Division of Paediatric Emergency Medicine, The Hospital for Sick Children, Toronto, ON, Canada.
Pediatrics. 2012 May;129(5):852-9. doi: 10.1542/peds.2011-2202. Epub 2012 Apr 16.
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.
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.
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.
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.
调查加拿大儿科急诊部门（ED）在需要住院治疗的急性哮喘儿童中静脉注射镁的使用情况，并探讨频繁使用沙丁胺醇/异丙托溴铵和及时使用皮质类固醇与住院之间的关系。
在 6 家 ED 对年龄在 2 至 17 岁的健康状况良好的急性哮喘儿童进行回顾性病历审查。提取病史、疾病严重程度以及吸入沙丁胺醇、异丙托溴铵、皮质类固醇和镁的 ED 稳定治疗的时间数据。主要结局是在 ED 接受镁治疗的住院儿童比例。次要结局是住院儿童在 ED 中接受“强化治疗”的情况，定义为分诊后 1 小时内接受 3 次沙丁胺醇吸入剂加异丙托溴铵和皮质类固醇。
19 名（12.3%）住院儿童接受了镁治疗（95%置信区间 7.1，17.5），而 962 名出院儿童中只有 2 名接受了镁治疗。接受镁治疗的儿童更有可能曾被 ICU 收治（优势比 [OR] 11.2）、过去 1 年内住院（OR 3.8）、到达前接受皮质类固醇治疗（OR 4.0）、出现严重恶化（OR 6.1），且在特定中心接受治疗（OR 14.9）。90 名住院儿童中，42 名（53%）未接受“强化治疗”。接受“强化治疗”的儿童更有可能根据哮喘指南出现严重疾病进入 ED（ORs 8.9、3.0）。在不同中心，所有稳定治疗的频率差异均有统计学意义。
在需要住院治疗的加拿大儿科 ED 中，急性哮喘患儿很少使用镁。这些儿童中许多也未接受频繁的沙丁胺醇和异丙托溴铵，或早期使用皮质类固醇。这些干预措施的使用存在显著差异。
