Management of Acute Contrast Reactions—Understanding Radiologists' Preparedness and the Efficacy of Simulation-Based Training in Canada

Abstract

French

Purpose

Acute radiologic emergencies, primarily severe contrast reactions, are rare but life-threatening events. Given a generalized paucity of formalized or mandated training, studies have shown that radiologists and trainees perform poorly when acutely managing such events. Moreover, skill base, knowledge, and comfort levels precipitously decline over time given the infrequent occurrence of these events during one's daily practice.

The primary aim of this study was to assess radiologists' preparedness for managing acute radiologic emergencies and to determine the efficacy of a high-fidelity simulation based training model in an effort to provide a rationale for similar programs to be implemented on a provincial or national level.

Methods

This was a prospective, observational study of radiology residents and attending radiologists throughout the province who were recruited to attend a full-day simulation-based course presenting various cases of acute radiologic emergencies. Participant demographics were collected at the time of commencement of the workshop. Course materials were disseminated 4 weeks prior to the workshop, and a 17-question knowledge quiz was administered before and after the workshop. Likert-type questionnaires were also distributed to survey comfort levels and equipment familiarity. The knowledge quiz and questionnaire were redistributed at 3- and 6-month intervals for acquisition of follow-up data.

Results

A total of 14 attending radiologists and 7 residents attended the workshop, with all participants completing the preworkshop questionnaire and 90.5% (19 of 21) completing the post-workshop questionnaire. Participants' principle locations of practice were as follows: academic institutions (50%), community hospitals (36.9%), and private clinics (13.1%). A significant increase in knowledge was demonstrated, with average scores of 10 out of 17 (59%) and 14.5 out of 17 (85%) (P < .001) before and after the workshop, respectively. A significant increase in participants' comfort levels in recognizing acute anaphylactic reactions (3.5; 4.7, P < .001), commencing initial management for acute radiologic emergencies (3.3; 5.0, P < .001), and administering the correct dose for anaphylactic reactions (2.5; 4.8, P < .001) was also demonstrated. Moreover, participants became increasingly familiar with the contents and equipment found within contrast reaction kits (2.8; 3.8, P < .01). Repeat evaluations at 3 and 6 months found an average knowledge test score of 13.8 out of 17 (81%) and 10.8 out of 17 (64%), respectively. Comfort levels were also reassessed in recognizing acute anaphylactic reactions (4.5; 4.1), commencing initial management (4.0; 3.9) and administering the correct dose of medication (4.0; 3.7) at 3- and 6-month intervals.

Conclusions

Acute radiologic emergencies are rare but life-threatening events that require rapid diagnosis and treatment to mitigate associated morbidity and mortality. Simulation-based workshops are a highly efficacious training model to increase knowledge, comfort levels, and equipment familiarity for radiologists and trainees alike; however, retraining at regular intervals is required.

Keywords

Medical education Radiology Simulation based Contrast reaction Anaphylaxis Anaphylactic reaction

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References

Cochran

S.T.

Bomyea

Sayre

J.W.

Trends in adverse events after IV administration of contrast media

Am J Roentgenol 2001; 176:1385–1388.

Mortele

K.J.

Oliva

M.R.

Ondategui

Ros

P.R.

Silverman

S.G.

Universal use of nonionic iodinated contrast medium for CT: evaluation of safety in a large urban teaching hospital

Am J Roentgenol 2005; 184:31–34.

Wang

C.L.

Cohan

R.H.

Ellis

J.H.

Frequency, outcome, and appropriateness of treatment of nonionic iodinated contrast media reactions

Am J Roentgenol 2008; 191:409–415.

Murphy

K.J.

Brunberg

J.A.

Cohan

R.H.

Adverse reactions to gadolinium contrast media: a review of 36 cases

Am J Roentgenol 1996; 167:847–849.

Murphy

K.J.

Szopinski

K.T.

Cohan

R.H.

Occurrence of adverse reactions to gadolinium-based contrast material and management of patients at increased risk: a survey of the American Society of Neuroradiology Fellowship Directors

Acad Radiol 1999; 6:656–664.

Davenport

M.S.

Dillman

J.R.

Cohan

R.H.

