Intravenous magnesium sulfate reduces hospital admission of children with moderate to severe acute asthma in the emergency department

SOURCE
Griffiths B, Kew KM. (2016). Intravenous magnesium sulfate for treating children with acute asthma in the emergency department. Cochrane Database Syst Rev 29:CD011050

CONTEXT
Intravenous magnesium sulfate(IV MgSO4)is recommended by various guidelines for children with acute asthma that have not responded to first-line treatment with bronchodilators and steroids.

CLINICAL QUESTION
Is intravenous administration of magnesium sulfate for treating children with acute asthma in the emergency department(ED)effective and safe?

BOTTOM LINE
Five studies were selected, four contributed data to at least one meta-analysis and three for the primary outcome ‘return to the emergency department within 48 hours’.

IV MgSO4 administration in children significantly reduces the rate of hospitalization. However, this result must be weighted due to a large heterogeneity and a small number of patients. The decrease in hospitalization is estimated at between 26% and 86%.

Only one study reported the criterion “ED treatment time” and another “hospitalization length of stay”. Intravenous MgSO4 use increases ED treatment time by an average of five minutes but reduces hospitalization length of stay by 5.3 hours. This decrease is significant but in both cases the level of scientific evidence is low.

There is no significant difference in the occurrence of side effects.

CAVEAT
Even if the risk of bias in the selected studies is low, the confidence in the results is greatly reduced due to the small sample of patients. In addition, subgroup analyses based on the age or severity of the crisis could not be completed due to the small number of studies.

AUTHORS INFORMATION

Daniel MEYRAN
Bataillon de Marins Pompiers de Marseille, groupement santé
Marseille, France
daniel.meyran@me.com

Julie DUMOUCHEL
Centre Hospitalo-Universitaire de TOURS
Tours, France
dumouchel.julie76@yahoo.fr

Tanveer Ahmed YADGIR
Fatima College of Health Sciences
Al Ain, United Arab Emirates
drtanveer2008@gmail.com