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Trial registered on ANZCTR
Registration number
ACTRN12622001496707p
Ethics application status
Not yet submitted
Date submitted
23/11/2022
Date registered
29/11/2022
Date last updated
29/11/2022
Date data sharing statement initially provided
29/11/2022
Type of registration
Prospectively registered
Titles & IDs
Public title
A study to determine how common anaemia is in children having major surgery.
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Scientific title
A retrospective observational study of preoperative anaemia in paediatric patients undergoing major surgery.
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Secondary ID [1]
308478
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Nil known
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Universal Trial Number (UTN)
U1111-1285-3731
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Trial acronym
ROAMS
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
Anaemia
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Perioperative Anaemia
328292
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Condition category
Condition code
Blood
325337
325337
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0
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Anaemia
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Anaesthesiology
325338
325338
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0
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Anaesthetics
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Intervention/exposure
Study type
Observational
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Patient registry
False
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Target follow-up duration
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Target follow-up type
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Description of intervention(s) / exposure
This is a retrospective observational study to determine the prevalence of anaemia (as defined by the World Health Organisation) in paediatric patients undergoing elective or emergency major surgery in a single tertiary centre in New Zealand.
Medical records for all patients undergoing major surgery between 01/01/2021 and 01/01/2022 will be analysed, and those with a full blood count within 3 months prior to surgery recruited. As well as haemoglobin concentration prior to surgery, researchers will collect ferritin concentration, creatinine concentration, folate/B12 concentration, gender, age, weight, ethnicity, ASA score, surgical priority, type of surgery, the presence of significant comorbidities, intraoperative and postoperative blood transfusions, length of stay in hospital, and 30 day mortality.
Data collected for each participant will pertain to a single admission episode.
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Intervention code [1]
324923
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Diagnosis / Prognosis
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Comparator / control treatment
Patients in the study population will be divided into anaemic and non-anaemic, and comparisons of outcomes made between the two.
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Control group
Active
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Outcomes
Primary outcome [1]
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Prevalence of anaemia as a percentage, as defined by WHO threshholds, from electronic patient record
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Assessment method [1]
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Timepoint [1]
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Within 3 months prior to surgery
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Primary outcome [2]
333201
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Red blood cell transfusion rate as a percentage from electronic patient record
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Assessment method [2]
333201
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Timepoint [2]
333201
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During surgical admission episode
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Secondary outcome [1]
416122
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All cause mortality as recorded in electronic patient record
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Assessment method [1]
416122
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Timepoint [1]
416122
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Within 30 days of index surgical procedure
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Secondary outcome [2]
416123
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Ferritin concentration from electronic patient record
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Assessment method [2]
416123
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Timepoint [2]
416123
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Within 3 months prior to surgery
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Secondary outcome [3]
416124
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Vitamin B12 concentration from electronic patient record
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Assessment method [3]
416124
0
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Timepoint [3]
416124
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Within 3 months prior to surgery
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Secondary outcome [4]
416125
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Folate concentration from electronic patient record
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Assessment method [4]
416125
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Timepoint [4]
416125
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Within 3 months prior to surgery
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Secondary outcome [5]
416126
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Creatinine concentration from electronic patient record
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Assessment method [5]
416126
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Timepoint [5]
416126
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Within 3 months prior to surgery
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Secondary outcome [6]
416127
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Duration of surgical admission from electronic patient record
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Assessment method [6]
416127
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Timepoint [6]
416127
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During surgical admission episode
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Secondary outcome [7]
416128
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Incidence of post operative complications (anaemia as defined by WHO, new infection requiring antimicrobial therapy, new thromboembolic event, new renal failure) as documented in the electronic patient record and patient electronic discharge summary for the surgical admission.
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Assessment method [7]
416128
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Timepoint [7]
416128
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During surgical admission episode
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Secondary outcome [8]
416302
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Red blood cell transfusion per kilogram body weight, from the electronic patient record
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Assessment method [8]
416302
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Timepoint [8]
416302
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During surgical admission episode
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Eligibility
Key inclusion criteria
All patients > 6 months and < 16 years undergoing major surgery between 01/01/2021 at 01/01/2022.
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Minimum age
6
Months
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Maximum age
15
Years
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Sex
Both males and females
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Can healthy volunteers participate?
No
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Key exclusion criteria
Age < 6 months or > 16 years.
Blood transfusion within 7 days prior to surgery.
No preoperative haemoglobin concentration available in the 3 month period prior to surgery.
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Study design
Purpose
Natural history
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Duration
Longitudinal
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Selection
Convenience sample
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Timing
Retrospective
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Statistical methods / analysis
Prevalence of anaemia in the general New Zealand paediatric population is estimated at 15%. Previously published studies of pre-operative anaemia in paediatric surgical patients in developed countries have described a prevalence between 24-46%. A sample size of 250 patients will have a precision of ±5% if observed prevalence is 20%, and ±6% if observed prevalence is 50%, with 95% confidence. Approximately 6 patients per week undergo major surgery at this centre, so collection of data over a 1 year period should ensure an adequate number of patients recruited.
Statistical methodology for this study has been discussed with a statistician prior to commencement. Statistician input will be sought for analysis of the final data.
Demographics and outcomes will be presented as frequencies and percentages for discrete variables, and median with interquartile range or mean (SD) for continuous variables. Discrete variables will be analysed with Chi-squared or Fisher’s exact tests where appropriate. Continuous variables will be analysed with either a two-sided Wilcoxon rank-sum test or Student’s t test after testing for normality. Missing data will be reported.
