Safety of parenteral ketorolac use for analgesia in geriatric emergency department patients

Gabrielle L. Anderson, Alicia E. Mattson, Caitlin S. Brown, Daniel Cabrera, Kristin C. Mara, Fernanda Bellolio

Research output: Contribution to journalArticle

Abstract

Objective: To assess the safety of a single dose of parenteral ketorolac for analgesia management in geriatric emergency department (ED) patients. Methods: This was a retrospective study of all administrations of parenteral ketorolac to adults ≥65 years of age and matched controls. The primary outcome was the occurrence of any of the following adverse events within 30 days of the ED visit: gastrointestinal bleeding, intracranial bleeding, acute decompensated heart failure, acute coronary syndrome, dialysis, transfusion, and death. The secondary outcome was the occurrence of an increase in serum creatinine of ≥1.5 times baseline within 7 and 30 days of the ED visit. Results: There were 480 patients included in the final analysis, of which 120 received ketorolac (3: 1 matching). The primary outcome occurred in 14 of 360 patients who did not receive ketorolac and 2 of 120 ketorolac patients (3.9% vs 1.7%, p = 0.38; OR 2.39, 95% CI 0.54–10.66). There was no occurrence of dialysis or death in either group. The secondary outcome occurred in 1 of 13 and 1 of 23 ketorolac patients with both a baseline serum creatinine and a measure within 7 and 30 days, respectively, but did not occur in patients who did not receive ketorolac (7 days: 7.7% vs 0.0%, p = 0.29; 30 days: 4.4% vs 0.0%, p = 0.22). Conclusion: The use of single doses of parenteral ketorolac for analgesia management was not associated with an increased incidence of adverse cardiovascular, gastrointestinal, or renal adverse outcomes in a select group of older adults.

Original languageEnglish (US)
JournalAmerican Journal of Emergency Medicine
DOIs
StateAccepted/In press - Jan 1 2019
Externally publishedYes

Fingerprint

Ketorolac
Geriatrics
Analgesia
Hospital Emergency Service
Safety
Dialysis
Creatinine
Hemorrhage
Acute Coronary Syndrome
Serum
Heart Failure
Retrospective Studies
Kidney
Incidence

Keywords

  • Analgesia
  • Drug-related side effects and adverse reactions
  • Emergency service, hospital
  • Geriatrics
  • Ketorolac
  • Patient safety

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Safety of parenteral ketorolac use for analgesia in geriatric emergency department patients. / Anderson, Gabrielle L.; Mattson, Alicia E.; Brown, Caitlin S.; Cabrera, Daniel; Mara, Kristin C.; Bellolio, Fernanda.

In: American Journal of Emergency Medicine, 01.01.2019.

Research output: Contribution to journalArticle

Anderson, Gabrielle L. ; Mattson, Alicia E. ; Brown, Caitlin S. ; Cabrera, Daniel ; Mara, Kristin C. ; Bellolio, Fernanda. / Safety of parenteral ketorolac use for analgesia in geriatric emergency department patients. In: American Journal of Emergency Medicine. 2019.
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abstract = "Objective: To assess the safety of a single dose of parenteral ketorolac for analgesia management in geriatric emergency department (ED) patients. Methods: This was a retrospective study of all administrations of parenteral ketorolac to adults ≥65 years of age and matched controls. The primary outcome was the occurrence of any of the following adverse events within 30 days of the ED visit: gastrointestinal bleeding, intracranial bleeding, acute decompensated heart failure, acute coronary syndrome, dialysis, transfusion, and death. The secondary outcome was the occurrence of an increase in serum creatinine of ≥1.5 times baseline within 7 and 30 days of the ED visit. Results: There were 480 patients included in the final analysis, of which 120 received ketorolac (3: 1 matching). The primary outcome occurred in 14 of 360 patients who did not receive ketorolac and 2 of 120 ketorolac patients (3.9{\%} vs 1.7{\%}, p = 0.38; OR 2.39, 95{\%} CI 0.54–10.66). There was no occurrence of dialysis or death in either group. The secondary outcome occurred in 1 of 13 and 1 of 23 ketorolac patients with both a baseline serum creatinine and a measure within 7 and 30 days, respectively, but did not occur in patients who did not receive ketorolac (7 days: 7.7{\%} vs 0.0{\%}, p = 0.29; 30 days: 4.4{\%} vs 0.0{\%}, p = 0.22). Conclusion: The use of single doses of parenteral ketorolac for analgesia management was not associated with an increased incidence of adverse cardiovascular, gastrointestinal, or renal adverse outcomes in a select group of older adults.",
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N2 - Objective: To assess the safety of a single dose of parenteral ketorolac for analgesia management in geriatric emergency department (ED) patients. Methods: This was a retrospective study of all administrations of parenteral ketorolac to adults ≥65 years of age and matched controls. The primary outcome was the occurrence of any of the following adverse events within 30 days of the ED visit: gastrointestinal bleeding, intracranial bleeding, acute decompensated heart failure, acute coronary syndrome, dialysis, transfusion, and death. The secondary outcome was the occurrence of an increase in serum creatinine of ≥1.5 times baseline within 7 and 30 days of the ED visit. Results: There were 480 patients included in the final analysis, of which 120 received ketorolac (3: 1 matching). The primary outcome occurred in 14 of 360 patients who did not receive ketorolac and 2 of 120 ketorolac patients (3.9% vs 1.7%, p = 0.38; OR 2.39, 95% CI 0.54–10.66). There was no occurrence of dialysis or death in either group. The secondary outcome occurred in 1 of 13 and 1 of 23 ketorolac patients with both a baseline serum creatinine and a measure within 7 and 30 days, respectively, but did not occur in patients who did not receive ketorolac (7 days: 7.7% vs 0.0%, p = 0.29; 30 days: 4.4% vs 0.0%, p = 0.22). Conclusion: The use of single doses of parenteral ketorolac for analgesia management was not associated with an increased incidence of adverse cardiovascular, gastrointestinal, or renal adverse outcomes in a select group of older adults.

AB - Objective: To assess the safety of a single dose of parenteral ketorolac for analgesia management in geriatric emergency department (ED) patients. Methods: This was a retrospective study of all administrations of parenteral ketorolac to adults ≥65 years of age and matched controls. The primary outcome was the occurrence of any of the following adverse events within 30 days of the ED visit: gastrointestinal bleeding, intracranial bleeding, acute decompensated heart failure, acute coronary syndrome, dialysis, transfusion, and death. The secondary outcome was the occurrence of an increase in serum creatinine of ≥1.5 times baseline within 7 and 30 days of the ED visit. Results: There were 480 patients included in the final analysis, of which 120 received ketorolac (3: 1 matching). The primary outcome occurred in 14 of 360 patients who did not receive ketorolac and 2 of 120 ketorolac patients (3.9% vs 1.7%, p = 0.38; OR 2.39, 95% CI 0.54–10.66). There was no occurrence of dialysis or death in either group. The secondary outcome occurred in 1 of 13 and 1 of 23 ketorolac patients with both a baseline serum creatinine and a measure within 7 and 30 days, respectively, but did not occur in patients who did not receive ketorolac (7 days: 7.7% vs 0.0%, p = 0.29; 30 days: 4.4% vs 0.0%, p = 0.22). Conclusion: The use of single doses of parenteral ketorolac for analgesia management was not associated with an increased incidence of adverse cardiovascular, gastrointestinal, or renal adverse outcomes in a select group of older adults.

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