Corticosteroid prophylaxis for patients with increased risk of adverse reactions to intravascular contrast agents: a survey of current practice in the UK.

There is no definite experimental evidence that prophylactic corticosteroids reduce the frequency or severity of adverse effects from low-osmolar contrast agents in patients at increased risk of reaction. There is no consensus in terms of how prophylaxis should be conducted. We have studied current radiologists' practice in the UK by sending postal questionnaires to 212 radiologists randomly selected from a list of current consultants who are Fellows of the Royal College of Radiologists. One hundred and seventy (80.2%) of the 212 questionnaires were completed. The majority of radiologists routinely use non-ionic low osmolar contrast media for intravenous administration, only 30 (17.6%) routinely using conventional ionic agents and six (3.5%) ionic low osmolar agents. All 170 use low osmolar contrast media for those patients perceived to be at increased risk of adverse reactions. Seventy-six radiologists (44.7%) never use steroid cover. There is no consistent practice amongst the 94 consultants (55.3%) who do use steroid cover. The indications for prophylaxis vary, as do the corticosteroid used and the dose regime employed. The total dose used varied from the equivalent of 7.5 mg to 400 mg of prednisolone, and the duration of prophylaxis varied from a single dose to a 4 day course. One hundred and forty-two radiologists (83.5%) would welcome nationally agreed guidelines for the use of steroid cover. The great variation in the use of steroid cover in the UK reflects the lack of clear evidence of its benefit in combination with low osmolar contrast media.