Background: Viscoelastic test–guided coagulation management has become increasingly important in assessing hemostasis. We developed Visual Clot, an animated, 3D 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, 2020, and October 6, 2020, in 5 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 9 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 and 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% CI 21.13-53.64; P<.001), exhibited more diagnostic confidence (OR 206.2, 95% CI 93.5-454.75; P<.001), and perceived less workload (coefficient –41.63; 95% CI –43.91 to –39.36; P<.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 health care settings.

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中文翻译：

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动画血凝块技术（Visual Clot）对没有粘弹性测试经验的用户决策的影响：多中心试验

背景：粘弹性测试引导的凝血管理在评估止血方面变得越来越重要。我们开发了 Visual Clot，这是一种动画 3D 血凝块，它以用户为中心和情境意识为导向的方法说明了原始旋转血栓弹力图 (ROTEM) 参数。目的：本研究旨在通过检查 Visual Clot 对粘弹性引导复苏新手用户的影响来评估 Visual Clot 的适用性。方法：我们于 2020 年 9 月 16 日至 2020 年 10 月 6 日在中欧的 5 家三级医院进行了一项由研究者发起的国际多中心研究。我们随机招募了医学生和没有经验的住院医师，他们之前没有明显接触过粘弹性测试。每个中心的 7 名参与者两次管理 9 个不同的 ROTEM 输出，一次作为标准 ROTEM 追踪，一次作为相应的视觉凝块。我们随机呈现了 18 个粘弹性病例，并询问参与者的治疗决定。我们使用混合统计模型评估了管理任务的性能、诊断信心和感知工作量，并针对可能的混杂因素进行了调整。结果：分析了总共 630 个结果，我们发现参与者正确解决了更多案例（优势比 [OR] 33.66，95% CI 21.13-53.64；P<.001），表现出更多的诊断信心（OR 206.2，95% CI 93.5-454.75；P<.001），并且与使用标准 ROTEM 追踪相比，使用 Visual Clot 感知的工作量更少（系数 –41.63；95% CI –43.91 至 –39.36；P<.001）。结论：这项研究强调了以用户为中心的方式呈现粘弹性测试结果的实际好处。Visual Clot 可能允许没有经验的用户参与治疗出血相关凝血病的决策过程。与这种可视化相关的诊断信心增加、诊断确定性、工作量减少和积极的用户反馈可能会促进粘弹性方法在不同的医疗保健环境中的进一步采用。

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