ketorolacJournal Club Summary

Methodology Score: 2.5/5                
Usefulness Score:  3/5
Motov S, et al.
Ann Emerg Med. 2016 Dec 14. pii: S0196-0644(16)31244-6. 
This randomized, double-blind study of the analgesic efficacy of ketorolac at three different doses (10mg, 15mg, 30mg) in 240 ED patients with acute pain, demonstrated no difference in verbal numeric rating scores of pain at 30 minutes. The results suggest an analgesic ceiling of ketorolac dosing at 10mg IV but significant methodological flaws preclude definitive conclusions (heterogeneous patient population, use of a continuous rather than binary outcome, not stratifying by pain severity or condition). 
By: Dr. Peter Reardon   

Epi lesson

Use of Continuous Data as Primary Outcome
Beware of studies that compare the effectiveness of interventions by using continuous data outcomes, such as pain scales (1-100), oxygen saturation values, and minutes to pain relief. These kinds of data can produce statistically significant differences between groups with relatively small sample sizes but often give you little information about clinical importance. Far better and almost always the norm are outcome measures given as proportions or percentages, such as % of patients who achieve: 20 points improvement in pain, an oxygen saturation of 90%, pain relief in less than 2 hours, or survival.
By: Dr. Ian Stiell