The intra-assay reproducibility of thromboelastography in very low birth weight infants

Research output: Contribution to journalArticle

Abstract

Background and aims: Despite the potential benefits of thromboelastography (TEG) for bedside hemostatic assessment in critical care settings, its accuracy remains to be determined, especially in critically ill neonates. We determined the intra-assay reproducibility of TEG parameters: Reaction time (R), clot kinetics (K) and Maximum Amplitude (MA) in a cohort of very low birth weight (VLBW) infants. Study design: Observational study. Subjects: One hundred VLBW newborns. Outcome measures: We performed TEG duplicate measurements for blood samples from VLBW newborns. To assess for correlation, we calculated the coefficients of correlation by plotting the values of the first vs the second measurement. Paired samples were compared with t-test and the coefficient of variation (CV) on paired results was also calculated as a measure of variability. To evaluate the agreement between duplicates, Bland-Altman (BA) analysis was performed. Results: We evaluated 228 TEG pairs. Both the coefficient of correlation and the BA analysis showed an acceptable level of agreement between duplicates. TEG variability (CV, mean ± SD) was highest for K (10.4%, ±12.9), lowest for MA (3.6%, ±8.0) and moderate for R (7.9%, ±9.0). The results from ANOVA one-way analysis describe different variability trends: K-CV increased at higher values, while MA-CV and R-CV increased at lower values. Conclusions: In VLBW newborns, the agreement between TEG duplicate measurements for R and MA parameters is adequate for clinical purposes. TEG is a promising tool to quickly assess hemostasis ensuring a significant blood sparing in critically ill neonates.

Original languageEnglish
Pages (from-to)48-52
Number of pages5
JournalEarly Human Development
Volume127
DOIs
Publication statusPublished - Dec 1 2018

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Thrombelastography
Very Low Birth Weight Infant
Newborn Infant
Critical Illness
Hemostatics
Critical Care
Hemostasis
Observational Studies
Analysis of Variance
Outcome Assessment (Health Care)

Keywords

  • Analytical variability
  • Coagulation
  • Global hemostatic assay
  • Point-of-care testing
  • TEG

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Obstetrics and Gynaecology

Cite this

@article{2632e1a3381f4513839f7512c265c027,
title = "The intra-assay reproducibility of thromboelastography in very low birth weight infants",
abstract = "Background and aims: Despite the potential benefits of thromboelastography (TEG) for bedside hemostatic assessment in critical care settings, its accuracy remains to be determined, especially in critically ill neonates. We determined the intra-assay reproducibility of TEG parameters: Reaction time (R), clot kinetics (K) and Maximum Amplitude (MA) in a cohort of very low birth weight (VLBW) infants. Study design: Observational study. Subjects: One hundred VLBW newborns. Outcome measures: We performed TEG duplicate measurements for blood samples from VLBW newborns. To assess for correlation, we calculated the coefficients of correlation by plotting the values of the first vs the second measurement. Paired samples were compared with t-test and the coefficient of variation (CV) on paired results was also calculated as a measure of variability. To evaluate the agreement between duplicates, Bland-Altman (BA) analysis was performed. Results: We evaluated 228 TEG pairs. Both the coefficient of correlation and the BA analysis showed an acceptable level of agreement between duplicates. TEG variability (CV, mean ± SD) was highest for K (10.4{\%}, ±12.9), lowest for MA (3.6{\%}, ±8.0) and moderate for R (7.9{\%}, ±9.0). The results from ANOVA one-way analysis describe different variability trends: K-CV increased at higher values, while MA-CV and R-CV increased at lower values. Conclusions: In VLBW newborns, the agreement between TEG duplicate measurements for R and MA parameters is adequate for clinical purposes. TEG is a promising tool to quickly assess hemostasis ensuring a significant blood sparing in critically ill neonates.",
keywords = "Analytical variability, Coagulation, Global hemostatic assay, Point-of-care testing, TEG",
author = "Stefano Ghirardello and Genny Raffaeli and Erica Scalambrino and Veena Chantarangkul and Giacomo Cavallaro and Andrea Artoni and Fabio Mosca and Armando Tripodi",
year = "2018",
month = "12",
day = "1",
doi = "10.1016/j.earlhumdev.2018.10.004",
language = "English",
volume = "127",
pages = "48--52",
journal = "Early Human Development",
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T1 - The intra-assay reproducibility of thromboelastography in very low birth weight infants

