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Table of Content

    01 March 2025, Volume 16 Issue 2
    Previous Issue   
    Review Article
    Tracheal intubation in the lateral position in emergency medicine: a narrative review and clinical protocol
    Ping Cui, Tingting Wen, Bingduo Wang, Shuijing Wu, Shiyu Chen, Xiangming Fang, TILP consortium
    2025, 16(2):  103-112.  doi:10.5847/wjem.j.1920-8642.2025.034
    Abstract    HTML    PDF (528KB)   

    BACKGROUND: Tracheal intubation (TI) is a fundamental procedure for securing the airway or assisting ventilation in emergency medicine. Tracheal intubation in the lateral position (TILP) has been utilized in clinical practice, demonstrating potential advantages in specific scenarios, including emergency settings. However, there is a lack of comprehensive reviews and practical protocols on TILP application. To address this gap, we performed a narrative review, and provided evidence-based recommendations to formulate a practice protocol, to assist clinicians to effectively apply TILP.
    METHODS: We conducted a narrative review of TILP applications and developed recommendations based on clinical research evidence and clinical experience. Delphi method was used among the TILP consortium to grade the strength of the recommendations and to help reach consensus. The practice protocols were formulated as warranted by advancements in medical knowledge, technology, and practice.
    RESULTS: This narrative review summarized the current evidence on TILP application, highlighting its safety, efficacy, challenges, and potential complications. In total, 24 recommendations and a clinical protocol for TILP application in emergency patients were established.
    CONCLUSION: TILP is a valuable technique in emergency medicine. We reviewed its application in emergency settings and formulated recommendations along with a clinical practice protocol. Future studies are needed to evaluate the safety and efficacy of TILP, broaden its scope of application, and explore effective training protocols.

    Original Articles
    Early identification of high-risk patients admitted to emergency departments using vital signs and machine learning
    Qingyuan Liu, Yixin Zhang, Jian Sun, Kaipeng Wang, Yueguo Wang, Yulan Wang, Cailing Ren, Yan Wang, Jiashan Zhu, Shusheng Zhou, Mengping Zhang, Yinglei Lai, Kui Jin
    2025, 16(2):  113-120.  doi:10.5847/wjem.j.1920-8642.2025.031
    Abstract    HTML    PDF (576KB)   

    BACKGROUND: Rapid and accurate identification of high-risk patients in the emergency departments (EDs) is crucial for optimizing resource allocation and improving patient outcomes. This study aimed to develop an early prediction model for identifying high-risk patients in EDs using initial vital sign measurements.
    METHODS: This retrospective cohort study analyzed initial vital signs from the Chinese Emergency Triage, Assessment, and Treatment (CETAT) database, which was collected between January 1st, 2020, and June 25th, 2023. The primary outcome was the identification of high-risk patients needing immediate treatment. Various machine learning methods, including a deep-learning-based multilayer perceptron (MLP) classifier were evaluated. Model performance was assessed using the area under the receiver operating characteristic curve (AUC-ROC). AUC-ROC values were reported for three scenarios: a default case, a scenario requiring sensitivity greater than 0.8 (Scenario I), and a scenario requiring specificity greater than 0.8 (Scenario II). SHAP values were calculated to determine the importance of each predictor within the MLP model.
    RESULTS: A total of 38,797 patients were analyzed, of whom 18.2% were identified as high-risk. Comparative analysis of the predictive models for high-risk patients showed AUC-ROC values ranging from 0.717 to 0.738, with the MLP model outperforming logistic regression (LR), Gaussian Naive Bayes (GNB), and the National Early Warning Score (NEWS). SHAP value analysis identified coma state, peripheral capillary oxygen saturation (SpO2), and systolic blood pressure as the top three predictive factors in the MLP model, with coma state exerting the most contribution.
    CONCLUSION: Compared with other methods, the MLP model with initial vital signs demonstrated optimal prediction accuracy, highlighting its potential to enhance clinical decision-making in triage in the EDs.

