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  • Measure Summary
  • NQMC:010241
  • Mar 2015

Diagnostic imaging: percentage of CT exams with contrast performed that resulted in extravasation.

American College of Radiology (ACR). National Radiology Data Registry: qualified clinical data registry. Non-PQRS measures. Reston (VA): American College of Radiology (ACR); 2015 Mar. 49 p.

View the original measure documentation External Web Site Policy

This is the current release of the measure.

Primary Measure Domain

Clinical Quality Measures: Outcome

Secondary Measure Domain

Does not apply to this measure

Description

This measure is used to assess the percentage of computed tomography (CT) exams with contrast performed that resulted in extravasation.

Measure calculated at facility/group level (National Provider Identifier [NPI]/Taxpayer Identification Number [TIN]) with rate assigned to all physicians within the facility/group who interpret CTs.

Rationale

Intravenous (IV) contrast enhanced computed tomography (CT) may be associated with significant morbidity. The reported incidence of IV contrast media extravasation related to power injection for CT has ranged from 0.1% to 0.9% (1/1,000 patients to 1/106 patients) (American College of Radiology, 2013). While the incidence of moderate or severe extravasation is lower, significant morbidity can result in these cases. Extravasation typically results in a combination of immediate pain, erythema, and swelling, but most extravasation reactions are limited to the immediately adjacent soft tissues (typically the skin and subcutaneous tissues) and are mild; long-term major morbidity is rare. However, severe skin and subcutaneous ulceration can occur, or compartment syndrome may result (neurovascular signs and symptoms due to increased volume in the confined spaces formed by the deep fascia).

The comparative feedback on this measure (which is part of a broader practice quality improvement project) provides radiologists with a means to analyze and improve performance of the procedure and avoid this adverse event. A high extravasation rate may indicate that patients received less than optimal care.

The measure is calculated at the level of facility/group because contrast is typically administered by nonphysician staff but performance improvement and treatment of adverse effects are driven by policies instituted by the physicians as a team.

Evidence for Rationale

ACR Committee on Drugs and Contrast Media. ACR manual on contrast media [version 9]. Reston (VA): American College of Radiology; 2013. 128 p.

American College of Radiology (ACR). National Radiology Data Registry: qualified clinical data registry. Non-PQRS measures. Reston (VA): American College of Radiology (ACR); 2015 Mar. 49 p.

Ayre-Smith G. Tissue necrosis following extravasation of contrast material. J Can Assoc Radiol. 1982 Jun;33(2):104. PubMed External Web Site Policy

Bellin MF, Jakobsen JA, Tomassin I, Thomsen HS, Morcos SK, Thomsen HS, Morcos SK, Almén T, Aspelin P, Bellin MF, Clauss W, Flaten H, Grenier N, Ideé JM, Jakobsen JA, Krestin GP, Stacul F, Webb JA, Contrast Media Safety Committee of the European Society of Urogenital Radiology. Contrast medium extravasation injury: guidelines for prevention and management. Eur Radiol. 2002 Nov;12(11):2807-12. PubMed External Web Site Policy

Birnbaum BA, Nelson RC, Chezmar JL, Glick SN. Extravasation detection accessory: clinical evaluation in 500 patients. Radiology. 1999 Aug;212(2):431-8. PubMed External Web Site Policy

Chew FS. Extravasation of iodinated contrast medium during CT: self-assessment module. AJR Am J Roentgenol. 2010 Dec;195(6 Suppl):S80-5. PubMed External Web Site Policy

Cochran ST, Bomyea K, Kahn M. Treatment of iodinated contrast material extravasation with hyaluronidase. Acad Radiol. 2002 Aug;9 Suppl 2:S544-6. PubMed External Web Site Policy

Cohan RH, Bullard MA, Ellis JH, Jan SC, Francis IR, Garner WL, Dunnick NR. Local reactions after injection of iodinated contrast material: detection, management, and outcome. Acad Radiol. 1997 Nov;4(11):711-8. PubMed External Web Site Policy

Cohan RH, Dunnick NR, Leder RA, Baker ME. Extravasation of nonionic radiologic contrast media: efficacy of conservative treatment. Radiology. 1990 Jul;176(1):65-7. PubMed External Web Site Policy

