Adherence to local rotational thromboelastometry recommendations in the care of trauma patients: A retrospective cohort study.

Abstract

Background: Rotational thromboelastometry (ROTEM) is a blood test that measures hemostatic parameters to guide hemostatic therapy. ROTEM outputs can be cognitively challenging to interpret, which may limit adherence in trauma care. Our objective was to assess hemostatic therapy administration adherence to local ROTEM recommendations.

Study design and methods: We conducted a retrospective cohort study of trauma patients receiving ROTEM testing at a level 1 trauma center between January 1st 2017, and December 31st 2021. Adherence to local ROTEM best practices was determined by comparing the blood products patients received after a patient's first ROTEM test to those that should have been administered based on their ROTEM results. Multivariable logistic regression models were used to determine the association between clinical and patient covariates with ROTEM adherence and between ROTEM adherence and in-hospital mortality.

Results: Only 46.6% (n = 208/446) of patients had complete adherence to ROTEM recommendations. Product-specific adherence was lower when product initiation was recommended (vs. not) by ROTEM. A greater number of ROTEM abnormalities (odds ratio [OR]: 0.11, 95% confidence interval [CI]: 0.05-0.19) and a higher injury severity score (OR: 0.96, 95% CI: 0.94-0.98) reduced adherence. Adherence to ROTEM did not reduce in-hospital mortality (OR: 0.71, 95% CI: 0.35-1.41). The number of ROTEM abnormalities was associated with in-hospital mortality (OR: 3.07, 95% CI: 2.01-4.77).

Discussion: We found moderate adherence to admission ROTEM recommendations with lower adherence for more severely injured patients. The number of ROTEM abnormalities increased the odds of in-hospital mortality. Quantifying adherence is valuable for understanding ROTEM implementations in trauma care.