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Trial registered on ANZCTR


Registration number
ACTRN12612000156886
Ethics application status
Approved
Date submitted
2/02/2012
Date registered
3/02/2012
Date last updated
3/02/2012
Type of registration
Prospectively registered

Titles & IDs
Public title
A randomised controlled trial to evaluate paediatric critical care telemedicine in Queensland
Scientific title
For children who have a remote intensive care consultation does telemedicine compared with standard telephone consultation improve clinical outcomes and provide economic savings to the health service?
Secondary ID [1] 279854 0
nil
Universal Trial Number (UTN)
U1111-1127-8931
Trial acronym
Linked study record

Health condition
Health condition(s) or problem(s) studied:
Remote consultation for critically ill children 285740 0
Condition category
Condition code
Public Health 285927 285927 0 0
Health service research

Intervention/exposure
Study type
Interventional
Description of intervention(s) / exposure
Arm 1: consultation by telemedicine (intervention)

When a consultation for a sick child is required between a clinciian at a referring hospital and a specialist at the tertiary hospital, it will be conducted using real-time video (a form of telemedicine). Telemedicine will allow audio-video interaction between clinicians at a distance. It will also allow the specialist to view the patient, medical images and medical equipment (e.g. the patient monitor, ventilator etc) in real time. Duration of consultations will vary according to clinical circumstance.
Intervention code [1] 284173 0
Diagnosis / Prognosis
Intervention code [2] 284174 0
Treatment: Other
Comparator / control treatment
Consultation by telephone (usual care)

When a consultation for a sick child is required between a clinician at a referring hospital and a specialist at the tertiary hospital, it will be conducted by telephone (usual care). Visual information will be unavailable. Duration of consultations will vary according to clinical circumstance.
Control group
Active

Outcomes
Primary outcome [1] 286414 0
Patient's physiological status (repeated measure, two time points), scored using CEWT (Children's Emergency Warning Tool).
Timepoint [1] 286414 0
1. Time of initial call from the referring hospital to the tertiary paediatric intensive care unit.
2. Time of arrival of the retrieval team at referring hospital.
Primary outcome [2] 286415 0
Stabilisation time (time spent on site at the referring hospital by the retrieval team, adjusted for initial risk using PIM2).
Timepoint [2] 286415 0
1. Recorded at time of departure of the retrieval team to the tertiary hospital.
Primary outcome [3] 286416 0
Change in diagnosis (repeated measure taked at three timepoints).
Timepoint [3] 286416 0
1. Time of initial call to tertiary hospital.
2. Time of arrival of retrieval team at the referring hospital.
3. Time of arrival of the retrieved patient at the tertiary hospital.
Secondary outcome [1] 295806 0
Change in destination of retrieved patients at the tertiary hospital (e.g. general ward vs. PICU).
Timepoint [1] 295806 0
1. Time of arrival of the retrieved patient at the tertiary hospital.
Secondary outcome [2] 295811 0
Whether telemedicine provided new clinically significant information.
Timepoint [2] 295811 0
Post hoc independent expert review of audio/video recording of consultation.
Secondary outcome [3] 295812 0
Whether telemedicine led to a change in intervention (carried out or avoided).
Timepoint [3] 295812 0
Post hoc independent expert review of audio/video recording of consultation.
Secondary outcome [4] 295839 0
Whether telemedicine allowed avoidance of retrieval.
Timepoint [4] 295839 0
Post hoc independent expert review of audio/video recording of consultation.
Secondary outcome [5] 295864 0
From the health services perspective, whether telemecicine provides economic benefits.
Timepoint [5] 295864 0
Post hoc economic evaluation of the cost of providing telemedicine versus the savings associated with avoided retreival and tertiary admission.
Secondary outcome [6] 295865 0
30 day mortality
Timepoint [6] 295865 0
30 days post admission to tertiary hospital

Eligibility
Key inclusion criteria
All children at the study sites for whom advice is need from the tertiary PICU and for whom parental consent can be obtained.
Minimum age
No limit
Maximum age
15 Years
Gender
Both males and females
Can healthy volunteers participate?
No
Key exclusion criteria
Nil

Study design
Purpose of the study
Treatment
Allocation to intervention
Randomised controlled trial
Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
Initial contact between the referring hospital physician and the tertiary PICU will always be made by telephone.

On receiving that call, the on-call PICU staff will select a sealed envelope from a box (one box per participating site) which will determine whether the consultation continues by telephone (i.e. usual care, control), or by telemedicine (the intervention).

