the first 5 years of universal nonionic use. S ince then, 10 severe reactions (0.02%) and one death have occurred. Seven r eactions occurred in patients after helical CT angiography. The extravasati on rate for iodinated contrast material has remained constant at 0.3-0.4% a nnually. The adverse reaction rate to gadolinium contrast material was 0.06 %. CONCLUSION. Mild and moderate adverse events are more common with ionic con trast material than with nonionic. Most reactions are allergic-like. Severe reactions are seen equally with ionic and nonionic contrast material but d iffer in type. The reactions were allergic-like in the ionic group but were predominantly attributable to cardiopulmonary decompensation in the nonion ic group. Helical CT angiography may play a role in reactions.