Cohan RH, Ellis JH, Garner WL. Extravasation of radiographic contrast material: recognition, prevention, and treatment. Radiology. 1996 Sep;200(3):593-604. PubMed External Web Site Policy

Federle MP, Chang PJ, Confer S, Ozgun B. Frequency and effects of extravasation of ionic and nonionic CT contrast media during rapid bolus injection. Radiology. 1998 Mar;206(3):637-40. PubMed External Web Site Policy

Gault DT. Extravasation injuries. Br J Plast Surg. 1993 Mar;46(2):91-6. PubMed External Web Site Policy

Jacobs JE, Birnbaum BA, Langlotz CP. Contrast media reactions and extravasation: relationship to intravenous injection rates. Radiology. 1998 Nov;209(2):411-6. PubMed External Web Site Policy

Lewis GB, Hecker JF. Radiological examination of failure of intravenous infusions. Br J Surg. 1991 Apr;78(4):500-1. PubMed External Web Site Policy

Powell CC, Li JM, Rodino L, Anderson FA. A new device to limit extravasation during contrast-enhanced CT. AJR Am J Roentgenol. 2000 Feb;174(2):315-8. PubMed External Web Site Policy

Schaverien MV, Evison D, McCulley SJ. Management of large volume CT contrast medium extravasation injury: technical refinement and literature review. J Plast Reconstr Aesthet Surg. 2008;61(5):562-5; discussion 565. PubMed External Web Site Policy

Sistrom CL, Gay SB, Peffley L. Extravasation of iopamidol and iohexol during contrast-enhanced CT: report of 28 cases. Radiology. 1991 Sep;180(3):707-10. PubMed External Web Site Policy

Sum W, Ridley LJ. Recognition and management of contrast media extravasation. Australas Radiol. 2006 Dec;50(6):549-52. PubMed External Web Site Policy

Wang CL, Cohan RH, Ellis JH, Adusumilli S, Dunnick NR. Frequency, management, and outcome of extravasation of nonionic iodinated contrast medium in 69,657 intravenous injections. Radiology. 2007 Apr;243(1):80-7. PubMed External Web Site Policy

Primary Health Components

Computed tomography (CT); intravenous (IV) iodinated contrast; extravasation

Denominator Description

Total number of computed tomography (CT) exams using intravenous iodinated contrast

Numerator Description

Total number of computed tomography (CT) exams using intravenous iodinated contrast resulting in extravasation

Type of Evidence Supporting the Criterion of Quality for the Measure

  • A clinical practice guideline or other peer-reviewed synthesis of the clinical research evidence
  • A formal consensus procedure, involving experts in relevant clinical, methodological, public health and organizational sciences
  • One or more research studies published in a National Library of Medicine (NLM) indexed, peer-reviewed journal

Additional Information Supporting Need for the Measure

Unspecified

Extent of Measure Testing

The measures in this set are being made available without any prior formal testing. However, these measures are included in the Centers for Medicare and Medicaid Services (CMS) approved American College of Radiology (ACR) National Radiology Data Registry, a CMS Physician Quality Reporting System (PQRS) Qualified Clinical Data Registry since 2014.

The ACR recognizes the importance of thorough testing all of its measures and encourages ongoing robust testing of the ACR National Radiology Data Registry measurement set for feasibility and reliability by organizations or individuals positioned to do so. The ACR will welcome the opportunity to promote such testing of these measures and to ensure that any results available from testing are used to refine the measures on an ongoing basis. Since these measures are in use for quality improvement and reporting, we can support data analysis of registry data to perform the testing, such as evaluation of gaps for validity testing, and signal-to-noise estimation for reliability testing.

Evidence for Extent of Measure Testing

Blakey A. (Administrator, Quality Management Programs, American College of Radiology, Reston, VA). Personal communication. 2016 Mar 7.  1 p.

