To determine the ECG manifestations of COPD exacerbations and their roles in the decision making process in admission.A descriptive cross-sectional study.Emergency Department (ED) of Kocaeli University, Turkey, from November 2016 to December 2017.All COPD patients who presented with exacerbation symptoms and agreed to participate in the study were enrolled, and the exacerbation characteristics were recorded in the standardised charts. Patients were excluded if they refused to participate in the study, if they presented repetitively to the ED with the same presentation, and if the ECG strip at the presentation could not be obtained. A binary logistic regression model was constructed to assess the factors predicting hospital admission, including the ECG features.A total of 146 patients were included in the final analysis. Upon presentation, 122 patients (83.6%) exhibited sinus rhythm, 21 exhibited atrial fibrillation (14.4%), and 3 of them were multifocal atrial tachycardia and junctional rhythm. Thirty-four admitted patients (41.0%) and 22 of the discharged patients (34.9%) exhibited ST and T wave changes in their ECGs (p=0.457). No statistically significant differences were found regarding the rhythms, axes, P wave characteristics, PR interval durations, QRS interval durations, corrected QT(QTc) durations, and bundle branch block occurrences between the admitted and discharged patients. Although the QTc dispersion was more prominent in the admitted group in the univariate analysis (p=0.035), the multivariate analysis revealed that only hypoxemia, older age, increased dyspnea scores, and sputum purulence were independent predictors of hospital admission.None of the ECG findings were determined to be successful in predicting the admission needs in COPD exacerbations.