The Viscoelastic Haemostatic Assay Landscape in Queensland, Australia: An Analysis of Use, Indications and Integration

IF 1.4 4区 医学 Q2 EMERGENCY MEDICINE
Akmez Latona, Samantha Lennard, Mark Rane, James Winearls, Biswadev Mitra
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引用次数: 0

Abstract

Background

Viscoelastic haemostatic assays (VHAs) guide transfusion decisions in bleeding patients. We assessed testing volumes, clinical indications and patient characteristics in a statewide population in Australia.

Methods

This retrospective study included all patients who underwent rotational thromboelastometry (ROTEM) or thromboelastography (TEG) across Queensland Health hospitals (1 January 2019 to 15 April 2025), using data from AUSLAB, the statewide laboratory information system and surveyed all hospitals for VHA device availability.

Result

Of 39 VHA devices, 31 were transmitting to AUSLAB, with 43,220 tests performed in 21,178 patients, during 18,389 admissions and 6418 ED presentations; 92.0% were ROTEM (n = 39,776) and 8.0% TEG (n = 3444). Most tests occurred during inpatient care (n = 35,527, 82.2%) versus ED (n = 7693, 17.8%). Indications included trauma (n = 23,875, 55.2%), non-variceal gastrointestinal bleeding (n = 4238, 9.8%), obstetrics (n = 3307, 7.7%) and chronic liver disease (CLD) (n = 3853, 8.9%), including 1097 (2.5%) with variceal bleeding.

Emergency department (ED) use increased overall (IRR 1.14; 95% CI 1.12–1.15), including trauma (IRR 1.15), CLD (1.16), variceal bleeding (1.12) and non-variceal bleeding (1.12) (all p < 0.001); obstetric use in ED did not change significantly (IRR 0.93; 95% CI 0.86–1.00). Inpatient use also increased (IRR 1.21; 95% CI 1.21–1.22), including trauma (IRR 1.22), CLD (1.16), variceal (1.10), non-variceal bleeding (1.17) and obstetrics (1.07) (all p < 0.001).

Conclusion

VHA use increased in both ED and inpatient settings, with prominent use in trauma and CLD. The results indicate growing recognition by clinicians of VHA's value in guiding haemorrhage management. The need for a consistent, evidence-based approach to testing and interpretation of results is paramount.

Abstract Image

澳大利亚昆士兰州的粘弹性止血试验景观:使用、适应症和整合分析
背景:粘弹性止血试验(VHAs)指导出血患者的输血决策。我们评估了澳大利亚全州人口的检测量、临床适应症和患者特征。方法本回顾性研究纳入了昆士兰州卫生医院(2019年1月1日至2025年4月15日)所有接受旋转血栓弹性测量(ROTEM)或血栓弹性成像(TEG)的患者,使用了AUSLAB(全州实验室信息系统)的数据,并调查了所有医院的VHA设备可用性。在39个VHA装置中,31个传输到AUSLAB,在18,389例入院和6418例ED中,在21,178例患者中进行了43,220次检测;92.0%为ROTEM (n = 39776), 8.0%为TEG (n = 3444)。大多数检测发生在住院期间(n = 35,527, 82.2%),而ED期间(n = 7693, 17.8%)。适应症包括创伤(n = 23,875例,占55.2%)、非静脉曲张消化道出血(n = 4238例,占9.8%)、产科(n = 3307例,占7.7%)和慢性肝病(CLD) (n = 3853例,占8.9%),其中静脉曲张出血1097例(2.5%)。急诊科(ED)的使用总体上增加(IRR 1.14; 95% CI 1.12 - 1.15),包括创伤(IRR 1.15)、CLD(1.16)、静脉曲张出血(1.12)和非静脉曲张出血(1.12)(均p <; 0.001);产科在急诊科的使用没有显著变化(IRR 0.93; 95% CI 0.86-1.00)。住院患者的使用也增加(IRR 1.21; 95% CI 1.21 - 1.22),包括创伤(IRR 1.22)、CLD(1.16)、静脉曲张(1.10)、非静脉曲张出血(1.17)和产科(1.07)(均p <; 0.001)。结论VHA在急诊科和住院部的使用均有增加,其中创伤和CLD的使用最为突出。结果表明,越来越多的临床医生认识到VHA在指导出血管理的价值。至关重要的是,需要采取一致的、以证据为基础的方法来检验和解释结果。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Emergency Medicine Australasia
Emergency Medicine Australasia 医学-急救医学
CiteScore
3.70
自引率
13.00%
发文量
217
审稿时长
6-12 weeks
期刊介绍: Emergency Medicine Australasia is the official journal of the Australasian College for Emergency Medicine (ACEM) and the Australasian Society for Emergency Medicine (ASEM), and publishes original articles dealing with all aspects of clinical practice, research, education and experiences in emergency medicine. Original articles are published under the following sections: Original Research, Paediatric Emergency Medicine, Disaster Medicine, Education and Training, Ethics, International Emergency Medicine, Management and Quality, Medicolegal Matters, Prehospital Care, Public Health, Rural and Remote Care, Technology, Toxicology and Trauma. Accepted papers become the copyright of the journal.
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