Use of ketorolac is associated with decreased pneumonia following rib fractures

Abstract

Background: The effectiveness of the nonsteroidal anti-inflammatory drug ketorolac in reducing pulmonary morbidity after rib fractures remains largely unknown.

Methods: A retrospective cohort study was conducted spanning January 2003 to June 2011 assessing pneumonia within 30 days and potential adverse effects of ketorolac among all patients with rib fractures who received ketorolac <4 days after injury compared with a random sample of those who did not.

Results: Among 202 patients who received ketorolac and 417 who did not, ketorolac use was associated with decreased pneumonia (odds ratio, .14; 95% confidence interval, .04 to .46) and increased ventilator-free days (difference, 1.8 days; 95% confidence interval, 1.1 to 2.5) and intensive care unit-free days (difference, 2.1 days; 95% confidence interval, 1.3 to 3.0) within 30 days. The rates of acute kidney injury, gastrointestinal hemorrhage, and fracture nonunion were not different.

Conclusions: Early administration of ketorolac to patients with rib fractures is associated with a decreased likelihood of pneumonia, without apparent risks.

Keywords: Analgesia; Ketorolac; Nonsteroidal anti-inflammatory drug; Pneumonia; Pulmonary complication; Rib fractures.

Copyright © 2014 Elsevier Inc. All rights reserved.

Figures

Figure 1

The association of ketorolac with decreased likelihood of pneumonia within 30 days of injury. Results are presented as odds ratios with 95% confidence intervals, and the asterisks (*) indicate that the odds ratios are adjusted for the number of rib fractures, Abbreviated Injury Scale chest and extremity scores, and the presence of chronic obstructive pulmonary disease. “Pneumonia by ATS” refers to diagnoses of pneumonia that met the American Thoracic Society criteria, and “Pneumonia by QI” refers to diagnoses of pneumonia ascertained by a hospital quality improvement committee blinded to this study.

Figure 2

The association of ketorolac with increased ventilator- and intensive care unit (ICU)-free days within 30 days of injury. Results are presented as the differences with 95% confidence intervals, adjusted for the number of rib fractures, Abbreviated Injury Scale chest and extremity scores, and the presence of chronic obstructive pulmonary disease.