Assessment of Management Delays Attributable to Screening for Renal Impairment Using Laboratory Serum Creatinine for Low Renal Risk ED Patients Undergoing IV Contrast CT

Abstract

patients with history of renal disease or diabetes. We aim to quantify the delays for Emergency Department (ED) patients undergoing IV contrast CT associated with renal function screening in this defined low risk population due to non-selective screening at our institution. Method: Retrospective case note review of 395 IV contrast CT studies requested from Gosford Hospital ED. Demographics, triage presentation category, patient flow data and serum creatinine were collected. Evidence of potentially delaying patients’ access to IV CT scan whilst awaiting eGFR was identified by specific instances of documentation in various electronic and scanned records. Results: Thirty-eight patients (9.6%) were identified with instances of Potential Delay, 357 patients (90.4%) had no evidence of delay (No-Delay). There was no difference between the groups in terms of mean time patient ED-arrival-to-CT-order (t=1.59, df=393,95%CI -56.52≤CI≤6.00, p=0.11) and mean time CT-Order-to-images-available (t=1.06, df=393, 95%CI -7.93≤CI≤26.5, p=0.29). However, there were proportionately more patients’ images available within 60 minutes in the No-Delay group when the two groups were compared (x2 =4.1, df=1, p=0.04 OR 2.31, 0≤OR≤5.1). Conclusion: Potential delay was demonstrated in 9.6% of the cohort by unnecessarily awaiting eGFR. Proportionately more patients had scans completed within 60 minutes when this unwarranted delay was not considered. We attribute these delays to ongoing misplaced concern of CIN despite most recent RANZCR Contrast Guidelines stating the contrary. Keywords: Contrast Induced Nephropathy; Creatinine Clearance; Emergency Department; Intravenous Contrast CT