    Feasibility of telemedicine in civil protection: a prospective observational study during a music festival
    Anna Müller, Robert Arimond, Janosch Kunczik, Rolf Rossaint, Michael Czaplik, Andreas Follmann
    2025, 16(2):  121-128.  doi:10.5847/wjem.j.1920-8642.2025.027
    Abstract    HTML    PDF (644KB)   

    BACKGROUND: As disasters intensify and professional deficits persist, civil protection is reliant on medical volunteers. With limited physician availability, telemedicine is promising. No system currently empowers lower-qualified paramedics for physician-delegated telemedicine. Existing telemedicine technology unfits for civil protection. This study aimed to evaluate a modified system at a music festival to simulate disaster situations.
    METHODS: A tablet-based telemedicine system, integrating vital sign monitoring, was deployed at the "Summerjam" music festival characterized by various medical emergencies. A physician could be contacted via telemedicine or requested onsite. Medical feasibility was rated by patient condition changes, with National Advisory Committee of Aeronautics (NACA) score and Primary Ranking for Initial Orientation in the Rescue service (PRIOR) algorithm for triaging. Technical feasibility was assessed by connection stability, communication, and vital sign transmission.
    RESULTS: Of 404 treatments, 34 (8.4%) were performed using telemedicine, 49 (12.1%) were carried out with a physician onsite. Telemedicine treatments accounted for 40.9% of all treatment in which a physician was involved. Patient conditions varied up to NACA III (moderate disturbance). A variety of internal medical (76.5%) and surgical (23.5%) conditions were addressed, some of which required invasive measures or application of medication. No patients experienced a deterioration in their condition. Despite technical difficulties, treatment was not significantly impacted, confirming technical feasibility.
    CONCLUSION: The study shows that lower-qualified paramedics can effectively use telemedicine for physician-delegated treatment, suggesting potential applicability to civil protection. Nonetheless, further system robustness improvements and research are needed.

    A two-sample Mendelian randomization study on the relationship of body weight, body mass index, and waist circumference with cardiac arrest
    Tingting Xu, Shaokun Wang, Liqiang Zhao, Jiawen Wang, Jihong Xing
    2025, 16(2):  129-135.  doi:10.5847/wjem.j.1920-8642.2025.035
    Abstract    HTML    PDF (472KB)   

    BACKGROUND: This study aims to explore the causal relationship of body weight, body mass index (BMI), and waist circumference (WC) with the risk of cardiac arrest (CA) using two-sample Mendelian randomization (MR).
    METHODS: Data were summarized using genome-wide association studies (GWAS). Two-sample MR analyses were performed using the inverse variance weighting (IVW) method, the weighted median method, and the MR-Egger analysis. Heterogeneity test and sensitivity analysis were performed using Cochran’s Q test and the leave-one-out method, respectively. The Steiger test was used to detect reverse causality. Bayesian model-averaged MR was used to identify the most influential risk factors.
    RESULTS: A total of 13 GWAS data were collected for BMI, body weight and WC. IVW analyses showed a positive correlation of body weight, BMI, and WC with CA (all OR>1 and P<0.05), with MR-Egger and weighted median methods confirming the IVW findings. No horizontal pleiotropy or heterogeneity was observed. Sensitivity analysis indicated that no single nucleotide polymorphism (SNP) caused significant changes in overall causality. Bayesian model-averaged MR was also used to rank causality based on marginal inclusion probability (MIP), and the corresponding model-averaged causal estimate (MACE) were confirmed, which indicated that WC (GWAS ID: ukb-b-9405) was the highest-ranked risk factor (MIP=0.119, MACE=0.011); its posterior probability was 0.057. A total of 14 sex-specific GWAS data on weight, BMI, and WC were analyzed in relationship with CA, and the MR results showed no significant effects of sex-specific factors.
    CONCLUSION: Body weight, BMI, and WC are causally associated with an increased risk of CA, with WC identified as the most important risk factor.

    The role of early changes in routine coagulation tests in predicting the occurrence and prognosis of sepsis
    Peili Chen, Yan Ge, Huiqiu Sheng, Wenwu Sun, Jiahui Wang, Li Ma, Enqiang Mao
    2025, 16(2):  136-143.  doi:10.5847/wjem.j.1920-8642.2025.036
    Abstract    HTML    PDF (555KB)   

