BRIPPED Scan for Evaluation of Emergency Department (ED) Patients With Shortness of Breath

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.