Evaluation of ketorolac ceiling dose effects in pediatric patients in the emergency department.

Background: The use of ketorolac for analgesia in the emergency department is a common practice for pediatric patients. There is a lack of guidance on optimal dosing to limit the risk of side effects especially in pediatric patients. The standard dosing is weight based with a cap at 30 mg, a dose which is higher than the typical max used for adult patients. The objective of this study is to compare the analgesic effect of intravenous ketorolac at doses of 15 mg versus doses greater than 15 mg.

Methods: This retrospective observational study was performed at a single-center, pediatric tertiary academic medical center. A system-generated report identified patients with an order for IV ketorolac within the ED from July 2021 to July 2022. Pediatric patients presenting to the ED with acute pain and being treated with monotherapy ketorolac for analgesia at a minimum dose of 15 mg were included. The primary outcome of this study evaluated the change in pain score in patients receiving one dose of ketorolac dosed at 15 mg as compared to doses greater than 15 mg.

Results: Our study population included 599 patients receiving ketorolac IV in the ED with baseline demographics similar between groups. For the primary outcome there was no statistically significant difference in the number of patients with a decrease in pain score between patient groups (p = 0.84).

Conclusion: This retrospective review demonstrates an association of similar analgesic effects using a capped dose of 15 mg of IV ketorolac as compared to larger doses in pediatric patients admitted to the ED.