Use of viscoelastic testing in the transfusion management of burn patients: a scoping review

Severe burns cause complex hemostatic alterations that complicate transfusion management. Conventional coagulation tests (CCTs) have limitations in timely and accurately assessing these disorders. Viscoelastic tests (VETs), such as thromboelastography (TEG) and rotational thromboelastometry (ROTEM), allow for a dynamic and real-time evaluation of coagulation. A scoping review was conducted following the Arksey and O'Malley methodology and PRISMA-ScR guidelines. Studies from 2010 to 2025 in English or Spanish that evaluated the use of VETs in burn patients were included. Databases such as PubMed, Scopus, and ScienceDirect were analyzed. Eighteen studies were included, mostly narrative reviews and observational studies. ROTEM was the most reported test. VETs were mainly used at admission and intraoperatively. Evidence indicates that TEG and ROTEM outperform CCTs in sensitivity, specificity, and speed, allowing for reduced transfusions and detection of both hypocoagulability and hypercoagulability. VETs are promising tools for transfusion management in burn patients. Although their use is not yet standardized, they offer significant advantages over CCTs and promote more accurate clinical decisions. More studies are needed to support their systematic implementation.