Informed consent will be gained by attending staff at the referring hospital. A patient information sheet and a consent form will be provided for this purpose.
Methods used to generate the sequence in which subjects will be randomised (sequence generation)
A table of random numbers will be generated using a computer random number geenration program. Odd numbers will denote allocation to the control group and even numbers to the intervention. Allocation to either group, based on the random number table will be printed on a piece of paper and sealed in sequentially numbered opaque envelopes. Five sets of envelopes will be produced, one for each study site. These will be placed in five tamper-proof boxes to be held at the tertiary PICU. Each box will be clearly labelled with the name of the remote study site. This process of generating the sequence, envelopes and boxes will be conducted by an independent party).
Masking / blinding
Open (masking not used)
Who is / are masked / blinded?



Intervention assignment
Parallel
Other design features
Phase
Not Applicable
Type of endpoint(s)
Efficacy
Statistical methods / analysis

Recruitment
Recruitment status
Not yet recruiting
Date of first participant enrolment
Anticipated
Actual
Date of last participant enrolment
Anticipated
Actual
Date of last data collection
Anticipated
Actual
Sample size
Target
Accrual to date
Final
Recruitment in Australia
Recruitment state(s)

Funding & Sponsors
Funding source category [1] 284627 0
Charities/Societies/Foundations
Name [1] 284627 0
Queensland Children's Medical Research Institute
Address [1] 284627 0
Royal Children's Hospital
Herston Road
Herston 4029
Queensland
Country [1] 284627 0
Australia
Primary sponsor type
University
Name
The University of Queensland
Address
Centre for Online Health
Level 3, Foundation Building
Royal Children's Hospital
Herston Road
Herston 4029
Queensland
Country
Australia
Secondary sponsor category [1] 283541 0
Hospital
Name [1] 283541 0
Royal Children's Hospital
Address [1] 283541 0
Paediatric Intensive Care Unit
Royal Children's Hospital
Herston Road
Herston 4029
Queensland
Country [1] 283541 0
Australia

Ethics approval
Ethics application status
Approved
Ethics committee name [1] 286614 0
Queensland Children's Health Service Human Research Ethics Committee
Ethics committee address [1] 286614 0
Ethics committee country [1] 286614 0
Australia
Date submitted for ethics approval [1] 286614 0
21/11/2011
Approval date [1] 286614 0
25/01/2012
Ethics approval number [1] 286614 0
HREC/11/QRCH/175

Summary
Brief summary
In Queensland, facilities for seriously ill children are centralised in Brisbane. The Paediatric Intensive Care Unit (PICU) at the Royal Children's Hospital provides advice and retrieval services for children who have presented at rural and regional hospitals throughout Queensland. When advice is needed, it is provided by telephone and this relies on the ability of the remote clinician to provide a good verbal description of the patient and an accurate interpretation of paediatric x-rays. Clinicians at the remote hospital may be relatively inexperienced at caring for critically ill children. Support from the PICU is essential.

Telemedicine allows clinicians to hold a consultation at a distance by video. In addition to face-to-face communication, telemedicine may be used to view the patient, the monitors and x-rays - as if present in the same room. The addition of visual information offers the potential for a much richer dialogue than is possible by telephone alone. Alongside high-quality local care and a well co-ordinated retrieval service, telemedicine may be a potentially useful tool.

This is a new area of research and very little has been reported in the literature. A limited number of studies in the USA have shown that telemedicine assists in the management of seriously ill children at a distance.

Over a three year period, this study will formally evaluate the use of telemedicine to provide critical care support from the RCH PICU to four regional hospital emergency departments. The study will provide evidence on the feasibility, clinical usefulness and economics of the approach within the Queensland context.

The following hypotheses will be tested:

Efficacy

Paediatric critical care consultation by telemedicine will:

(i) improve patient condition between initial call and retrieval team arrival;
(ii) reduce the time needed by the retrieval team to stablise the patient before transport;
(iii) reduce diagnostic discordance;
(iv) reduce the number of retrieved patients admitted to general wards;
(v) improve 30 day mortality.

Economics

Paediatric critical care telemedicine is economically beneficial from the health service perspective reducing the number and therefore cost of retrieval and unnecessary tertiary admission.
Trial website
Trial related presentations / publications
Public notes

Contacts
Principal investigator
Name 33720 0
Address 33720 0
Country 33720 0
Phone 33720 0
Fax 33720 0
Email 33720 0
Contact person for public queries
Name 16967 0
Dr Nigel R. Armfield
Address 16967 0
Centre for Online Health
Level 3, Foundation Building
Royal Children's Hospital
Herston 4029
Queenland
Country 16967 0
Australia
Phone 16967 0
+61 7 3346 4754
Fax 16967 0
Email 16967 0
N.R.Armfield@uq.edu.au
Contact person for scientific queries
Name 7895 0
Dr Nigel R. Armfield
Address 7895 0
Centre for Online Health
Level 3, Foundation Building
Royal Children's Hospital
Herston 4029
Queenland
Country 7895 0
Australia
Phone 7895 0
+61 7 3346 4754
Fax 7895 0
Email 7895 0
N.R.Armfield@uq.edu.au

No information has been provided regarding IPD availability
Summary results
No Results