Latona Akmez, Lennard Samantha, Rane Mark, Winearls James, Mitra Biswadev
Emergency Department, Ipswich Hospital, Ipswich, Queensland, Australia.
LifeFlight Retrieval Medicine, Toowoomba, Queensland, Australia.
Emerg Med Australas. 2025 Oct;37(5):e70131. doi: 10.1111/1742-6723.70131.
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.
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.
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).
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.
粘弹性止血检测（VHA）指导出血患者的输血决策。我们评估了澳大利亚全州范围内的检测量、临床适应症和患者特征。
这项回顾性研究纳入了昆士兰卫生系统医院（2019年1月1日至2025年4月15日）所有接受旋转血栓弹力图（ROTEM）或血栓弹力图（TEG）检测的患者，使用全州实验室信息系统AUSLAB的数据，并调查了所有医院VHA设备的可用性。
39台VHA设备中，31台向AUSLAB传输数据，在21178例患者中进行了43220次检测，涉及18389次住院和6418次急诊就诊；92.0%为ROTEM检测（n = 39776），8.0%为TEG检测（n = 3444）。大多数检测发生在住院治疗期间（n = 35527，82.2%），而急诊期间为（n = 第769页，17.8%）。适应症包括创伤（n = 238张75，55.2%）、非静脉曲张性消化道出血（n = 4238，9.8%）、产科（n = 3307，7.7%）和慢性肝病（CLD）（n = 3853，8.9%），其中1097例（2.5%）为静脉曲张破裂出血。急诊科（ED）的总体使用量有所增加（发病率比值（IRR）1.14；95%置信区间（CI）1.12 - 1.15），包括创伤（IRR 1.15）、CLD（1.16）、静脉曲张破裂出血（1.12）和非静脉曲张性出血（1.12）（均p < 0.001）；急诊产科使用量无显著变化（IRR 0.93；95% CI 0.86 - 1.00）。住院使用量也有所增加（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）、非静脉曲张性出血（1.17）和产科（1.07）（均p < 0.001）。
VHA在急诊科和住院环境中的使用均有所增加，在创伤和CLD中使用突出。结果表明临床医生越来越认识到VHA在指导出血管理中的价值。采用一致的、基于证据的方法进行检测和结果解读至关重要。
