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International practice patterns of IV magnesium in paediatric acute asthma
  1. Laura Simone1,
  2. Roger Zemek2,
  3. Damian Roland3,4,
  4. Mark D Lyttle5,
  5. Simon Craig6,
  6. Stuart R Dalziel7,
  7. Jocelyn Gravel8,
  8. Yaron Finkelstein9,
  9. Sarah Curtis10,
  10. Stephen B Freedman11,
  11. Amy C Plint12,
  12. Suzanne Schuh13
  13. on behalf of the Pediatric Emergency Research Network Group
    1. 1Emergency Medicine, Hospital for Sick Children, Toronto, Ontario, Canada
    2. 2Pediatrics, CHEO, Ottawa, Ontario, Canada
    3. 3Health Sciences, University of Leicester, Leicester, UK
    4. 4Paediatric Emergency Medicine Leicester Academic (PEMLA) Group, University Hospitals of Leicester NHS Trust, Leicester, UK
    5. 5Emergency Department, Bristol Royal Children's Hospital, Bristol, UK
    6. 6Division of Pediatric Emergency Medicine, Monash Medical Centre Clayton, Clayton, Victoria, Australia
    7. 7Emergency Medicine, Starship Children’s Hospital, Auckland, New Zealand
    8. 8Department of Pediatrics, CHU SainteJustine, Montreal, Québec, Canada
    9. 9Division of Emergency Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
    10. 10University of Alberta, Edmonton, Alberta, Canada
    11. 11Paediatrics, Alberta Children's Hospital, Calgary, Alberta, Canada
    12. 12Emergency Medicine, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
    13. 13Division of Pediatric Emergency Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
    1. Correspondence to Dr Suzanne Schuh, Emergency Medicine, Hosp Sick Children, Toronto, ON M5G 1X8, Canada; suzanne.schuh{at}sickkids.ca

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    Guideline recommendations about discharge of children with acute asthma treated with IV magnesium (IV-Mg) are disparate and inconclusive (see online supplemental material). The majority of children given IV-Mg in the emergency department (ED) are hospitalised, independent of asthma severity or degree of response to IV-Mg.1 The rationale for this practice is unknown but may be due to limited evidence whether children with a satisfactory response to IV-Mg can be safely discharged.2–4

    Supplemental material

    [emermed-2022-212642supp001.pdf]

    We conducted this international survey of three paediatric emergency research networks in Canada (Paediatric Emergency Research Canada), Australia/New Zealand (Paediatric Research in Emergency Departments International Collaborative) and the UK/Ireland (Paediatric Emergency Research United Kingdom and Ireland) belonging to the international Paediatric Emergency Research Network to determine the proportion of paediatric ED physicians who agree there is adequate evidence that children with acute asthma refractory to the initial corticosteroid and bronchodilator therapy, and who attain a satisfactory and sustained response to IV-Mg, can be safely discharged home. The modified Dillman’s method5 was used for participant contact from March to June 2021. Using network membership and email lists, we invited participants by email to click on a link to complete a web-based, 25-item, two-page Research Electronic Data Capture survey (online supplemental material). The first page asked screening and demographic questions; the second page contained the survey questions. Physicians not treating children and those in training were ineligible. Following best practices for survey studies,6 study authors performed item generation, reduction, pretesting and pilot testing. Physicians were asked to rate on a 4-point Likert scale (‘strongly agree’ to ‘strongly disagree’) the extent to which they agreed that children remaining in marked respiratory distress after stabilisation therapy with bronchodilators and steroids, who then have a satisfactory and sustained response to IV-Mg (mild asthma: PRAM 2/12 points for …

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    Footnotes

    • Handling editor Steve Rothrock

    • Twitter @damian_roland, @mdlyttle

    • Collaborators Pediatric Emergency Research Network Group Co-Authors: Naveen Poonai, MD, MSc (Division of Pediatric Emergency Medicine, Children’s Hospital of Western Ontario, Departments of Pediatrics, Internal Medicine, Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, London, Ontario, Canada); Franz E Babl (Emergency Department, Royal Children’s Hospital, Melbourne, Australia; Murdoch Children’s Research Institute; Melbourne, Australia; Departments of Paediatrics and Critical Care, University of Melbourne, Melbourne, Australia), MD, MPH; Graham Thompson (Departments of Pediatrics and Emergency Medicine, Alberta Children's Hospital, University of Calgary, Calgary, AB, Canada), MD, MSc; Francine M Ducharme (Department of Pediatric Emergency Medicine, CHU Sainte-Justine, Montreal, Université de Montréal, Qc, Canada; Department of Pediatrics and of Social and Preventive Medicine, Université de Montréal, Montreal, Qc, Canada), MD, MSc; David W. Johnson (Departments of Pediatrics, Emergency Medicine, and Physiology & Pharmacology, Alberta Children's Hospital, Calgary, AB, Canada; Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada), MD; Terry P Klassen (Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada; Children’s Hospital Research Institute of Manitoba, Winnipeg, MB Canada), MD, MSc; Bethany Lerman (Division of Pediatric Emergency Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada), BA; Bryan Maguire (Department of Clinical Research Services, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada), MSc; Rebecca Emerton (Departments of Pediatrics and Emergency Medicine, Alberta Children's Hospital, University of Calgary, Calgary, AB, Canada), BA.

    • Contributors LS and SS conceptualised and designed the study, drafted the initial manuscript, and reviewed and revised the manuscript for important intellectual content. RZ, DR, MDL, SCr, SRD, YF, SCu, SBF, ACP, NP, FEB, GT, FMD, DWJ and TPK designed the study and revised the manuscript for important intellectual content. JG designed the study, translated the survey into French and revised the manuscript for important intellectual content. BL and RE coordinated and supervised the data collection and reviewed the manuscript for important intellectual content. BM conducted the statistical analysis and revised the manuscript for important intellectual content. All authors approved the final manuscript as submitted and agreed to be accountable for all aspects of the work.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.