When was the last time you saw a Dinosaur? I encounter one quite regularly. Native to dark rooms, surviving off Starbucks, Dragon dictation, and PO contrast, the radiologasaurus frowns upon “positive dimer” for a reason for chest CT and not providing oral contrast for abdomen/pelvis CT scans.
Two studies from 2012 help slay this oral contrastivore. In the first, 395 abdomen/pelvis scans were obtained, 184 of them with IV only contrast. Studies were aiming to evaluate for SBO, appendicitis, diverticulitis, or perforation. Not surprisingly, length of ED stay, time to admission, time to OR, and time to discharge from ED were all significantly lower in the IV only arm. Rescan rates were 9% vs 8.7% (PO v. No PO). There was one missed appendicitis, and one patient that was read as early appendicitis and for some reason rescanned with PO contrast that still, amazingly, had appendicitis.
An even larger study retrospectively analyzed patients 2 months before and 2 months after eliminating PO contrast from abdomen/pelvis CT. Patients with inflammatory bowel disease, prior gastrointestinal tract-altering surgery, or lean body habitus continued to receive oral contrast, and those that would not have received PO contrast otherwise (ie, looking for kidney stones), were excluded from analysis. 2,001 ED patients (1,014 before and 987 after protocol change) were examined. 617 pre-intervention and 611 post-intervention were eligible for oral contrast and included. Of these, 95 % received oral contrast prior to the intervention and 42 % thereafter. After the intervention, mean ED LOS among oral contrast eligible patients decreased by 97 min, P < 0.001. Mean time from order to CT decreased by 66 min, P < 0.001. No patient with CT negative for acute findings had additional subsequent abdomen/pelvic imaging within 72 hours at the study institution that led to a change in diagnosis. 611 patients over two months, none of which bounced back or had a change in diagnosis without PO contrast that would have otherwise received it.
Further reason to starve the contrastivorous radiologasaurus.