In children being treated for acute asthma in emergency departments, the use of intravenous magnesium sulfate occurs late in the treatment regimen and in only a small percentage of patients, according to study results published in The Journal of Pediatrics.
The aim of this multicenter, retrospective, cohort study was to assess the use of intravenous magnesium sulfate in children with asthma who presented to the emergency department for acute asthma. A secondary aim was to evaluate the safety of this treatment based on the rate of emergency department revisits. Electronic health data records were obtained from the Pediatric Emergency Care Applied Research Network registry, which included tertiary and community pediatric emergency departments.
To be included in this study, children had to be between 2 and 17 years and diagnosed with asthma, reactive airway disease, wheeze, or bronchospasm during an emergency department visit. The primary outcome was the rate of treatment with intravenous magnesium sulfate, and the secondary outcome was the rate of returns to the emergency department within 72 hours after the initial visit. The length of hospital and emergency department stay as well as the dosage and the timing of intravenous magnesium sulfate administration were also analyzed.
Of the 61,854 children who visited the emergency department for acute asthma, 36.4% were hospitalized, and of the 39,352 discharged, 3.6% returned to the emergency department within 72 hours. Treatment using intravenous magnesium sulfate was used in 10.5% of all visits and in 25.7% of the visits that required hospitalization. After treatment with intravenous magnesium sulfate, 11.1% of the children were discharged home and 1.8% returned within 72 hours.
On average it took 154 minutes before intravenous magnesium sulfate was administered. It was preceded by systemic corticosteroids in 85% of the cases, 3 albuterol treatments in 92% of the cases, both systemic corticosteroids and albuterol in 83% of the cases, and ipratropium in 91% of the cases. The median time from intravenous magnesium sulfate to discharge was 201 minutes. The median dose of intravenous magnesium sulfate was 49.5 mg/kg. Hypotension occurred in 7.6% of the visits that involved intravenous magnesium sulfate.
Multivariable analysis revealed that intravenous magnesium sulfate was used more frequently in children with a severe initial asthma score (adjusted odds ratio, 6.02; 95% CI, 5.36-6.76) and less frequently at community emergency departments when compared with tertiary emergency departments (bivariable odds ratio, 0.75; 95% CI, 0.70-0.81).
Limitations of this study included the inability to assess if children were taken to a different emergency department after discharge from the initial visit, the potential use of steroids prior to the hospital visit, and the duration of the intravenous magnesium sulfate infusion.
The researchers concluded, “The use of [intravenous magnesium sulfate] occurs late in the [emergency department] course, in approximately 10% of pediatric [emergency department] visits for acute asthma, and is highly variable among sites, with less use in community vs tertiary pediatric [emergency departments].”
Johnson MD, Zorc JJ, Nelson DS, et al; for the Pediatric Emergency Care Applied Research Network (PECARN). Intravenous magnesium in asthma pharmacotherapy: Variability in use in the PECARN registry [published online March 5, 2020]. J Pediatr. doi:10.1016/j.jpeds.2020.01.062