Effect of abrupt substitution of gadobenate dimeglumine for gadopentetate dimeglumine on rate of allergic-like reactions

Radiology 2013; 266:773–782.

LeBedis

C.A.

Rosenkrantz

A.B.

Otero

H.J.

Decker

S.J.

Ward

R.J.

Contrast reaction training in US radiology residencies: a COARDRI study

Clin Imaging 2017; 43:140–143.

Pfeifer

Staib

Arango

Kirsch

High-fidelity contrast reaction simulation training: performance comparison of faculty, fellows, and residents

J Am Coll Radiol 2016; 13:81–87.

Lightfoot

C.B.

Abraham

R.J.

Mammen

Abdolell

Kapur

Abraham

R.J.

Survey of radiologists' knowledge regarding the management of severe contrast material-induced allergic reactions

Radiology 2009; 251:691–696.

10.

Wang

C.L.

Davenport

M.S.

Chinnugounder

Errors of epinephrine administration during severe allergic-like contrast reactions: lessons learned from a bi-institutional study using high-fidelity simulation testing

Abdom Imag 2014; 39:1127–1133.

11.

Bartlett

M.J.

Bynevelt

Acute contrast reaction management by radiologists: a local audit study

Australas Radiol 2003; 47:363–367.

12.

Gaca

A.M.

Frush

D.P.

Hohenhaus

S.M.

Luo

Enhancing pediatric safety: using simulation to assess radiology resident preparedness for anaphylaxis from intravenous contrast media

Radiology 2007; 245:236–244.

13.

Tubbs

R.J.

Murphy

Mainiero

M.B.

High-fidelity medical simulation as an assessment tool for radiology residents' acute contrast reaction management skills

J Am Coll Radiol 2009; 6:582–587.

14.

Tofil

N.M.

White

M.L.

Grant

Severe contrast reaction emergencies high-fidelity simulation training for radiology residents and technologists in a children's hospital

Acad Radiol 2010; 17:934–940.

15.

Trout

A.T.

Cohan

R.H.

Ellis

J.H.

Khalatbari

Teaching management of contrast reactions: does it work and how often do we need to refresh?

Acad Radiol 2012; 19:498–504.

16.

Wang

C.L.

Schopp

J.G.

Petscavage

J.M.

Paladin

A.M.

Richardson

M.L.

Bush

W.H.

Prospective randomized comparison of standard didactic lecture versus high-fidelity simulation for radiology resident contrast reaction management training

Am J Roentgenol 2011; 196:1288–1295.

17.

Wang

C.L.

Schopp

J.G.

Kani

Petscavage-Thomas

Prospective randomized study of contrast reaction management curricula: computer-based interactive simulation versus high-fidelity hands-on simulation

Eur J Radiol 2013; 82:2247–2252.

18.

Niell

B.L.

Kattapuram

Halpern

E.F.

Prospective analysis of an interprofessional team training program using high-fidelity simulation of contrast reactions

Am J Roentgenol 2015; 204:670–676.

19.

Picard

Curry

Collins

Soma

Comparison of high-fidelity simulation versus didactic instruction as a reinforcement intervention in a comprehensive curriculum for radiology trainees in learning contrast reaction management: does it matter how we refresh?

Acad Radiol 2015; 22:1268–1276.

20.

Wang

C.L.

Chinnugounder

Hippe

D.S.

Zaidi

Comparative effectiveness of hands-on versus computer simulation-based training for contrast media reactions and teamwork skills

J Am Coll Radiol 2017; 14:103–110.

21.

Cooper

Taqueti

A brief history of the development of mannequin simulators for clinical education and training

Postgrad Med J 2008; 84:563–570.

22.

Petscavage

J.M.

Wang

C.L.

Schopp

J.G.

Paladin

A.M.

Richardson

M.L.

Bush

W.H.

Cost analysis and feasibility of high-fidelity simulation based radiology contrast reaction curriculum

Acad Radiol 2011; 18:107–112.

23.

Chinnugounder

Hippe

D.S.

Maximin

O'Malley

R.B.

Wang

C.L.

Perceived barriers to the use of high-fidelity hands-on simulation training for contrast reaction management: why programs are not using it

Curr Probl Diagn Radiol 2015; 44:474–478.