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.