Trial Outcomes & Findings for Early Percutaneous Cryoablation for Pain Control After Rib Fractures Among Elderly Patients (NCT NCT04482582)

NCT ID: NCT04482582

Last Updated: 2026-03-27

Results Overview

The patient will be asked to verbalize their numeric pain score on the day of hospital discharge. Pain is measured on a scale of 0 to 10, with 0 being no pain and 10 being the worst pain. Note: The timing of hospital discharge varies by patient as these are polytrauma patients.

Recruitment status

COMPLETED

Study phase

NA

Target enrollment

127 participants

Primary outcome timeframe

Hospital discharge (up to 1 month)

Results posted on

2026-03-27

Participant Flow

Patients were pre-screened to determine if they met eligibility criteria. If this was met, they were approached by a CRC for in-person consent at Stanford Healthcare (SHC). The enrollment period was from June 1, 2021, to April 15, 2024.

Participant milestones

Participant milestones
Measure
Image-guided Percutaneous ICN (pICN): Group A
Patients who were admitted after a traumatic injury, with rib fractures identified, who are \>= 65 years of age will be randomized to percutaneous image-guided cryoneurolysis (pICN) group within 72 hours of presentation.
Standard-of Care : Group B
Patients who were admitted after a traumatic injury, with rib fractures identified, who are \>= 65 years of age will be randomized to standard-of-care group within 72 hours of presentation.
Baseline
STARTED
72
55
Baseline
COMPLETED
49
54
Baseline
NOT COMPLETED
23
1
1-month follow-up
STARTED
56
54
1-month follow-up
COMPLETED
39
38
1-month follow-up
NOT COMPLETED
17
16
3-month follow-up
STARTED
56
49
3-month follow-up
COMPLETED
35
37
3-month follow-up
NOT COMPLETED
21
12
12-month follow-up
STARTED
53
47
12-month follow-up
COMPLETED
30
32
12-month follow-up
NOT COMPLETED
23
15

Reasons for withdrawal

Reasons for withdrawal
Measure
Image-guided Percutaneous ICN (pICN): Group A
Patients who were admitted after a traumatic injury, with rib fractures identified, who are \>= 65 years of age will be randomized to percutaneous image-guided cryoneurolysis (pICN) group within 72 hours of presentation.
Standard-of Care : Group B
Patients who were admitted after a traumatic injury, with rib fractures identified, who are \>= 65 years of age will be randomized to standard-of-care group within 72 hours of presentation.
Baseline
Screen failure
20
0
Baseline
Withdrawal by Subject
2
0
Baseline
Dropped by Investigator
1
0
Baseline
Protocol Violation
0
1
1-month follow-up
Lost to Follow-up
17
11
1-month follow-up
Withdrawal by Subject
0
5
3-month follow-up
Lost to Follow-up
18
10
3-month follow-up
Death
1
0
3-month follow-up
Withdrawal by Subject
2
2
12-month follow-up
Lost to Follow-up
21
12
12-month follow-up
Death
2
3

Baseline Characteristics

Early Percutaneous Cryoablation for Pain Control After Rib Fractures Among Elderly Patients

