title: A multicenter randomized controlled trial of intravenous magnesium for sickle cell pain crisis in children.
abstract: Magnesium, a vasodilator, anti-inflammatory, and pain reliever, could alter the pathophysiology of sickle cell pain crises. We hypothesized that intravenous magnesium would shorten length of stay, decrease opioid use, and improve health-related quality of life (HRQL) for pediatric patients hospitalized with sickle cell pain crises. The Magnesium for Children in Crisis (MAGiC) study was a randomized, double-blind, placebo-controlled trial of intravenous magnesium vs normal saline placebo conducted at 8 sites within the Pediatric Emergency Care Applied Research Network (PECARN). Children 4 to 21 years old with hemoglobin SS or Sβ(0) thalassemia requiring hospitalization for pain were eligible. Children received 40 mg/kg of magnesium or placebo every 8 hours for up to 6 doses plus standard therapy. The primary outcome was length of stay in hours from the time of first study drug infusion, compared using a Van Elteren test. Secondary outcomes included opioid use and HRQL. Of 208 children enrolled, 204 received the study drug (101 magnesium, 103 placebo). Between-group demographics and prerandomization treatment were similar. The median interquartile range (IQR) length of stay was 56.0 (27.0-109.0) hours for magnesium vs 47.0 (24.0-99.0) hours for placebo (P = .24). Magnesium patients received 1.46 mg/kg morphine equivalents vs 1.28 mg/kg for placebo (P = .12). Changes in HRQL before discharge and 1 week after discharge were similar (P > .05 for all comparisons). The addition of intravenous magnesium did not shorten length of stay, reduce opioid use, or improve quality of life in children hospitalized for sickle cell pain crisis. This trial was registered at www.clinicaltrials.gov as #NCT01197417.
authors.affiliation: Pediatric Emergency Medicine, Medical College of Wisconsin, and the Children's Research Institute, Milwaukee, WI;
authors.forename: David C
authors.identifier: http://orcid.org/0000-0001-7995-6504
authors.initials: DC
authors.lastname: Brousseau
authors.affiliation: Pediatric Hematology and Oncology/Blood Research Institute, Medical College of Wisconsin, and the Children's Research Institute, Milwaukee, WI;
authors.forename: J Paul
authors.initials: JP
authors.lastname: Scott
authors.affiliation: Pediatric Emergency Medicine, Johns Hopkins University, Baltimore, MD;
authors.forename: Oluwakemi
authors.initials: O
authors.lastname: Badaki-Makun
authors.affiliation: Pediatric Hematology and Oncology, Children's National Medical Center, Washington, DC;
authors.forename: Deepika S
authors.initials: DS
authors.lastname: Darbari
authors.affiliation: Pediatric Emergency Medicine and.
authors.forename: Corrie E
authors.initials: CE
authors.lastname: Chumpitazi
authors.affiliation: Pediatric Hematology and Oncology, Baylor College of Medicine/Texas Children's Hospital, Houston, TX;
authors.forename: Gladstone E
authors.initials: GE
authors.lastname: Airewele
authors.affiliation: Pediatric Emergency Medicine, Children's Hospital of Philadelphia, Philadelphia, PA;
authors.forename: Angela M
authors.initials: AM
authors.lastname: Ellison
authors.affiliation: Pediatric Hematology and Oncology, Children's Hospital of Philadelphia, Philadelphia, PA;
authors.forename: Kim
authors.initials: K
authors.lastname: Smith-Whitley
authors.affiliation: Pediatric Emergency Medicine, Wayne State University/Children's Hospital of Michigan, Detroit, MI;
authors.forename: Prashant
authors.initials: P
authors.lastname: Mahajan
authors.affiliation: Pediatric Hematology and Oncology, Wayne State University/Children's Hospital of Michigan, Detroit, MI;
authors.forename: Sharada A
authors.initials: SA
authors.lastname: Sarnaik
authors.affiliation: University of Utah/Pediatric Emergency Care Applied Research Network Data Coordinating Center, Salt Lake City, UT;
authors.forename: T Charles
authors.initials: TC
authors.lastname: Casper
authors.affiliation: University of Utah/Pediatric Emergency Care Applied Research Network Data Coordinating Center, Salt Lake City, UT;
authors.forename: Lawrence J
authors.initials: LJ
authors.lastname: Cook
authors.affiliation: University of Utah/Pediatric Emergency Care Applied Research Network Data Coordinating Center, Salt Lake City, UT;
authors.forename: J Michael
authors.initials: JM
authors.lastname: Dean
authors.affiliation: Pediatric Emergency Medicine, Nationwide Children's Hospital, Columbus, OH;
authors.forename: Julie
authors.initials: J
authors.lastname: Leonard
authors.affiliation: Division of Pediatric Hematology and Oncology, Washington University School of Medicine, St. Louis, MO;
authors.forename: Monica L
authors.initials: ML
authors.lastname: Hulbert
authors.affiliation: Division of Emergency Medicine and.
authors.forename: Elizabeth C
authors.initials: EC
authors.lastname: Powell
authors.affiliation: Hematology, Oncology & Stem Cell Transplant, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL;
authors.forename: Robert I
authors.initials: RI
authors.lastname: Liem
authors.affiliation: Pediatric Emergency Medicine, Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, PA; and.
authors.forename: Robert
authors.initials: R
authors.lastname: Hickey
authors.affiliation: Department of Pediatrics, Aflac Cancer and Blood Disorders Center, Emory University School of Medicine, Atlanta, GA;
authors.forename: Lakshmanan
authors.initials: L
authors.lastname: Krishnamurti
authors.affiliation: Pediatric Hematology and Oncology, Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, PA;
authors.forename: Cheryl A
authors.initials: CA
authors.lastname: Hillery
authors.affiliation: Pediatric Emergency Medicine, Medical College of Wisconsin, and the Children's Research Institute, Milwaukee, WI;
authors.forename: Mark
authors.initials: M
authors.lastname: Nimmer
authors.affiliation: Pediatric Hematology and Oncology, Medical College of Wisconsin, and the Children's Research Institute, Milwaukee, WI.
authors.forename: Julie A
authors.initials: JA
authors.lastname: Panepinto
mesh_terms: D000293:Adolescent; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000755:Anemia, Sickle Cell / Q000150:complications / Q000188:drug therapy*; D002648:Child; D002675:Child, Preschool; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D007902:Length of Stay; D008274:Magnesium / Q000008:administration & dosage*; D008297:Male; D010146:Pain / Q000188:drug therapy* / Q000209:etiology; D011788:Quality of Life; D014665:Vasodilator Agents / Q000008:administration & dosage*; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid; D014665:Vasodilator Agents; D008274:Magnesium