Perlin 1994.

Methods	Allocation: randomized Controlled: placebo Blinding: double‐blind Arm: 2‐arm, parallel‐group design Centre: single centre Study Duration: unclear
Participants	Inclusion criteria: aged ≥ 15 years, people with SCD admitted to emergency department with pain of VOC Exclusion criteria: active peptic ulcer disease; systemic bleeding disorders; impaired renal function (urea > 20 mg/dL /or serum creatinine > 1 mg/dL, or both); other medical condition; history of hypersensitivity to NSAIDs; pregnant women Baseline characteristics N: 21 participants; 21 VOC episodes Gender: F 10, M 11 Age (range): 19–41 years Number randomized: 10 intervention; 11 control Number completed: 9 intervention; 9 control Setting and location: Howard University Hospital, Washington, DC, USA
Interventions	Treatment group (10 participants; 10 VOC episodes): loading dose ketorolac 30 mg continuous IV infusion ketorolac 120 mg, 5 mg/hr, total dose 150 mg on the first day, then maximum 120 mg/day for up to 5 days Control group (11 participants; 11 VOC episodes): loading dose saline continuous IV infusion saline, dose each/hr, for up to 5 days Duration of treatment: duration of crisis, 5‐day infusion period Follow‐up period: not stated Cointerventions/additional analgesia: supplemental IM meperidine 100 mg as needed, frequency no more than 3 hr
Outcomes	Primary outcomes Quantity of meperidine required over 5‐day period Secondary outcomes Pain intensity Verbal Categorical Scale, VAS (0–100, Pain Relief Verbal Scale (0–4)) Duration of hospital stay (measured from the day of enrolment to the day of discharge) Global Assessment (1–5: 1 = much worse, 5 = much better) Adverse events
Notes	Sources of funding: supported in part by a grant from Syntex Research, a division of Syntex (USA), Inc, who manufacture ketorolac as Toradol
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Quote: "the study was randomized," "The study drugs were prepared by a designated hospital pharmacist (J.P.) and allocated according to a predetermined, computer generated random code, balanced in blocks of four."
Allocation concealment (selection bias)	Low risk	Comment: preparations by a hospital pharmacist, not study investigators.
Blinding of participants and personnel (performance bias) All outcomes	Low risk	Quote: "the study drugs were prepared by a designated hospital pharmacist (J.P.) and allocated according to a predetermined, computer generated random code, balanced in blocks of four." Comment: not explicitly stated, but likely that investigators remained blinded to treatment allocation.
Blinding of outcome assessment (detection bias) All outcomes	Low risk	Comment: not explicitly stated, but likely that investigators remained blinded to treatment allocation.
Incomplete outcome data (attrition bias) All outcomes	Unclear risk	Quote: "3 participants withdrawn prematurely (1‐active, 2‐control)...ITT analysis to account for withdrawals." Comment: effect not likely to be small, but appropriate ITT analysis to cope with withdrawals.
Selective reporting (reporting bias)	Low risk	Comment: no protocol available, but all planned outcomes were reported in results
Size	High risk	Comment: total participants 21, fewer than 50 participants per treatment arm.
Other bias	Low risk	Comment: no other potential sources of bias. General comment: ITT analysis performed.