Allergic reactions tied to many contrast media malpractice cases

Severe allergic reactions among patients and clinicians' failure to diagnose or treat such reactions make up the majority of malpractice suits tied to contrast media use, suggest findings published September 19 in Radiology.

A team led by Amin Khan, MBBS, from Yale School of Medicine in New Haven, CT also found that many suits are tied to inappropriate management of contrast media discharge and contrast-induced renal injury. It also reported that judgment favored the defense in all cases that went to trial.

“While most radiologists understand the risks of liability for missed findings or lapses of communication, liability for the use of contrast agents in imaging procedures is underappreciated,” Khan and colleagues wrote.

While previous studies have shown the potential benefits of using contrast agents in medical imaging such as CT, ultrasound, and mammography to improve image quality, this method also carries its share of risks. These include errors or mistakes in administration, allergic reactions, renal injuries, and reaction management or resuscitation issues.

Khan and colleagues noted a lack of evidence-based literature analyzing the medicolegal implications tied to contrast agent use, which they wrote could raise awareness among radiologists. The researchers investigated the clinical context and outcomes of lawsuits alleging medical malpractice in procedures that called for contrast media use.

The authors included 151 published case summaries in their study. They found that severe allergic reactions following contrast agent administration were the most common medical complications, at 45 cases (30%). Of these, 42 malpractice suits were from allegations of failure to diagnose developing anaphylaxis or failure to treat the adverse reaction.

The researchers also found that 41 cases (27%) were from allegations of inappropriate management of contrast media extravasation, and 19 cases (13%) stemmed from alleged contrast agent-induced acute kidney injury.

Finally, the group reported that of the 11 cases of alleged kidney injury that went to trial, all resulted in a judgment in favor of the defense.

Khan and co-authors suggested the following efforts be taken to mitigate the incidence of malpractice suits in this area:

  • Provide additional provider education efforts on anaphylaxis triggers and management, and stronger patient safeguards.
  • Use more sophisticated technology, such as epinephrine autoinjectors, to manage severe allergic reactions.
  • Issue internal policies on premedication and contrast agent allergies for radiologists to abide by.
  • Make sure radiologists adhere to the standard of care.

The study authors also wrote that AI could help with reviewing electronic medical records to further improve taking precautions for patients with an allergy history and that institutions should review the degree of discretion a radiologist may have in terms of protocoling studies.

In an accompanying editorial, Isabelle Trop, MD, from the University of Montreal wrote that while legal systems around the world are different, the frequency of adverse events and complications tied to contrast agent use represent generalizable information.

“Analyzing the breadth of previous malpractice claims related to the use of contrast agents informs radiologists of what can go wrong in practice, and this invaluable information can help develop improved health care protocols and policies,” Trop wrote.

The full report can be found here.

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