Baseline characteristics by cohort

Baseline characteristics by cohort
Measure
Image-guided Percutaneous ICN (pICN): Group A
n=56 Participants
Patients who were admitted after a traumatic injury, with rib fractures identified, who are \>= 65 years of age will be randomized to percutaneous image-guided cryoneurolysis (pICN) group within 72 hours of presentation.
Standard-of Care : Group B
n=54 Participants
Patients who were admitted after a traumatic injury, with rib fractures identified, who are \>= 65 years of age will be randomized to standard-of-care group within 72 hours of presentation.
Total
n=110 Participants
Total of all reporting groups
Age, Continuous
76 years
n=56 Participants
81 years
n=62 Participants
79.5 years
n=123 Participants
Sex: Female, Male
Female
28 Participants
n=56 Participants
31 Participants
n=62 Participants
59 Participants
n=123 Participants
Sex: Female, Male
Male
28 Participants
n=56 Participants
23 Participants
n=62 Participants
51 Participants
n=123 Participants
Race/Ethnicity, Customized
Race · Asian
6 Participants
n=56 Participants
6 Participants
n=62 Participants
12 Participants
n=123 Participants
Race/Ethnicity, Customized
Race · Native Hawaiian or Pacific Islander
0 Participants
n=56 Participants
1 Participants
n=62 Participants
1 Participants
n=123 Participants
Race/Ethnicity, Customized
Race · Black of African American
1 Participants
n=56 Participants
1 Participants
n=62 Participants
2 Participants
n=123 Participants
Race/Ethnicity, Customized
Race · White
42 Participants
n=56 Participants
41 Participants
n=62 Participants
83 Participants
n=123 Participants
Race/Ethnicity, Customized
Race · Unknown or not reported
7 Participants
n=56 Participants
5 Participants
n=62 Participants
12 Participants
n=123 Participants
Highest pain score in first 24 hours
8.11 points
STANDARD_DEVIATION 1.55 • n=56 Participants
8.04 points
STANDARD_DEVIATION 1.64 • n=62 Participants
8.07 points
STANDARD_DEVIATION 1.58 • n=123 Participants
Daily opioid equivalents in first 24 hours
24.75 MMEs
n=56 Participants
25 MMEs
n=62 Participants
25 MMEs
n=123 Participants

PRIMARY outcome

Timeframe: Hospital discharge (up to 1 month)

Population: Includes 7 ITT patients per September 2023 protocol amendment

The patient will be asked to verbalize their numeric pain score on the day of hospital discharge. Pain is measured on a scale of 0 to 10, with 0 being no pain and 10 being the worst pain. Note: The timing of hospital discharge varies by patient as these are polytrauma patients.

Outcome measures

Outcome measures
Measure
Image-guided Percutaneous ICN (pICN): Group A
n=56 Participants
Patients who were admitted after a traumatic injury, with rib fractures identified, who are \>= 65 years of age will be randomized to percutaneous image-guided cryoneurolysis (pICN) group within 72 hours of presentation.
Standard-of Care : Group B
n=54 Participants
Patients who were admitted after a traumatic injury, with rib fractures identified, who are \>= 65 years of age will be randomized to standard-of-care group within 72 hours of presentation.
Acute Pain Assessed by Numeric Pain Score
5.61 score on a scale
Standard Deviation 2.42
5.93 score on a scale
Standard Deviation 2.44

SECONDARY outcome

Timeframe: 1 month after hospital discharge

Population: This analysis population includes patients with available data.

Will be obtained from chart review after discharge

Outcome measures

Outcome measures
Measure
Image-guided Percutaneous ICN (pICN): Group A
n=55 Participants
Patients who were admitted after a traumatic injury, with rib fractures identified, who are \>= 65 years of age will be randomized to percutaneous image-guided cryoneurolysis (pICN) group within 72 hours of presentation.
Standard-of Care : Group B
n=49 Participants
Patients who were admitted after a traumatic injury, with rib fractures identified, who are \>= 65 years of age will be randomized to standard-of-care group within 72 hours of presentation.
30-day Mortality
0 Participants
0 Participants

SECONDARY outcome

Timeframe: 1 month after hospital discharge

Population: Includes 7 ITT patients

Will be obtained from chart review after discharge

Outcome measures

Outcome measures
Measure
Image-guided Percutaneous ICN (pICN): Group A
n=56 Participants
Patients who were admitted after a traumatic injury, with rib fractures identified, who are \>= 65 years of age will be randomized to percutaneous image-guided cryoneurolysis (pICN) group within 72 hours of presentation.
Standard-of Care : Group B
n=54 Participants
Patients who were admitted after a traumatic injury, with rib fractures identified, who are \>= 65 years of age will be randomized to standard-of-care group within 72 hours of presentation.
Number of Participants Requiring ICU Admission
6 Participants
6 Participants

SECONDARY outcome

Timeframe: Up to 1 month

Population: Includes 7 ITT patients

The Length of Stay will be obtained from the patient's chart after discharge and will depend on the level of care required for recovery from their injuries.

