Early versus delayed administration of intravenous magnesium sulfate for pediatric asthma

Objective: This study aims to describe and examine the factors associated with the early administration of intravenous magnesium sulfate (IV Mg) in children presenting to the pediatric emergency department (ED) for an asthma exacerbation. Methods: Retrospective cohort study of children aged 5–11 years who received IV Mg in the pediatric ED between September 1, 2018 and August 31, 2019 for management of an asthma exacerbation. Primary outcome was administration of IV Mg in ≤60 min from ED triage (‘early administration’). Comparison of clinical management and therapies in children who received early versus delayed IV Mg and the factors associated with early administration of IV Mg were examined. Results: Early (n = 90; 31.6%) IV Mg was associated with more timely bronchodilators (47 versus 68 min; p ≤ 0.001) and systemic corticosteroids (36 versus 46.5 min; p ≤ 0.001). There was no difference between the two cohorts in returns to the ED within 72 h (1.1% versus 2.1%; p = .99) or readmissions within 1 week one week (2.2% versus 0.5%; p = .2). Hypoxia (aOR = 3.76; 95% CI = 2.02–7.1), respiratory rate (aOR = 1.04; 95% CI = 1.02–1.07), retractions (aOR = 2.21; 95% CI = 1.25–3.94), and prior hospital use for asthma-related complaints (aOR = 2.1; 95% CI = 1.16–3.84) were significantly associated with early IV Mg. Conclusions: Early administration of IV Mg was associated with more timely delivery of first-line asthma therapies, was safe, and improved ED throughput without increasing return ED visits or hospitalizations for asthma.