Evaluating the correlation between the quantra hemostasis system and rotational thromboelastometry (ROTEM) for viscoelastic hemostatic assessment: A systematic review and meta-analysis.
Abstract
Abstract Introduction/Background: Perioperative and trauma-induced coagulopathy considerably contributes to morbidity and mortality. While Rotational Thromboelastometry (ROTEM) remains a cornerstone for viscoelastic coagulation assessment, its operational complexity may limit its utility in emergency and urgent care settings. The Quantra Hemostasis System, a fully automated and ultrasound-based alternative, offers a streamlined operation with a rapid turnaround time (TAT). This systematic review and meta-analysis seeks to evaluate the correlation between the Quantra system and ROTEM in assessing key coagulation parameters in surgical and trauma populations. Methods: A systematic review and meta-analysis were conducted as per PRISMA guidelines. PubMed, Google Scholar, and the Cochrane Library were searched for prospective observational studies comparing Quantra and ROTEM in the context of viscoelastic hemostatic testing. Two reviewers independently conducted data extraction and quality assessment. A total of 367 articles were screened, of which eight prospective studies comprising 631 participants met the inclusion criteria and were subsequently included in the meta-analysis. The correlation between the following outcome pairs was analysed: Quantra clot stiffness and ROTEM EXTEM, Quantra clot time and ROTEM INTEM, Quantra fibrinogen contribution and ROTEM FIBTEM, and Quantra platelet contribution and ROTEM platelet-attributable shear modulus. Pooled Pearson correlation coefficients (r) and corresponding 95% confidence intervals (95% CI) were calculated using a random-effects model with inverse variance weighting. Fisher's z-transformation was applied to normalise data, with results back-transformed for interpretation. A two-tailed p-value of <0.01 was considered statistically significant. Results: Across the 8 included studies, the pooled Pearson correlation coefficients demonstrated a strong positive correlation for multiple parameters: Quantra clot stiffness, fibrinogen contribution, platelet contribution, and ROTEM external temogram (r = 0.91, 95% CI: 0.87–0.94, p = <0.01), ROTEM fibrinogen temogram (r = 0.89, 95% CI: 0.85 — 0.92, p = <0.01), ROTEM Platelet-attributable-shear modulus (r = 0.81, 95% CI: 0.53 – 0.93, p <0.01), respectively. A moderately strong correlation was observed between Quantra clot time and ROTEM intrinsic temogram clotting time (r = 0.74, 95% CI: 0.63–0.83, p = <0.01). All correlations were statistically significant (p < 0.01). Conclusion: The Quantra Hemostasis System demonstrates strong and statistically significant correlations with ROTEM across key coagulation parameters, supporting its reliability as a point-of-care tool. Its ease of use, closed-cartridge design, and rapid result availability make it an efficient and viable alternative to traditional systems such as ROTEM for monitoring coagulation function in perioperative settings.