Outcome measures

Outcome measures
Measure
Image-guided Percutaneous ICN (pICN): Group A
n=56 Participants
Patients who were admitted after a traumatic injury, with rib fractures identified, who are \>= 65 years of age will be randomized to percutaneous image-guided cryoneurolysis (pICN) group within 72 hours of presentation.
Standard-of Care : Group B
n=54 Participants
Patients who were admitted after a traumatic injury, with rib fractures identified, who are \>= 65 years of age will be randomized to standard-of-care group within 72 hours of presentation.
Length of Hospital Stay
4 days
Interval 3.0 to 7.0
5.5 days
Interval 3.0 to 7.0

SECONDARY outcome

Timeframe: Hospital discharge (up to 1 month), 1 month, 3 months, 12 months after hospital discharge

Population: Includes 7 ITT patients

Daily oral narcotic equivalents

Outcome measures

Outcome measures
Measure
Image-guided Percutaneous ICN (pICN): Group A
n=56 Participants
Patients who were admitted after a traumatic injury, with rib fractures identified, who are \>= 65 years of age will be randomized to percutaneous image-guided cryoneurolysis (pICN) group within 72 hours of presentation.
Standard-of Care : Group B
n=54 Participants
Patients who were admitted after a traumatic injury, with rib fractures identified, who are \>= 65 years of age will be randomized to standard-of-care group within 72 hours of presentation.
Use of Narcotic Equivalents
Discharge
24.11 MME/day
Interval 5.63 to 45.0
15.00 MME/day
Interval 3.75 to 33.75
Use of Narcotic Equivalents
1-month follow-up
0 MME/day
Interval 0.0 to 4.7
0 MME/day
Interval 0.0 to 0.0
Use of Narcotic Equivalents
3-month follow-up
0 MME/day
Interval 0.0 to 0.0
0 MME/day
Interval 0.0 to 0.0
Use of Narcotic Equivalents
12-month follow-up
0 MME/day
Interval 0.0 to 0.0
0 MME/day
Interval 0.0 to 0.0

SECONDARY outcome

Timeframe: 1 month after hospital discharge

Population: Participants with available data were included in this analysis.

The patient will be admitted back to the hospital if pain level relates to rib-specific injuries such as hemothorax and pneumonia.

Outcome measures

Outcome measures
Measure
Image-guided Percutaneous ICN (pICN): Group A
n=55 Participants
Patients who were admitted after a traumatic injury, with rib fractures identified, who are \>= 65 years of age will be randomized to percutaneous image-guided cryoneurolysis (pICN) group within 72 hours of presentation.
Standard-of Care : Group B
n=49 Participants
Patients who were admitted after a traumatic injury, with rib fractures identified, who are \>= 65 years of age will be randomized to standard-of-care group within 72 hours of presentation.
Number of Participants With a Rib-specific Readmission Within 30 Days of Discharge
0 Participants
1 Participants

SECONDARY outcome

Timeframe: 1 month, 3 months, 12 months (all from hospital discharge)

Population: The analysis population includes everyone who has at least 1 McGill score reported at any follow-up timepoint.

The McGill Pain Questionnaire (MPQ) is a validated 20 question instrument to quantify subjective pain and the scoring system yields a Pain Rating Index (PRI) score between Mild, Moderate or Severe. The questionnaire will be administered to the patient by study/ clinical staff at 1-month, 3-month, and 12-month follow-ups. Using the questionnaires, McGill Present Pain Intensity (PPI), Sensory, Affective, and Visual Analogue Scale scores will be calculated and reported. PPI and Visual Analogue Scale scores are on a scale of 0-10, Sensory scores are on a scale of 0-33, and Affective scores are on a scale of 0-12. Higher scores indicate worse pain for all McGill scores.