State of Use

Current routine use

Current Use

Internal quality improvement

Pay-for-reporting

Professional certification

Public reporting

Measurement Setting

Ambulatory/Office-based Care

Ambulatory Procedure/Imaging Center

Hospital Inpatient

Hospital Outpatient

Professionals Involved in Delivery of Health Services

Physicians

Least Aggregated Level of Services Delivery Addressed

Clinical Practice or Public Health Sites

Statement of Acceptable Minimum Sample Size

Unspecified

Target Population Age

Unspecified

Target Population Gender

Either male or female

National Quality Strategy Aim

Better Care

National Quality Strategy Priority

Health and Well-being of Communities
Prevention and Treatment of Leading Causes of Mortality

IOM Care Need

Getting Better

Living with Illness

Staying Healthy

IOM Domain

Effectiveness

Case Finding Period

Unspecified

Denominator Sampling Frame

Patients associated with provider

Denominator (Index) Event or Characteristic

Diagnostic Evaluation

Denominator Time Window

Does not apply to this measure

Denominator Inclusions/Exclusions

Inclusions
Total number of computed tomography (CT) exams using intravenous iodinated contrast

Exclusions
None

Exclusions/Exceptions

None

Numerator Inclusions/Exclusions

Inclusions
Total number of computed tomography (CT) exams using intravenous iodinated contrast resulting in extravasation

Exclusions
Unspecified

Numerator Search Strategy

Fixed time period or point in time

Data Source

Registry data

Type of Health State

Adverse Health State

Instruments Used and/or Associated with the Measure

Unspecified

Measure Specifies Disaggregation

Does not apply to this measure

Scoring

Rate/Proportion

Interpretation of Score

Desired value is a lower score

Allowance for Patient or Population Factors

Unspecified

Standard of Comparison

External comparison at a point in, or interval of, time

Internal time comparison

Original Title

CT IV contrast extravasation rate (low osmolar contrast media).

Measure Collection Name

National Radiology Data Registry Measurement Set

Submitter

American College of Radiology - Medical Specialty Society

Developer

American College of Radiology - Medical Specialty Society

Funding Source(s)

None

Composition of the Group that Developed the Measure

The American College of Radiology (ACR) National Radiology Data Registry (NRDR) helps facilities benchmark outcomes and process-of-care measures and to develop quality improvement programs. The composition of the workgroup is has representation from each of our six data registries:

  1. CT Colonography Registry Committee (CTC)
  2. Dose Index Registry Committee (DIR)
  3. General Radiology Improvement Database Committee (GRID)
  4. National Mammography Database Committee (NMD)
  5. Lung Cancer Screening Registry Committee (LCSR)
  6. IR & INR Registries (Interventional Radiology)

Committee Members

  • Morin Richard, PhD, FACR, Chair of NRDR
  • Kalpana Kanal, PhD, Chair of DIR
  • Zuley Margarita, MD, Chair of NMD
  • Abe Dachman, MD, Chair of CTC Committee
  • Frank Rybicki, MD, Chair of Metrics Committee
  • Siegel Eliot, MD, RSNA Liaison
  • Chad Calendine, MD, Co-Chair of GRID
  • Geoffrey Wiot, Co-Chair of GRID
  • Jeremy Durack, Chair of IR Registry Committee
  • Ella Kazerooni, Co-Chair of Lung-Cancer Screening Committee
  • Deni Aberle, Co-Chair of Lung-Cancer Screening Committee

Committee Staff

  • Judy Burleson, MHSA, American College of Radiology
  • Mythreyi Bhargavan Chatfield, PhD, American College of Radiology

Financial Disclosures/Other Potential Conflicts of Interest

Unspecified

Adaptation

This measure was not adapted from another source.

Date of Most Current Version in NQMC

2015 Mar

Measure Maintenance

This measure is reviewed annually

Date of Next Anticipated Revision

2017 Mar

Measure Status

This is the current release of the measure.

Source(s)

American College of Radiology (ACR). National Radiology Data Registry: qualified clinical data registry. Non-PQRS measures. Reston (VA): American College of Radiology (ACR); 2015 Mar. 49 p.

Measure Availability

Source available from the American College of Radiology (ACR) Web site External Web Site Policy.

For more information, contact ACR at 1891 Preston White Drive, Reston, VA 20191; Phone: 703-648-8900; E-mail: nrdr@acr.org; Web site: www.acr.org External Web Site Policy.

NQMC Status

This NQMC measure summary was completed by ECRI Institute on December 11, 2015. The information was verified by the measure developer on March 7, 2016.

Copyright Statement

This NQMC summary is based on the original measure, which is subject to the measure developer's copyright restrictions.

©2014 American College of Radiology. All Rights Reserved.

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