Bedside Renal, Inferior Vena Cava, Pulmonary, Pleural, Epicardial, Diaphragm (BRIPPED) Scan for Evaluating Patients Presenting With Dyspnea in the Emergency Department

Background: Acute dyspnea is a common and challenging presentation in the emergency department (ED), with multiple potential etiologies. Rapid and accurate bedside evaluation is critical to guide timely management. The Bedside Renal, Inferior Vena Cava, Pulmonary, Pleural, Epicardial, Diaphragm (BRIPPED) scan is a focused, multiorgan ultrasound protocol incorporating assessment of pulmonary B-lines, right ventricular size, inferior vena cava collapsibility, pleural and pericardial effusion, pneumothorax, left ventricular ejection fraction, and lower extremity deep venous thrombosis, designed to differentiate the causes of acute dyspnea in the ED. Methods: We conducted a prospective observational study of 148 adult patients presenting to the ED with acute dyspnea. Each patient underwent a BRIPPED scan at the time of presentation. Scan findings were compared with the final diagnosis established through clinical evaluation, laboratory investigations, imaging, and specialist consultation. Diagnostic performance metrics, including sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV), were calculated for cardiac, pulmonary, mixed (cardiac plus pulmonary), and noncardiopulmonary causes of dyspnea. Results: For cardiac causes, the BRIPPED scan demonstrated a sensitivity of 98.46% and a specificity of 96.39%, with a PPV of 95.52% and an NPV of 98.77%. For pulmonary causes, sensitivity was 100%, specificity 95.65%, PPV 93.33%, and NPV 100%. In mixed etiologies, sensitivity and specificity were 20% and 100%, respectively, with a PPV of 100% and an NPV of 97.28%. For noncardiopulmonary causes of dyspnea, the protocol showed a sensitivity of 86.36%, a specificity of 99.21%, a PPV of 95.00%, and an NPV of 97.66%. Conclusion: In this single-center study, the BRIPPED ultrasound protocol demonstrated high diagnostic accuracy for broad etiologic categorization of acute dyspnea. The protocol showed particularly strong performance for identifying cardiac and pulmonary causes. Its implementation may improve early diagnostic accuracy and facilitate timely patient management. Multicenter validation with blinded adjudication and a larger sample size is warranted to assess generalizability and reduce biases.