    BACKGROUND: This study aimed to explore the importance of routine coagulation tests for the early detection of sepsis and to quickly identify patients at a high risk of mortality.
    METHODS: This retrospective single-center study collected data from patients meeting the clinical criteria for systemic inflammatory response syndrome (SIRS) with a confirmed infection source. Patients with coagulation disorders or on medications affecting coagulation were excluded. Patients were divided into sepsis and non-sepsis groups based on a Sequential Organ Failure Assessment (SOFA) score of ≥2. Univariate and multivariate logistic regression identified indicators from routine coagulation tests that predict sepsis. Prognostic roles of coagulation indicators were analyzed within the sepsis group.
    RESULTS: A total of 512 patients were included, with 396 in the sepsis group and 116 in the non-sepsis group. The predictive factors in the sepsis prediction model encompass fibrin degradation products (FDP), D-dimer, lactate, procalcitonin (PCT) levels and the utilization of mechanical ventilation. Early elevation of FDP and D-dimer levels predicted sepsis onset. The model exhibited an area under the curve (AUC) of 0.943 (95% CI: 0.923-0.963). In the sepsis group, Cox regression analysis revealed an association between prothrombin time (PT) and in-hospital mortality.
    CONCLUSION: Abnormal high FDP and D-dimer levels in the early stages of sepsis provide a supplementary method for predicting sepsis. As the disease progresses, prolonged PT in the early stages of sepsis suggests a poor prognosis.

    Circulating circular RNAs act as potential novel biomarkers for sepsis secondary to pneumonia: a prospective cohort study
    Chunxue Wang, Dianyin Yang, Yuxin Zhu, Qian Yang, Tong Liu, Xiandong Liu, Dongyang Zhao, Xiaowei Bao, Tiancao Dong, Li Shao, Lunxian Tang
    2025, 16(2):  144-152.  doi:10.5847/wjem.j.1920-8642.2025.033
    Abstract    HTML    PDF (680KB)   

    BACKGROUND: Circulating biomarkers for sepsis are lacking, and research on circular RNAs (circRNAs) as potential biomarkers of pneumonia-induced sepsis is limited. This study aims to investigate the diagnostic and prognostic potential of circRNAs in patients with pneumonia-induced sepsis.
    METHODS: This prospective cohort study included 40 healthy individuals, 60 patients with pneumonia, and 80 patients with pneumonia-induced sepsis. CircRNAs identified through RNA-sequencing were validated using quantitative real-time polymerase chain reaction (qRT-PCR). Spearman correlation analysis was used to evaluate the associations between circRNAs, inflammatory markers, Sequential Organ Failure Assessment (SOFA) scores, and Acute Physiology and Chronic Health Evaluation II (APACHE II) scores. Receiver operating characteristic (ROC) curves analysis were used to assess the diagnostic performance of circRNAs, while ROC curves and Kaplan-Meier survival analysis were used to evaluate their prognostic value of 28-day mortality.
    RESULTS: qRT-PCR confirmed the significant upregulation of Circ-CTD-2281E23.2 and downregulation of Circ-0075723 and Circ-0008679 in sepsis patients. Spearman correlation analysis showed that Circ-CTD-2281E23.2 was positively correlated with inflammatory markers and severity scores, whereas Circ-0075723 and Circ-0008679 were negatively correlated with these parameters. The area under the curve (AUC) values for Circ-CTD-2281E23.2, Circ-0075723, and Circ-0008679 in diagnosing pneumonia-induced sepsis were 0.728, 0.706, and 0.793, respectively. The combination of these circRNAs (AUC=0.846) and the combination with other clinical indicators (AUC=0.990) demostrated enhanced AUC values. The AUC values for Circ-CTD-2281E23.2 and Circ-0075723 in predicting 28-day mortality were 0.664 and 0.765, respectively.
    CONCLUSION: This study suggest the additional diagnostic and prognostic value of circRNAs in pneumonia-induced sepsis. Circ-CTD-2281E23.2, Circ-0075723, and Circ-0008679 exhibit diagnostic potential, with Circ-CTD-2281E23.2 and Circ-0075723 showing positive prognostic value for 28-day mortality in sepsis patients.

    A predictive model for intracranial hemorrhage in adult patients receiving extracorporeal membrane oxygenation
    Yi Zhu, Lina Mao, Zhongman Zhang, Sae Rom Lee, Tianshi Li, Hao Zhou, Yanbin Dong, Di An, Wei Li, Xufeng Chen
    2025, 16(2):  153-160.  doi:10.5847/wjem.j.1920-8642.2025.037
    Abstract    HTML    PDF (631KB)   

