Intravenous ketorolac in the emergency department management of sickle cell pain and predictors of its effectiveness.
| Autor: | Beiter JL Jr; 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 HK, Chambliss CR, Adamkiewicz T, Sullivan K |
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| Jazyk: | angličtina |
| Zdroj: | Archives of pediatrics & adolescent medicine [Arch Pediatr Adolesc Med] 2001 Apr; Vol. 155 (4), pp. 496-500. |
| DOI: | 10.1001/archpedi.155.4.496 |
| Abstrakt: | 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. |
| Databáze: | MEDLINE |
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