’Roid (Not Quite) Rage: The Controversy Surrounding Pre-Medication for Contrast Reactions
Skepticism about the appropriateness of steroid premedication to prevent severe contrast reactions
Harry Jha, MD (@RogueRad), is back, with another Radiology Fire Line (RFL) podcast . Joining him again is C. Matthew Hawkins, MD (@MattHawkinsMD). For this episode, they welcome guest participant pediatric radiology fellow Neil U. Lall, MD (@NULall).
Anabolic steroids and other forms of doping in sports don't monopolize the market on controversies related to steroid use (or misuse). Corticosteroids (to prevent severe contrast reactions) are getting their own fair share of scrutiny lately. Listen as this week's RFL participants debate the merits versus disadvantages of premedicating patients for contrast allergies (or "allergic-like" reactions per the ACR Contrast Manual.
If radiologists are to break a habit of prescribing premedication, they will be unlikely to do so as a group until the ACR Contrast Manual language changes. Until radiology leadership adjusts its stance, the fear of going against the tide is this: rarely do physicians get sued for doing too much. On the other hand, if someone does indeed have a severe contrast reaction after premedication was withheld despite only minimal documented previous reaction, well, you know where that's headed: breach of standard of care. So until those contrast allergy premedication standards are modernized, most radiologists will probably be like the boy in the comic above and continue to follow existing guidelines.
Listen to the latest episode of the Firing Line and share your thoughts in the comments below.