RT Journal
A1 Beiter JL, Jr, Simon HK, Chambliss C, Adamkiewicz T, Sullivan K
T1 INtravenous ketorolac in the emergency department management of sickle cell pain and predictors of its effectiveness
JF Archives of Pediatrics & Adolescent Medicine
JO Archives of Pediatrics & Adolescent Medicine
YR 2001
FD April 1
VO 155
IS 4
SP 496
OP 500
DO 10.1001/archpedi.155.4.496
UL http://dx.doi.org/10.1001/archpedi.155.4.496
AB Objectives 
    To evaluate the effectiveness of intravenous (IV) ketorolac tromethamine in the treatment of children with sickle cell disease with moderate to severe acute vaso-occlusive pain (VOP) and to develop a predictive model that would determine who would need additional IV analgesics.Design 
    A prospective case series.Setting 
    The emergency department of an urban children's hospital in the southeastern United States.Patients 
    A convenience sample of 51 children aged 6 to 18 years, representing 70 distinct episodes of VOP requiring IV analgesics.Intervention 
    All patients were given 0.5 to 1 mg/kg IV ketorolac and IV fluids.Main Outcome Measures 
    Patients, parents, nurses, and physicians assessed pain before and after ketorolac using a standard 100-mm visual analog scale (VAS).Results 
    Of the 70 episodes of VOP, 37 (53%) adequately resolved with IV ketorolac and IV fluids and required no IV opioids (group A). Thirty-one episodes (47%) required the addition of an IV opioid (group B). Group B had a significantly greater proportion of episodes reporting 4 or more painful sites than group A, 43% (12/28) vs 9% (3/33), respectively (P<.01). Group B also had significantly higher mean initial VAS scores than group A as assessed by the patient (81 vs 60; P<.01), parent (71 vs 54; P<.01), nurse (78 vs 51, P<.01), and physician (69 vs 53; P = .01). Of the patient assessments with an initial VAS score greater than 70, 69% (18/26) required the addition of an opioid.Conclusions 
    First-line therapy with IV ketorolac and IV fluids resulted in adequate resolution of pain in 53% of episodes with acute VOP. A reported 4 or more painful sites and an initial VAS score greater than 70 were predictors of the likelihood to need additional IV analgesics.