• Donghoon Kim, Joo Jeong, Joonghee Kim, Youngjin Cho, Inwon Park, Sang-Min Lee, Young Taeck Oh, Sumin Baek, Dongin Kang, Eunkyoung Lee, and Bumi Jeong.
• Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
• J. Korean Med. Sci. 2023 Nov 20; 38 (45): e322e322.

BackgroundHyperkalemia is a potentially fatal condition that mandates rapid identification in emergency departments (EDs). Although a 12-lead electrocardiogram (ECG) can indicate hyperkalemia, subtle changes in the ECG often pose detection challenges. An artificial intelligence application that accurately assesses hyperkalemia risk from ECGs could revolutionize patient screening and treatment. We aimed to evaluate the efficacy and reliability of a smartphone application, which utilizes camera-captured ECG images, in quantifying hyperkalemia risk compared to human experts.MethodsWe performed a retrospective analysis of ED hyperkalemic patients (serum potassium ≥ 6 mmol/L) and their age- and sex-matched non-hyperkalemic controls. The application was tested by five users and its performance was compared to five board-certified emergency physicians (EPs).ResultsOur study included 125 patients. The area under the curve (AUC)-receiver operating characteristic of the application's output was nearly identical among the users, ranging from 0.898 to 0.904 (median: 0.902), indicating almost perfect interrater agreement (Fleiss' kappa 0.948). The application demonstrated high sensitivity (0.797), specificity (0.934), negative predictive value (NPV) (0.815), and positive predictive value (PPV) (0.927). In contrast, the EPs showed moderate interrater agreement (Fleiss' kappa 0.551), and their consensus score had a significantly lower AUC of 0.662. The physicians' consensus demonstrated a sensitivity of 0.203, specificity of 0.934, NPV of 0.527, and PPV of 0.765. Notably, this performance difference remained significant regardless of patients' sex and age (P < 0.001 for both).ConclusionOur findings suggest that a smartphone application can accurately and reliably quantify hyperkalemia risk using initial ECGs in the ED.© 2023 The Korean Academy of Medical Sciences.

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