Outcome measures

Outcome measures
Measure
Image-guided Percutaneous ICN (pICN): Group A
n=48 Participants
Patients who were admitted after a traumatic injury, with rib fractures identified, who are \>= 65 years of age will be randomized to percutaneous image-guided cryoneurolysis (pICN) group within 72 hours of presentation.
Standard-of Care : Group B
n=48 Participants
Patients who were admitted after a traumatic injury, with rib fractures identified, who are \>= 65 years of age will be randomized to standard-of-care group within 72 hours of presentation.
The McGill Pain Questionnaire (MPQ) and Pain Rating Index (PRI) Scale Score
PPI at 1-month follow-up (0-10)
2.72 scores on a scale
Standard Deviation 2.35
1.73 scores on a scale
Standard Deviation 1.76
The McGill Pain Questionnaire (MPQ) and Pain Rating Index (PRI) Scale Score
Sensory at 1-month follow-up (0-33)
4.64 scores on a scale
Standard Deviation 4.89
1.50 scores on a scale
Standard Deviation 2.01
The McGill Pain Questionnaire (MPQ) and Pain Rating Index (PRI) Scale Score
Affective at 1-month follow-up
1.15 scores on a scale
Standard Deviation 1.48
0.41 scores on a scale
Standard Deviation 0.89
The McGill Pain Questionnaire (MPQ) and Pain Rating Index (PRI) Scale Score
Visual Analogue Scale at 1-month follow-up
0 scores on a scale
Standard Deviation 0
The McGill Pain Questionnaire (MPQ) and Pain Rating Index (PRI) Scale Score
PPI at 3-month follow-up
1.42 scores on a scale
Standard Deviation 1.75
0.89 scores on a scale
Standard Deviation 1.30
The McGill Pain Questionnaire (MPQ) and Pain Rating Index (PRI) Scale Score
Sensory at 3-month follow-up
1.00 scores on a scale
Standard Deviation 1.44
0.63 scores on a scale
Standard Deviation 1.55
The McGill Pain Questionnaire (MPQ) and Pain Rating Index (PRI) Scale Score
Affective at 3-month follow-up
0.12 scores on a scale
Standard Deviation 0.42
0.12 scores on a scale
Standard Deviation 0.48
The McGill Pain Questionnaire (MPQ) and Pain Rating Index (PRI) Scale Score
Visual Analogue Scale at 3-month follow-up
1 scores on a scale
0.50 scores on a scale
Standard Deviation 0.71
The McGill Pain Questionnaire (MPQ) and Pain Rating Index (PRI) Scale Score
PPI at 12-month follow-up
0.60 scores on a scale
Standard Deviation 1.10
0.55 scores on a scale
Standard Deviation 1.26
The McGill Pain Questionnaire (MPQ) and Pain Rating Index (PRI) Scale Score
Sensory at 12-month follow-up
0.37 scores on a scale
Standard Deviation 0.72
0.29 scores on a scale
Standard Deviation 0.74
The McGill Pain Questionnaire (MPQ) and Pain Rating Index (PRI) Scale Score
Affective at 12-month follow-up
0 scores on a scale
Standard Deviation 0
0 scores on a scale
Standard Deviation 0

SECONDARY outcome

Timeframe: 1 month, 3 months, 12 months (all from hospital discharge)

Population: Participants who had GOS-E data at any follow-up time point are included.

The Glasgow Outcome Scale (GOS) is a global scale for functional outcome that rates patient status into one of five categories: Dead, Vegetative State, Severe Disability, Moderate Disability or Good Recovery. The Extended GOS (GOSE) provides more detailed categorization into eight categories by subdividing the categories of severe disability, moderate disability and good recovery into a lower and upper category: 1. Death (D) 2. Vegetative state (VS) 3. Lower severe disability (SD -) 4. Upper severe disability (SD +) 5. Lower moderate disability ( MD -) 6. Upper moderate disability ( MD +) 7. Lower good recovery (GR -) 8. Upper good recovery (GR +) The questionnaire will be administered to the patient by study/clinical staff upon discharge.

