Effects of an animated blood clot on the decision-making of users inexperienced in viscoelastic testing - Visual Clot technology: a multicenter trial.

BACKGROUND Viscoelastic-test-guided coagulation management has become increasingly important in assessing hemostasis. We developed Visual Clot, an animated, 3-dimensional blood clot that illustrates raw rotational thromboelastometry (ROTEM) parameters in a user-centered and situation awareness-oriented method. OBJECTIVE This study aimed to evaluate the applicability of Visual Clot by examining its effects on users that are novices in viscoelastic-guided resuscitation. METHODS We conducted an investigator-initiated, international, multicenter study between September 16 and October 6, 2020, in five tertiary care hospitals in central Europe. We randomly recruited medical students and inexperienced resident physicians without significant prior exposure to viscoelastic testing. The 7 participants per center managed nine different ROTEM outputs twice, once as standard ROTEM tracings and once as the corresponding Visual Clot. We randomly presented the 18 viscoelastic cases and asked the participants for their therapeutic decisions. We assessed the performance, diagnostic confidence, and perceived workload in managing the tasks using mixed statistical models, adjusted for possible confounding factors. RESULTS Analyzing a total of 630 results, we found that the participants solved more cases correctly (odds ratio [OR]: 33.66; 95% confidence interval [CI]: 21.13-53.64; P<0.001), perceived more diagnostic confidence (OR: 206.2; 95% CI: 93.5-454.75; P<0.001) and less workload (coefficient -41.63; 95% CI: -43.91 to -39.36; P<0.001) using Visual Clot compared to using standard ROTEM tracings. CONCLUSIONS This study emphasizes the practical benefit of presenting viscoelastic test results in a user-centered way. Visual Clot may allow inexperienced users to be involved in the decision-making process to treat bleeding-associated coagulopathy. The increased diagnostic confidence, diagnostic certainty, reduced workload, and positive user feedback associated with this visualization may promote the further adoption of viscoelastic methods in diverse healthcare settings.