1. Intravenous ketorolac in the emergency department management of sickle cell pain and predictors of its effectiveness
- Author
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Simon Hk, Thomas V. Adamkiewicz, Keith M. Sullivan, Beiter Jl, and Chambliss Cr
- Subjects
Male ,Adolescent ,Visual analogue scale ,Analgesic ,Pain ,Anemia, Sickle Cell ,Ketorolac Tromethamine ,Severity of Illness Index ,Severity of illness ,Medicine ,Humans ,Prospective Studies ,Prospective cohort study ,Child ,Infusions, Intravenous ,Likelihood Functions ,business.industry ,Patient Selection ,Anti-Inflammatory Agents, Non-Steroidal ,Emergency department ,medicine.disease ,Sickle cell anemia ,Ketorolac ,Anesthesia ,Pediatrics, Perinatology and Child Health ,Female ,Emergencies ,business ,medicine.drug - Abstract
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.A prospective case series.The emergency department of an urban children's hospital in the southeastern United States.A convenience sample of 51 children aged 6 to 18 years, representing 70 distinct episodes of VOP requiring IV analgesics.All patients were given 0.5 to 1 mg/kg IV ketorolac and IV fluids.Patients, parents, nurses, and physicians assessed pain before and after ketorolac using a standard 100-mm visual analog scale (VAS).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.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.
- Published
- 2001