{
  "id": "medical/contrast-allergy-history-missed",
  "signature": "AI orders CT with IV contrast for a patient with documented severe contrast allergy, no premedication ordered",
  "signature_zh": "AI为有严重造影剂过敏史的患者开具CT增强扫描，未安排预处理用药",
  "regex": "(CT|computed tomography)\\s*(with|IV|intravenous)\\s*(contrast|dye)\\s*(without|no)\\s*(premedication|premed|allergy)",
  "domain": "medical",
  "category": "data_error",
  "subcategory": null,
  "root_cause": "Skipping premedication (e.g., prednisone, diphenhydramine) for patients with prior anaphylactoid reaction to iodinated contrast can trigger life-threatening anaphylaxis; electronic health record allergy alerts are often overlooked.",
  "root_cause_type": "generic",
  "root_cause_zh": "对既往有碘造影剂过敏反应的患者跳过预处理（如泼尼松、苯海拉明）可能引发危及生命的过敏反应；电子病历中的过敏警报常被忽视。",
  "versions": [
    {
      "version": "iohexol 350mgI/mL",
      "introduced": null,
      "deprecated": null,
      "removed": null,
      "behavior_change": null,
      "status": "active"
    },
    {
      "version": "ACR manual on contrast media v2023",
      "introduced": null,
      "deprecated": null,
      "removed": null,
      "behavior_change": null,
      "status": "active"
    },
    {
      "version": "EHR allergy module v5.2",
      "introduced": null,
      "deprecated": null,
      "removed": null,
      "behavior_change": null,
      "status": "active"
    }
  ],
  "os_specific": {},
  "dead_ends": [
    {
      "action": "",
      "why_fails": "Low-osmolar reduces but does not eliminate risk in patients with prior severe reaction; premedication still indicated",
      "fail_rate": 0.8,
      "condition": "",
      "sources": []
    },
    {
      "action": "",
      "why_fails": "Anaphylaxis can occur within minutes regardless of infusion rate; reactive monitoring is insufficient",
      "fail_rate": 0.85,
      "condition": "",
      "sources": []
    },
    {
      "action": "",
      "why_fails": "Non-ionic contrast still carries risk; premedication protocol applies to all iodinated contrast agents",
      "fail_rate": 0.75,
      "condition": "",
      "sources": []
    }
  ],
  "workarounds": [
    {
      "action": "Order premedication: prednisone 50mg PO at 13h, 7h, 1h before scan + diphenhydramine 50mg IV 1h before; use `python -c \"print('Premed: pred 50mg PO at t-13, t-7, t-1; benadryl 50mg IV at t-1')\"`",
      "success_rate": 0.9,
      "how": "Order premedication: prednisone 50mg PO at 13h, 7h, 1h before scan + diphenhydramine 50mg IV 1h before; use `python -c \"print('Premed: pred 50mg PO at t-13, t-7, t-1; benadryl 50mg IV at t-1')\"`",
      "condition": "",
      "sources": []
    },
    {
      "action": "If urgent scan needed, use emergency premedication (methylprednisolone 40mg IV + diphenhydramine 50mg IV) 1h prior",
      "success_rate": 0.85,
      "how": "If urgent scan needed, use emergency premedication (methylprednisolone 40mg IV + diphenhydramine 50mg IV) 1h prior",
      "condition": "",
      "sources": []
    },
    {
      "action": "Consider alternative imaging without contrast (e.g., non-contrast CT, MRI with gadolinium if no contraindication)",
      "success_rate": 0.8,
      "how": "Consider alternative imaging without contrast (e.g., non-contrast CT, MRI with gadolinium if no contraindication)",
      "condition": "",
      "sources": []
    }
  ],
  "workarounds_zh": [
    "Order premedication: prednisone 50mg PO at 13h, 7h, 1h before scan + diphenhydramine 50mg IV 1h before; use `python -c \"print('Premed: pred 50mg PO at t-13, t-7, t-1; benadryl 50mg IV at t-1')\"`",
    "If urgent scan needed, use emergency premedication (methylprednisolone 40mg IV + diphenhydramine 50mg IV) 1h prior",
    "Consider alternative imaging without contrast (e.g., non-contrast CT, MRI with gadolinium if no contraindication)"
  ],
  "transition_graph": {
    "leads_to": [],
    "preceded_by": [],
    "frequently_confused_with": []
  },
  "official_doc_url": "https://www.acr.org/Clinical-Resources/Contrast-Manual",
  "official_doc_section": null,
  "error_code": "CONTRAST-ALLERGY-002",
  "verification_tier": "ai_generated",
  "confidence": 0.88,
  "fix_success_rate": 0.85,
  "resolvable": "true",
  "first_seen": "2024-04-10",
  "last_confirmed": "2024-06-01",
  "last_updated": "2024-06-01",
  "evidence_count": 1,
  "tags": [],
  "locale": "en",
  "aliases": []
}