Inquest Begins Into Man’s Anaphylactic Death from Contrast Injection

An inquest has begun investigating the anaphylactic death of a man who was injected with iodinated contrast dye needed for a CT scan.

In March of 2022, David Horsman was having the scan performed as part of a routine follow-up after successful treatment for bowel cancer.

The scan was performed outside Royal Bolton Hospital in a mobile van owned by InHealth, a provider of diagnostic and health services throughout the UK.

Although Horsman had no history of allergy to the dye, after the scan, his skin flushed and he began to feel very hot and started to cough.

Indogesit Okon, the radiographer who performed the scan realized the man was suffering a serious allergic reaction. He called the hospital’s radiology department but no one answered, so he called the hospital’s crash team and told them there was an “emergency at the CT van, the patient reacted to contrast.” 

Unfortunately, the crash team rushed to the hospital’s children’s ward due to a miscommunication, possibly due to a language barrier, as Okon had arrived weeks earlier from Nigeria. The result was a 17-minute delay before arriving at the van and beginning emergency care.

During the wait, Okon repeatedly called the hospital’s emergency department who dispatched a nurse that began chest compressions when Horsman stopped breathing. He was still performing the chest compressions when the crash team arrived and rushed Horsman into the hospital.

Although the van carried a defibrillator, Okon had not yet been trained on how to operate it since arriving from Nigeria on assignment. Another radiographer and the nurse testified that they located the defibrillator but struggled to get it to work.

Horsman did not survive, and the coroner declared the cause of death to be an anaphylactic reaction to the contrast dye with heart disease as a contributing factor.

Testifying at the inquest, Horsman’s wife described how shocked she was by the news of her husband’s reaction, as he had had a number of similar scans in the past without any adverse reactions.

Our sincere condolences go out to the wife of Mr Horsman and his family. We hope the inquest brings them some measure of closure.

Contrast dye reactions happen in an estimated 3%-15% of patients and are generally mild but can escalate to full-blown anaphylaxis quickly, according to Verywell Health.

These factors appear to put people at greater risk for developing adverse reactions:

• Past reactions to a similar type of contrast
• Having asthma
• Having allergies
• Having heart disease
• Having kidney disease
• Taking beta-blockers, medications commonly used for a variety of conditions, including heart conditions

Older adults also are at increased risk.

Small test doses are not a reliable indicator of whether a reaction will occur to a full dose of contrast dye. Doctors can prescribe a pre-medication for those at elevated risk consisting of oral corticosteroids like prednisone and antihistamines.

Needless to say, a radiology department should be stocked with epinephrine and a defibrillator and have personnel trained to administer them in an emergency.