AU - Ghirardello, Stefano

AU - Raffaeli, Genny

AU - Scalambrino, Erica

AU - Chantarangkul, Veena

AU - Cavallaro, Giacomo

AU - Artoni, Andrea

AU - Mosca, Fabio

AU - Tripodi, Armando

PY - 2018/12/1

Y1 - 2018/12/1

N2 - Background and aims: Despite the potential benefits of thromboelastography (TEG) for bedside hemostatic assessment in critical care settings, its accuracy remains to be determined, especially in critically ill neonates. We determined the intra-assay reproducibility of TEG parameters: Reaction time (R), clot kinetics (K) and Maximum Amplitude (MA) in a cohort of very low birth weight (VLBW) infants. Study design: Observational study. Subjects: One hundred VLBW newborns. Outcome measures: We performed TEG duplicate measurements for blood samples from VLBW newborns. To assess for correlation, we calculated the coefficients of correlation by plotting the values of the first vs the second measurement. Paired samples were compared with t-test and the coefficient of variation (CV) on paired results was also calculated as a measure of variability. To evaluate the agreement between duplicates, Bland-Altman (BA) analysis was performed. Results: We evaluated 228 TEG pairs. Both the coefficient of correlation and the BA analysis showed an acceptable level of agreement between duplicates. TEG variability (CV, mean ± SD) was highest for K (10.4%, ±12.9), lowest for MA (3.6%, ±8.0) and moderate for R (7.9%, ±9.0). The results from ANOVA one-way analysis describe different variability trends: K-CV increased at higher values, while MA-CV and R-CV increased at lower values. Conclusions: In VLBW newborns, the agreement between TEG duplicate measurements for R and MA parameters is adequate for clinical purposes. TEG is a promising tool to quickly assess hemostasis ensuring a significant blood sparing in critically ill neonates.

AB - Background and aims: Despite the potential benefits of thromboelastography (TEG) for bedside hemostatic assessment in critical care settings, its accuracy remains to be determined, especially in critically ill neonates. We determined the intra-assay reproducibility of TEG parameters: Reaction time (R), clot kinetics (K) and Maximum Amplitude (MA) in a cohort of very low birth weight (VLBW) infants. Study design: Observational study. Subjects: One hundred VLBW newborns. Outcome measures: We performed TEG duplicate measurements for blood samples from VLBW newborns. To assess for correlation, we calculated the coefficients of correlation by plotting the values of the first vs the second measurement. Paired samples were compared with t-test and the coefficient of variation (CV) on paired results was also calculated as a measure of variability. To evaluate the agreement between duplicates, Bland-Altman (BA) analysis was performed. Results: We evaluated 228 TEG pairs. Both the coefficient of correlation and the BA analysis showed an acceptable level of agreement between duplicates. TEG variability (CV, mean ± SD) was highest for K (10.4%, ±12.9), lowest for MA (3.6%, ±8.0) and moderate for R (7.9%, ±9.0). The results from ANOVA one-way analysis describe different variability trends: K-CV increased at higher values, while MA-CV and R-CV increased at lower values. Conclusions: In VLBW newborns, the agreement between TEG duplicate measurements for R and MA parameters is adequate for clinical purposes. TEG is a promising tool to quickly assess hemostasis ensuring a significant blood sparing in critically ill neonates.

KW - Analytical variability

KW - Coagulation

KW - Global hemostatic assay

KW - Point-of-care testing

KW - TEG

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EP - 52

JO - Early Human Development

JF - Early Human Development

SN - 0378-3782

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