    BACKGROUND: Intracranial hemorrhage (ICH), a severe complication among adults receiving extracorporeal membrane oxygenation (ECMO), is often related to poor outcomes. This study aimed to establish a predictive model for ICH in adults receiving ECMO treatment.
    METHODS: Adults who received ECMO between January 2017 and June 2022 were the subjects of a single-center retrospective study. Patients under the age of 18 years old, with acute ICH before ECMO, with less than 24 h of ECMO support, and with incomplete data were excluded. ICH was diagnosed by a head computed tomography scan. The outcomes included the incidence of ICH, in-hosptial mortality and 28-day mortality. Multivariate logistic regression analysis was used to identify relevant risk factors of ICH, and a predictive model of ICH with a nomogram was constructed.
    RESULTS: Among the 227 patients included, 22 developed ICH during ECMO. Patients with ICH had higher in-hospital mortality (90.9% vs. 47.8%, P=0.001) and higher 28-day mortality (81.8% vs. 47.3%, P=0.001) than patients with non-ICH. ICH was associated with decreased grey-white-matter ratio (GWR) (OR=0.894, 95%CI: 0.841-0.951, P<0.001), stroke history (OR=4.265, 95%CI: 1.052-17.291, P=0.042), fresh frozen plasma (FFP) transfusion (OR=1.208, 95%CI: 1.037-1.408, P=0.015) and minimum platelet (PLT) count during ECMO support (OR=0.977, 95%CI: 0.958-0.996, P=0.019). The area under the receiver operating characteristic curve of the ICH predictive model was 0.843 (95%CI: 0.762-0.924, P<0.001).
    CONCLUSION: ECMO-treated patients with ICH had a higher risk of death. GWR, stroke history, FFP transfusion, and the minimum PLT count were independently associated with ICH, and the ICH predictive model showed that these parameters performed well as diagnostic tools.

    Research Letter
    The occurrence of propofol injection pain in the emergency department: an exploratory analysis
    Mischa Veen, M. Christien van der Linden
    2025, 16(2):  161-163.  doi:10.5847/wjem.j.1920-8642.2025.023
    Abstract    HTML    PDF (324KB)   
    Viewpoints
    Cardiac complications in acute pancreatitis: an under-diagnosed clinical concern
    Longfei Pan, Zequn Niu, Song Ren, Lei Zhang, Honghong Pei, Zhengliang Zhang, Yanxia Gao
    2025, 16(2):  164-167.  doi:10.5847/wjem.j.1920-8642.2025.024
    Abstract    HTML    PDF (337KB)   
    Impact of the COVID-19 pandemic on research publications in emergency medicine
    Syrus Razavi, Arjun Sharma, Cassidy Lavin, Ali Pourmand, Quincy Khoi Tran
    2025, 16(2):  168-171.  doi:10.5847/wjem.j.1920-8642.2025.022
    Abstract    HTML    PDF (472KB)   
    Letter to Editor
    Case Letters
    Mild diarrhea leading to tacrolimus toxicity in an immunocompromised patient with suspected community-acquired pneumonia: a case report
    Xueying Chen, Jianbo Ding, Jiali Zhang, Hongyan Jiang, Haibin Dai, Lingyan Yu
    2025, 16(2):  174-176.  doi:10.5847/wjem.j.1920-8642.2025.021
    Abstract    HTML    PDF (335KB)   
    Explosive pleuritis: a rare case of fever and chest pain
    Muzamil Khan, Ali Pourmand, Melanie Schroeder, Quincy Khoi Tran, James Scott, Amanda Miller, Jalil Ahari
    2025, 16(2):  177-179.  doi:10.5847/wjem.j.1920-8642.2025.013
    Abstract    HTML    PDF (918KB)   
    A fulminant case of Streptococcus pyogenes bacteremic pneumonia
    Ksenia Ivanova, Daria Strelkova, Svetlana Rachina, Olga Kupriushina, Svetlana Yatsyshina, Marina Mamoshina, Yulia Mikhailova, Svetlana Kochetkova, Elena Burmistrova, Olga Ignatenko
    2025, 16(2):  183-185.  doi:10.5847/wjem.j.1920-8642.2025.014
    Abstract    HTML    PDF (495KB)   
    Pharmacobezoars: the challenges of gastric lavage for a patient with drug overdose
    Hao Wang, Qing Tang, Shuxin Hua, Shuai Su, Chongwen Bi, Jiaqi Xu, Yanfen Chai, Lijun Wang
    2025, 16(2):  186-188.  doi:10.5847/wjem.j.1920-8642.2025.025
    Abstract    HTML    PDF (912KB)   
    Transesophageal lung ultrasonography in empyema detection: a case report
    Issac Cheong, Francisco Marcelo Tamagnone
    2025, 16(2):  189-191.  doi:10.5847/wjem.j.1920-8642.2025.029
    Abstract    HTML    PDF (317KB)