title: Intravenous ketorolac in the emergency department management of sickle cell pain and predictors of its effectiveness.
abstract: 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.
authors: 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
authors: J L
authors: JL
authors: Beiter
authors: H K
authors: HK
authors: Simon
authors: C R
authors: CR
authors: Chambliss
authors: T
authors: T
authors: Adamkiewicz
authors: K
authors: K
authors: Sullivan
mesh_terms: 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
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D020911:Ketorolac Tromethamine