Summary of findings 3. Opioids compared with active comparator for painful sickle cell vaso‐occlusive crises.

Opioids compared with active comparator for painful sickle cell vaso‐occlusive crises
Patient or population: adults with sickle cell disease in a vaso‐occlusive crisis Settings: emergency departments Intervention: opioids (morphine) Comparison: active comparator (butorphanol or paracetamol)
Outcomes	Illustrative comparative risks* (95% CI)		Relative effect (95% CI)	No of participants (studies)	Quality of the evidence (GRADE)	Comments
	Active comparator	Opioids
Participant‐reported pain relief of 50% or greater	No data	No data	N/A	N/A	No dataa	Quality of the evidence is unknown
Participant‐reported pain relief of 30% or greater	No data	No data	N/A	N/A	No dataa	Quality of the evidence is unknown
PGIC very much improved (Follow‐up: within 1 day)	19.1 per 100	33.3 per 100	N/A	18 participants, 24 VOC events (1 study)	⊕⊝⊝⊝ Very lowb	—
PGIC much or very much improved	No data	No data	N/A	N/A	No dataa	Quality of the evidence is unknown
Any adverse event (Follow‐up: within 1 day)	7/64	9/66	N/A	124 participants, 130 VOC events (2 studies)	⊕⊝⊝⊝ Very lowb	—
Serious adverse event (Follow‐up: within 1 day)	0/64	0/66	N/A	124 participants, 130 VOC events (2 studies)	⊕⊝⊝⊝ Very lowb	—
Withdrawals due to adverse events	No data	No data	N/A	N/A	No dataa	Quality of the evidence is unknown
*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; N/A: not applicable; PGIC: Patient Global Impression of Change; RR: risk ratio; VOC: vaso‐occlusive crisis.
GRADE Working Group grades of evidence High quality: we are very confident that the true effect lies close to that of the estimate of the effect; Moderate quality: we are moderately confident in the effect estimate; the true effect is likely to be close to the estimate of effect, but there is a possibility that it is substantially different; Low quality: our confidence in the effect estimate is limited; the true effect may be substantially different from the estimate of the effect; Very low quality: we have very little confidence in the effect estimate; the true effect is likely to be substantially different from the estimate of effect.

^a No data available, therefore no GRADE rating has been performed for this outcome and the quality of the evidence is unknown.

^b Downgraded three levels; too few data (limited number of participants per treatment arm) to have confidence in results.