title: BRIPPED scan for evaluation of ED patients with shortness of breath.
abstract: OBJECTIVE
  The BRIPPED scan is an ultrasound evaluation of pulmonary B-lines, right ventricle size, inferior vena cava collapsibility, pleural and pericardial effusion, pneumothorax, left ventricle ejection fraction, and lower extremity deep venous thrombosis. The primary goal was to evaluate the effect of the BRIPPED scan on the physician's list of differential diagnoses for patients presenting with shortness of breath.
  
  
  METHODS
  This prospective randomized control trial was performed on patients presenting to the emergency department with shortness of breath. Primary data analysis was performed using an ordinal quasi-symmetry model to compare the magnitude of change in the differential diagnoses between 2 groups. Secondary outcome measures included changes in physician orders or interventions, time to disposition, time to perform the BRIPPED scan, and the interrater reliability of the interpretation of the scan.
  
  
  RESULTS
  A total of 104 patients and 24 physicians were enrolled in this study. Fifty-two patients were randomly assigned to each cohort. Among the BRIPPED cohort, there was significant movement of likelihood for several etiologies of shortness of breath on the physician differential. There was no significance in the change of differential diagnosis between the BRIPPED and control cohorts. The average (SD) time to perform the scan was 5.7 (1.3) minutes (95% confidence interval, 5.4-6 minutes).
  
  
  CONCLUSIONS
  The BRIPPED scan is a rapid ultrasound evaluation of shortness of breath in the emergency department. BRIPPED influenced physician differential diagnoses to the same degree as laboratory and radiographic testing. BRIPPED did not alter the final diagnosis in this patient population.
authors.affiliation: Department of Emergency Medicine, Eastern Virginia Medical School, Norfolk, VA; Department of Emergency Medicine, Riverside Regional Medical Center, Newport News, VA. Electronic address: vms0419@gmail.com.
authors.forename: Virginia M
authors.initials: VM
authors.lastname: Stewart
authors.affiliation: Department of Emergency Medicine, Eastern Virginia Medical School, Norfolk, VA; Department of Emergency Medicine, Landspital-University Hospital, Reykjavik, Iceland.
authors.forename: Hjalti M
authors.initials: HM
authors.lastname: Bjornsson
authors.affiliation: Department of Emergency Medicine, Eastern Virginia Medical School, Norfolk, VA; Department of Emergency Medicine at Carilion Roanoke Memorial Hospital, Roanoke, VA.
authors.forename: Michelle
authors.initials: M
authors.lastname: Clinton
authors.affiliation: Department of Emergency Medicine, Eastern Virginia Medical School, Norfolk, VA.
authors.forename: Donald V
authors.initials: DV
authors.lastname: Byars
mesh_terms: D002985:Clinical Protocols; D003937:Diagnosis, Differential; D004417:Dyspnea / Q000000981:diagnostic imaging* / Q000209:etiology*; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015203:Reproducibility of Results; D014463:Ultrasonography