{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T18:21:39Z","timestamp":1780510899771,"version":"3.54.1"},"reference-count":77,"publisher":"Public Library of Science (PLoS)","issue":"6","license":[{"start":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T00:00:00Z","timestamp":1780444800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      While guidelines recommend intravenous magnesium (IVMg) for refractory pediatric acute asthma, evidence for benefit is scant and disparate. IVMg therapy is resource-intensive and can cause hypotension. To determine if IVMg alters the exacerbation course, it must be given\n                      <jats:italic>early<\/jats:italic>\n                      , and the clinical effect measured at the peak effect of routine co-interventions.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Primary aim<\/jats:title>\n                    <jats:p>In children with acute asthma remaining in moderate-severe respiratory distress after initial ED therapy, to determine if early IVMg therapy is associated with a significantly greater improvement in respiratory distress at 2 hours after starting IVMg, compared to placebo.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Hypothesis<\/jats:title>\n                    <jats:p>IVMg will yield significantly greater Pediatric Respiratory Assessment Measure (PRAM) improvement of \u22651.0 point than placebo.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Study design<\/jats:title>\n                    <jats:p>A randomized double-blind placebo-controlled trial in 6 Canadian pediatric EDs of otherwise healthy children 2\u201317 years old with acute asthma and PRAM \u22655 after initial 1 hour therapy with systemic corticosteroids and 3 inhaled salbutamol\u2009\u00b1\u2009ipratropium treatments.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec005\">\n                    <jats:title>Intervention<\/jats:title>\n                    <jats:p>IVMg sulfate (75\u2009mg\/kg, max 2.5\u2009g) or normal saline placebo over 30 minutes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec006\">\n                    <jats:title>Primary outcome<\/jats:title>\n                    <jats:p>\n                      PRAM 2 hours post-intervention start.\n                      <jats:bold>\n                        <jats:italic>Secondary:<\/jats:italic>\n                      <\/jats:bold>\n                      PRAM \u22643 at 2 hours; change in PRAM and vital signs over 3 hours; hospitalization; asthma re-visits by 72 hours.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec007\">\n                    <jats:title>Sample size<\/jats:title>\n                    <jats:p>With 192 patients, a two-sided test and alpha 0.05 have 80% power to achieve statistical significance if IVMg yields a difference in PRAM changes \u22651.0 point between groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec008\">\n                    <jats:title>Primary analysis<\/jats:title>\n                    <jats:p>Student\u2019s t test comparing a difference in PRAM changes between groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec009\">\n                    <jats:title>Expected outcomes<\/jats:title>\n                    <jats:p>This trial will clarify if there is an incremental clinical benefit of IVMg in pediatric refractory asthma. A positive result will establish a proven routine standard of care for this indication; a negative result will lead to de-implementation of IVMg which may also lead to cost savings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec010\">\n                    <jats:title>Status<\/jats:title>\n                    <jats:p>Enrolling at SickKids and McMaster, start of other sites pending. No results generated yet.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec011\">\n                    <jats:title>Study title<\/jats:title>\n                    <jats:p>Magnesium Trial in Acute Asthma in Emergency Department<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0349553","type":"journal-article","created":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T17:52:28Z","timestamp":1780509148000},"page":"e0349553","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Magnesium in acute pediatric asthma in the emergency department (MAGICIAN)\u2014A multicentre randomized controlled clinical trial protocol"],"prefix":"10.1371","volume":"21","author":[{"given":"Suzanne","family":"Schuh","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sunita","family":"O\u2019Shea","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2319-6192","authenticated-orcid":true,"given":"Stephen B.","family":"Freedman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed","family":"Eltorki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jocelyn","family":"Gravel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francine M.","family":"Ducharme","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Waleed","family":"Alqurashi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7807-2459","authenticated-orcid":true,"given":"Roger","family":"Zemek","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George","family":"Wells","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jesse","family":"Elliott","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9977-0966","authenticated-orcid":true,"given":"April","family":"Kam","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Curtis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Allan L.","family":"Coates","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Terry","family":"Klassen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Bedford","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yaron","family":"Finkelstein","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"for the Pediatric Emergency Research Canada (PERC) network","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,6,3]]},"reference":[{"issue":"1","key":"pone.0349553.ref001","first-page":"1","article-title":"Surveillance for asthma--United States, 1960-1995","volume":"47","author":"DM Mannino","year":"1998","journal-title":"MMWR CDC Surveill Summ"},{"key":"pone.0349553.ref002","volume-title":"Overview of Emergency Department Visits in the United States, 2011. 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