Reproducibility of thrombelastometry (ROTEM^®): Point-of-care versus hospital laboratory performance

Abstract

Thrombelastometry (ROTEM^®) has gained wide acceptance in detecting and tailoring acquired hemostatic changes in adults and children. We investigated in this observational trial whether the reproducibility of this point-of-care testing was influenced by performance at the bedside or in the hospital laboratory. In addition, difference in time of performance between both measurements was compared. Perioperative blood samples obtained during major pediatric surgery were run in duplicate on two different ROTEM^® devices located in the OR and in the hospital laboratory. The Bland-Altman test was used to compare differences of both measurements. ROTEM^® measurements of 90 blood samples obtained from 24 children showed no overall clinically meaningful differences, whether they were performed bedside or in the hospital laboratory. Minor differences were found for the InTEM clot formation time (CFT) showing a mean bias of 10.79 seconds. Time saving was 11 minutes (8–16 minutes) if ROTEM^® measurements were performed bedside (p < 0.001). In conclusion, there were minimal effects on ROTEM® measurements irrespective of whether they were performed in the hospital laboratory or at the bedside by a single trained staff member, while the latter saved valuable time.

Key Words::

• Anaesthesiology
• point-of-care testing
• internal quality control
• secondary haemostasis

Acknowledgements

We thank Monica Ceresetti and the entire team of the routine haematology laboratory for excellent collaboration and participation in the study.

Declaration of interest: Dr Haas has received lecturer fee from CSL Behring, Bern, Switzerland. The authors alone are responsible for the content and writing of the paper.