• Zubaid Rafique, Jorge Aceves, Ilse Espina, Frank Peacock, David Sheikh-Hamad, and Dick Kuo.
• Baylor College of Medicine, Department of Emergency Medicine, Ben Taub General Hospital, Houston, TX, USA. Electronic address: zubaidrafique@gmail.com.
• Am J Emerg Med. 2020 Jan 1; 38 (1): 105-108.

ObjectiveAlthough there is no consensus on how to use an electrocardiogram (ECG) in patients with hyperkalemia, physicians often obtain it in the acute setting when diagnosing and treating hyperkalemia. The objective of this study is to evaluate if physicians are able to detect hyperkalemia based on the ECG.MethodsThe study was conducted at a large county hospital with a population of end stage renal disease (ESRD) patients who received hemodialysis (HD) solely on an emergent basis. Five hundred twenty eight ECGs from ESRD patients were evaluated. The prevalence of hyperkalemia was approximately 60% in this cohort, with at least half of them in the severe hyperkalemia range (K ≥ 6.5 mEq/L).ResultsThe mean sensitivity and specificity of the emergency physicians detecting hyperkalemia were 0.19 (± 0.16) and 0.97(± 0.04) respectively. The mean positive predictive value of evaluators for detecting hyperkalemia was 0.92 (±0.13) and the mean negative predictive value was 0.46 (± 0.05). In severe hyperkalemia (K ≥ 6.5 mEq/L), the mean sensitivity improved to 0.29 (± 0.20), while specificity decreased to 0.95 (±0.07).ConclusionAn ECG is not a sensitive method of detecting hyperkalemia and should not be relied upon to rule it out. However, the ECG has a high specificity for detecting hyperkalemia and could be used as a rule in test.Copyright © 2019 Elsevier Inc. All rights reserved.

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