Magnesium Use in Asthma Pharmacotherapy: A Pediatric Emergency Research Canada Study WHAT’S KNOWN ON THIS SUBJECT: We know that many evidence- based treatments for acute asthma are underused, and adherence with treatment guidelines is poor; however, studies have focused on b 2 agonists and corticosteroids, but little is known about intravenous magnesium, which has substantial evidence of benefit. WHAT THIS STUDY ADDS: Magnesium is used infrequently in Canadian pediatric emergency departments in hospitalized children with acute asthma, with variation across sites. More than half of this population does not receive frequent bronchodilators and timely corticosteroids. abstract OBJECTIVES: To examine the use of intravenous magnesium in Canadian pediatric emergency departments (EDs) in children requiring hospital- ization for acute asthma and association of administration of frequent albuterol/ipratropium and timely corticosteroids with hospitalization. METHODS: Retrospective medical record review at 6 EDs of otherwise healthy children 2 to 17 years of age with acute asthma. Data were extracted on history, disease severity, and timing of ED stabilization treatments with inhaled albuterol, ipratropium, corticosteroids, and magnesium. Primary outcome was the proportion of hospitalized chil- dren given magnesium in the ED. Secondary outcome was the ED use of “intensive therapy” in hospitalized children, defined as 3 albuterol inha- lations with ipratropium and corticosteroids within 1 hour of triage. RESULTS: A total of 19 (12.3%) of 154 hospitalized children received magnesium (95% confidence interval 7.1, 17.5) versus 2 of 962 dis- charged patients. Children given magnesium were more likely to have been previously admitted to ICU (odds ratio [OR] 11.2), hospitalized within the past year (OR 3.8), received corticosteroids before arrival (OR 4.0), presented with severe exacerbation (OR 6.1), and to have been treated at 1 particular center (OR 14.9). Forty-two (53%) of 90 hospitalized children were not given “intensive therapy.” Children receiving “intensive therapy” were more likely to present with severe disease to EDs by using asthma guidelines (ORs 8.9, 3.0). Differences in the frequencies of all stabilization treatments were significant across centers. CONCLUSIONS: Magnesium is used infrequently in Canadian pediatric EDs in acute asthma requiring hospitalization. Many of these children also do not receive frequent albuterol and ipratropium, or early cor- ticosteroids. Significant variability in the use of these interventions was detected. Pediatrics 2012;129:852–859 AUTHORS: Suzanne Schuh, MD, FRCPC, a Roger Zemek, MD, FRCPC, b Amy Plint, MD, FRCPC, b Karen J. L. Black, MD, FRCPC, c Stephen Freedman, MD, FRCPC, a Robert Porter, MD, CCFP (EM), d Serge Gouin, MDCM, FRCPC, e Alexandra Hernandez, MD, FRCPC, f and David W. Johnson, MD, FAAP g Divisions of Pediatric Emergency Medicine, a The Hospital for Sick Children, Toronto, Ontario, Canada; b Children’ s Hospital of Eastern Ontario (CHEO), Ottawa, Ontario, Canada; c Izaak Walton Killam Health Centre, Halifax, Nova Scotia, Canada; d Janeway Children’ s Hospital, St John’ s, Newfoundland and Labrador, Canada; e cho Sainte-Justine, Montreal, Quebec, Canada; f McMaster University, Hamilton, Ontario, Canada; and g Alberta Children’ s Hospital, Calgary, Alberta, Canada KEY WORDS acute asthma, emergency medicine, emergency department, children, intravenous magnesium ABBREVIATIONS CI—confidence interval ED—emergency department IQR—interquartile range IV—intravenous OR—odds ratio PRAM—Pediatric Respiratory Assessment Measure www.pediatrics.org/cgi/doi/10.1542/peds.2011-2202 doi:10.1542/peds.2011-2202 Accepted for publication Jan 13, 2012 Address correspondence to Suzanne Schuh, MD, FRCPC, Division of Paediatric Emergency Medicine, The Hospital for Sick Children, 555 University Ave, Toronto, ON, Canada M5G 1X8. E-mail: suzanne. schuh@sickkids.ca PEDIATRICS (ISSN Numbers: Print, 0031-4005; Online, 1098-4275). Copyright © 2012 by the American Academy of Pediatrics FINANCIAL DISCLOSURE: The authors have indicated they have no financial relationships relevant to this article to disclose. FUNDING: No external funding. 852 SCHUH et al by guest on October 6, 2016 Downloaded from