title: Magnesium use in asthma pharmacotherapy: a Pediatric Emergency Research Canada study.
abstract: OBJECTIVE
  To examine the use of intravenous magnesium in Canadian pediatric emergency departments (EDs) in children requiring hospitalization 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 children given magnesium in the ED. Secondary outcome was the ED use of "intensive therapy" in hospitalized children, defined as 3 albuterol inhalations 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 discharged 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 corticosteroids. Significant variability in the use of these interventions was detected.
authors.affiliation: Division of Paediatric Emergency Medicine, The Hospital for Sick Children, Toronto, ON, Canada. suzanne.schuh@sickkids.ca
authors.forename: Suzanne
authors.initials: S
authors.lastname: Schuh
authors.forename: Roger
authors.initials: R
authors.lastname: Zemek
authors.forename: Amy
authors.initials: A
authors.lastname: Plint
authors.forename: Karen J L
authors.initials: KJ
authors.lastname: Black
authors.forename: Stephen
authors.initials: S
authors.lastname: Freedman
authors.forename: Robert
authors.initials: R
authors.lastname: Porter
authors.forename: Serge
authors.initials: S
authors.lastname: Gouin
authors.forename: Alexandra
authors.initials: A
authors.lastname: Hernandez
authors.forename: David W
authors.initials: DW
authors.lastname: Johnson
mesh_terms: D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage*; D000420:Albuterol / Q000008:administration & dosage*; D018927:Anti-Asthmatic Agents / Q000008:administration & dosage*; D001249:Asthma / Q000188:drug therapy*; D002648:Child; D002675:Child, Preschool; D018450:Disease Progression; D004359:Drug Therapy, Combination; D004363:Drug Utilization; D004636:Emergency Service, Hospital; D005260:Female; D019983:Guideline Adherence; D006760:Hospitalization; D006801:Humans; D015278:Intensive Care Units, Pediatric; D009241:Ipratropium / Q000008:administration & dosage*; D008274:Magnesium / Q000008:administration & dosage*; D008297:Male; D010359:Patient Readmission; D012189:Retrospective Studies
chemical_list: D000305:Adrenal Cortex Hormones; D018927:Anti-Asthmatic Agents; D009241:Ipratropium; D008274:Magnesium; D000420:Albuterol