Purpose or Case Report: To evaluate the incidence and risk factors of acute adverse reactions (ADRs) to nonionic low-osmolar iodinated contrast media (LOCM) in a pediatric population.
Methods & Materials: This single-center retrospective study included consecutive data on injections of nonionic LOCMs in pediatric patients (aged ≤18 years) from January 1, 2016, to June 30, 2023. The per-exam incidence of ADRs (i.e., physiologic and allergic-like reactions) were assessed. Severity of those reactions were classified according to the American College of Radiology manual. Multivariable logistic regression analysis using generalized estimating equations was conducted to explore risk factors associated with the occurrence of each type of ADR.
Results: A total of 23,429 injections (iomeprol, n=11,910; iopamidol, n=6217; iohexol, n=4221; ioversol, n=989; iobitridol, n=85; iopromide, n=7) in 13,172 pediatric patients were included (mean age, 8.7±6.5 years; boys:girls, 13,028:10,401). Acute allergic-like reactions occurred in 0.89% of injections (208/23,429), mostly mild (0.79%; 186/23,429), followed by moderate (0.07%; 17/23,429) and severe (0.02%; 5/23,429). Acute physiologic reactions occurred in 0.55% of injections (128/23,429), also mostly mild (0.50%; 118/23,429), followed by moderate (0.04%; 9/23,429) and severe (0.01%; 1/23,429). Both types of ADRs occurred more frequently in older patients (adjusted OR, 1.11 [95% CI: 1.04, 1.14] for allergic-like reactions; 1.06 [95% CI: 1.02, 1.09] for physiologic reactions) and when the patient had a history of the same type of ADR (adjusted OR, 4.18 [95% CI: 1.85, 9.48] for allergic-like reactions; 6.92 [95% CI: 1.94, 24.74] for physiologic reactions). In addition, allergic-like reactions occurred less frequently in inpatient/emergency settings compared to outpatient settings (adjusted OR, 0.59 [95% CI: 0.45, 0.79]), and physiologic reactions occurred less frequently during heart CT compared to abdomen and pelvis CT (adjusted OR, 0.26 [95% CI: 0.08, 0.80]). Although the incidence of allergic-like reactions differed significantly between ICM generic profiles, there was no evidence of a statistical difference when stratified by age (<2, 2–12, >12 years).
Conclusions: LOCM-associated ADRs occur rarely in children. Older age and a history of ADRs were risk factors for both types of ADRs. In addition, patient status during examinations is a risk factor for allergic-like reactions, and CT type is a risk factor for physiologic reactions.