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KMID : 0191120230380450322
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Journal of Korean Medical Science
2023 Volume.38 No. 45 p.322 ~ p.322
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Hyperkalemia Detection in Emergency Departments Using Initial ECGs: A Smartphone AI ECG Analyzer vs. Board-Certified Physicians
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Kim Dong-Hoon
Jeong Joo
Kim Joong-Hee
Cho Young-Jin
Park In-Won
Lee Sang-Min
Oh Young-Taeck
Baek Su-Min
Kang Dong-In
Lee Eun-Kyoung
Jeong Bu-Mi
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Abstract
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Background : Hyperkalemia 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.
Methods : We 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).
Results : Our 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).
Conclusion : Our findings suggest that a smartphone application can accurately and reliably quantify hyperkalemia risk using initial ECGs in the ED.
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KEYWORD
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Hyperkalemia, Emergency Departments, Artificial Intelligence, Smartphone Application, Electrocardiography
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