Intravenous ketorolac in the emergency department management of sickle cell pain and predictors of its effectiveness.
OBJECTIVE
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.


METHODS
A prospective case series.


METHODS
The emergency department of an urban children's hospital in the southeastern United States.


METHODS
A convenience sample of 51 children aged 6 to 18 years, representing 70 distinct episodes of VOP requiring IV analgesics.


METHODS
All patients were given 0.5 to 1 mg/kg IV ketorolac and IV fluids.


METHODS
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.
Beiter
J L
JL
Department of Pediatrics, Hughes Spalding Children's Hospital, Emory University School of Medicine, Children's Healthcare of Atlanta at Egleston, GA, USA. jbeiterjr@aol.com
Simon
H K
HK
Chambliss
C R
CR
Adamkiewicz
T
T
Sullivan
K
K
D000293:Adolescent; D000755:Anemia, Sickle Cell / Q000150:complications / Q000188:drug therapy*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D002648:Child; D004630:Emergencies; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D020911:Ketorolac Tromethamine / Q000627:therapeutic use*; D016013:Likelihood Functions; D008297:Male; D010146:Pain / Q000188:drug therapy* / Q000209:etiology; D018579:Patient Selection; D011446:Prospective Studies; D012720:Severity of Illness Index
D000894:Anti-Inflammatory Agents, Non-Steroidal; D020911:Ketorolac Tromethamine