BRIPPED Scan for Evaluation of Emergency Department (ED) Patients With Shortness of Breath
BRIPPED Scan for Evaluation of Emergency Department (ED) Patients With Shortness of Breath
The B-RIPPED scan is a standardized ultrasound evaluation of pulmonary B-lines, Right
 ventricle size and strain, Inferior Vena Cava collapsibility, Pleural and Pericardial
 Effusion, Pneumothorax, Ejection Fraction, and lower extremity Deep Venous Thrombosis.
 Primary outcomes measured are the magnitude of change in differential diagnoses.
This prospective randomized control trial will be performed on a convenience sample of 200
 patients presenting with undifferentiated SOB to an academic emergency department (ED)
 (volume 56,000 patients/year). Subjects are excluded if they have a known history of asthma,
 are 20 or more weeks pregnant, or have had thoraco-abdominal trauma in the past 72 hours. The
 BRIPPED pilot investigation (IRB #10-02-FB-0026) enrolled 43 patients and physician subjects
 from 4/30/2010 to 1/20/2011. This study differs in methodology from the pilot study in the
 reduction of the total number of ultrasound images obtained to decrease the total time to
 perform the scan. Instead of a cohort study, this randomized control trial includes the
 addition of a control group for cost and time saved comparison. As in the pilot study,
 eligible patients will be evaluated by the treating ED physician who will rank potential
 diagnoses from most to least likely. A study investigator performs the B-RIPPED scan and
 provides the initial treating physician with the results. The treating physician will again
 be asked to complete a differential diagnosis ranking knowing the B-RIPPED results. Changes
 in the differential diagnosis ranking, physician orders, and interventions will be compiled.
 A randomized control cohort will be assigned for eligible patients. In the control group, the
 treating physician will complete the diagnosis rank list prior to the completion of the
 workup, and then once all lab values are back. Time to disposition, and comparison of labs
 and radiology tests ordered will be compared to the cohort receiving the BRIPPED scan.
 Patients will be assigned a number at time of enrollment, which randomly assigns them to the
 control or experimental (patients receiving the BRIPPED scan) group. Packets containing the
 appropriate data collection form (control or experimental) will be organized so even numbered
 patients will belong to one group, and odd numbered patients will be assigned to the other.
Inclusion Criteria:

 Subjects are included if they are between the ages of 18-89 and present to the Emergency
 Department with a chief complaint of shortness of breath or dyspnea.

 Exclusion Criteria:

 -  known history of asthma,

 -  are 20 or more weeks pregnant, or

 -  have had thoraco-abdominal trauma in the past 72 hours.