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

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.