Intensive Asthma Therapy and Intravenous Magnesium Sulfate in the Emergency Department Management of Pediatric Asthma

OBJECTIVE: The aim of the stud is to determine whether intravenous magnesium sulfate (IVMg) is associated with hospitalization and time to albuterol every 4 hours in a cohort of children who received intensive asthma therapy (IAT) in the emergency department (ED). METHODS: This retrospective cohort study included children 2-18 years who received IAT, defined as 3 bronchodilators and corticosteroids within 60 minutes of ED triage, with or without IVMg in the ED between 2019 and 2021. Primary outcome was hospitalization and among hospitalized children, secondary outcome was time to albuterol every 4 hours. Additional secondary outcomes included adjuvant medications, respiratory support, and length of stay. RESULTS: Among 851 patient encounters, 61% (n = 516) received IAT with IVMg in the ED and most patients were hospitalized (n = 565, 66%). Patients who received IVMg had increased odds of hospitalization (adjusted odds ratio [aOR] 25.3, 95% confidence interval [CI] 14.49-42.52, P < 0.001) and a longer time to albuterol every 4 hours (aOR 13.8, 95% CI 9.61-17.75, P < 0.001), even when controlling for demographic and clinical markers of severe asthma. In the adjusted analysis, patients who received IAT with IVMg had increased odds of adjuvant medications in the ED (aOR 7.3, 95% CI 2.97-17.95, P < 0.001) and respiratory support in the ED (aOR 3.6, 95% CI 2.22-5.85, P < 0.001) and the inpatient setting (aOR 3.9, 95% CI 1.87-7.97, P < 0.001). CONCLUSIONS: Children who received IAT and IVMg in the ED for management of an acute asthma exacerbation had significantly higher odds of hospitalization without any improvement in the time to albuterol every 4 hours for admitted patients. The results of this observational study underscore the need for randomized controlled trials to determine the efficacy of IVMg for acute pediatric asthma.