The following will be calculated:
Prevalence of anaemia as a percentage
Prevalence of red blood cell transfusion as a percentage
Volume of red blood cell transfused per kilogram body weight
Independent variables associated with anaemia will be investigated.
Outcomes will be compared between anaemic and non-anaemic patients.
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Recruitment
Recruitment status
Not yet recruiting
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Date of first participant enrolment
Anticipated
1/01/2023
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Actual
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Date of last participant enrolment
Anticipated
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Actual
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Date of last data collection
Anticipated
6/03/2023
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Actual
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Sample size
Target
250
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Accrual to date
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Final
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Recruitment outside Australia
Country [1]
25154
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New Zealand
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State/province [1]
25154
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Auckland
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Funding & Sponsors
Funding source category [1]
312720
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Hospital
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Name [1]
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Department of Anaesthesia, Starship Children's Hospital
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Address [1]
312720
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2 Park Road,
Grafton,
Auckland 1023
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Country [1]
312720
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New Zealand
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Primary sponsor type
Hospital
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Name
Department of Anaesthesia, Starship Children's Hospital
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Address
2 Park Road,
Grafton,
Auckland 1023
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Country
New Zealand
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Secondary sponsor category [1]
314344
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None
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Name [1]
314344
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Address [1]
314344
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Country [1]
314344
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Ethics approval
Ethics application status
Not yet submitted
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Ethics committee name [1]
312021
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The Auckland Health Research Ethics Committee (AHREC)
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Ethics committee address [1]
312021
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The University of Auckland Private Bag 92019 Auckland 1142
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Ethics committee country [1]
312021
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New Zealand
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Date submitted for ethics approval [1]
312021
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01/12/2022
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Approval date [1]
312021
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Ethics approval number [1]
312021
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Summary
Brief summary
Anaemia is a common problem worldwide. In the perioperative setting, it has been identified as a predictor of morbidity and mortality in both adults and children. Anaemic patients undergoing surgery often require transfusion of autologous blood products in the perioperative period, which carries both a risk of morbidity and increased healthcare costs. For these reasons, patient blood management programmes have been developed internationally which emphasise diagnosis and treatment of preoperative anaemia with the aim of improving outcomes and reducing costs in the adult surgical population. The prevalence of preoperative anaemia in the paediatric surgical population is poorly described in the literature, and the current prevalence of anaemia in children undergoing major elective surgery in New Zealand is unknown. Some pathologies requiring major surgery in children disproportionately affect groups at higher risk of anaemia, such as postmenarchal adolescent females undergoing surgical correction of idiopathic scoliosis. Recent studies suggest that anaemia in the general paediatric population in New Zealand is common, and disproportionately affects those of Maori and Pacific ethnicity. A better understanding of preoperative anaemia as a clinical entity in the paediatric surgical population in New Zealand will allow an opportunity to improve quality of clinical care, and develop strategies to target any inherent inequities in our current system. This study aims to: - Quantify the prevalence of preoperative anaemia in paediatric patients undergoing major surgery. - Investigate the subtypes of anaemia in those patients identified as being anaemic. - Identify differences in preoperative anaemia prevalence between different ethnic groups. - Identify differences in preoperative anaemia prevalence between surgical disciplines. - Describe the association between preoperative anaemia and transfusion of blood products. - Investigate the association between preoperative anaemia and patient morbidity and mortality.
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Trial website
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Trial related presentations / publications
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Public notes
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Contacts
Principal investigator
Name
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Dr Matthew Hart
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Address
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Starship Children's Hospital
2 Park Road,
Grafton,
Auckland 1023
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Country
123202
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New Zealand
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Phone
123202
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+64 9 367 0000
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Fax
123202
0
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Email
123202
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[email protected]
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Contact person for public queries
Name
123203
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Caroline Mann
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Address
123203
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Starship Children's Hospital
2 Park Road,
Grafton,
Auckland 1023
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Country
123203
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New Zealand
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Phone
123203
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+64 9 367 0000
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Fax
123203
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Email
123203
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[email protected]
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Contact person for scientific queries
Name
123204
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Caroline Mann
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Address
123204
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Starship Children's Hospital
2 Park Road,
Grafton,
Auckland 1023
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Country
123204
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New Zealand
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Phone
123204
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+64 9 367 0000
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Fax
123204
0
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Email
123204
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[email protected]
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Data sharing statement
Will individual participant data (IPD) for this trial be available (including data dictionaries)?
Yes
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What data in particular will be shared?
Individual participant data underlying published results only.
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When will data be available (start and end dates)?
Beginning immediately following publication and ending 10 years following publication of main results.
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Available to whom?
Published data will only be available to approved researchers after approval by the Principal Investigator and under specific data-sharing arrangements arranged through the Starship Research & Innovation Office.
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Available for what types of analyses?
Data will be made available for research on perioperative anaemia.
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How or where can data be obtained?
Published data will only be available to approved researchers after approval by the Principal Investigator and under specific data-sharing arrangements arranged through the Starship Research & Innovation Office. This can be requested by emailing
[email protected]
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What supporting documents are/will be available?
No Supporting Document Provided
Doc. No.
Type
Citation
Link
Email
Other Details
Attachment
17694
Study protocol
[email protected]
Results publications and other study-related documents
Documents added manually
No documents have been uploaded by study researchers.
Documents added automatically
No additional documents have been identified.
Download to PDF