Outcome measures

Outcome measures
Measure
Image-guided Percutaneous ICN (pICN): Group A
n=48 Participants
Patients who were admitted after a traumatic injury, with rib fractures identified, who are \>= 65 years of age will be randomized to percutaneous image-guided cryoneurolysis (pICN) group within 72 hours of presentation.
Standard-of Care : Group B
n=47 Participants
Patients who were admitted after a traumatic injury, with rib fractures identified, who are \>= 65 years of age will be randomized to standard-of-care group within 72 hours of presentation.
The Glasgow Outcome Scale Extended (GOS-E) Score
1-month follow-up · SD-
2 Participants
0 Participants
The Glasgow Outcome Scale Extended (GOS-E) Score
1-month follow-up · SD+
13 Participants
17 Participants
The Glasgow Outcome Scale Extended (GOS-E) Score
1-month follow-up · MD-
3 Participants
1 Participants
The Glasgow Outcome Scale Extended (GOS-E) Score
1-month follow-up · MD+
6 Participants
5 Participants
The Glasgow Outcome Scale Extended (GOS-E) Score
1-month follow-up · GR-
6 Participants
6 Participants
The Glasgow Outcome Scale Extended (GOS-E) Score
1-month follow-up · GR+
9 Participants
8 Participants
The Glasgow Outcome Scale Extended (GOS-E) Score
3-month follow-up · SD-
0 Participants
0 Participants
The Glasgow Outcome Scale Extended (GOS-E) Score
3-month follow-up · SD+
3 Participants
9 Participants
The Glasgow Outcome Scale Extended (GOS-E) Score
3-month follow-up · MD-
0 Participants
2 Participants
The Glasgow Outcome Scale Extended (GOS-E) Score
3-month follow-up · MD+
4 Participants
2 Participants
The Glasgow Outcome Scale Extended (GOS-E) Score
3-month follow-up · GR-
9 Participants
3 Participants
The Glasgow Outcome Scale Extended (GOS-E) Score
3-month follow-up · GR+
18 Participants
19 Participants
The Glasgow Outcome Scale Extended (GOS-E) Score
12-month follow-up · SD-
0 Participants
0 Participants
The Glasgow Outcome Scale Extended (GOS-E) Score
12-month follow-up · SD+
5 Participants
3 Participants
The Glasgow Outcome Scale Extended (GOS-E) Score
12-month follow-up · MD-
0 Participants
0 Participants
The Glasgow Outcome Scale Extended (GOS-E) Score
12-month follow-up · MD+
1 Participants
4 Participants
The Glasgow Outcome Scale Extended (GOS-E) Score
12-month follow-up · GR-
4 Participants
6 Participants
The Glasgow Outcome Scale Extended (GOS-E) Score
12-month follow-up · GR+
20 Participants
18 Participants

SECONDARY outcome

Timeframe: 1 month, 3 months, 12 months (all from hospital discharge)

Population: Participants with available SF-12 scores at any follow-up time point were included.

The 12-Item Short-Form Health Survey is a widely used composite score used to gauge overall health. The composite score is based on 8 domains scores contained in the SF-12 questionnaire, which will be administered to the patient by study/clinical staff upon discharge. The composite score is split into two summary scores: the Physical Component Summary (PCS) and the Mental Component Summary (MCS). Both scores are on a scale of 0-100, with higher scores representing better mental health-related (MCS) or physical health-related (PCS) quality of life. The means of both scores are standardized to 50 with a standard devation of 10.

Outcome measures

Outcome measures
Measure
Image-guided Percutaneous ICN (pICN): Group A
n=48 Participants
Patients who were admitted after a traumatic injury, with rib fractures identified, who are \>= 65 years of age will be randomized to percutaneous image-guided cryoneurolysis (pICN) group within 72 hours of presentation.
Standard-of Care : Group B
n=46 Participants
Patients who were admitted after a traumatic injury, with rib fractures identified, who are \>= 65 years of age will be randomized to standard-of-care group within 72 hours of presentation.
Short Form (SF-12) Health Survey Scale Score
SF-12 PCS at 1-month follow-up
32.93 score on a scale
Interval 25.18 to 41.52
29.89 score on a scale
Interval 24.16 to 43.68
Short Form (SF-12) Health Survey Scale Score
SF-12 MCS score at 1-month follow-up
55.14 score on a scale
Interval 49.7 to 58.14
55.65 score on a scale
Interval 46.08 to 60.13
Short Form (SF-12) Health Survey Scale Score
SF-12 PCS at 3-month follow-up
51.38 score on a scale
Interval 43.0 to 53.55
47.96 score on a scale
Interval 29.86 to 55.5
Short Form (SF-12) Health Survey Scale Score
SF-12 MCS score at 3-month follow-up
58.73 score on a scale
Interval 53.1 to 60.76
57.83 score on a scale
Interval 49.37 to 60.29
Short Form (SF-12) Health Survey Scale Score
SF-12 PCS at 12-month follow-up
52.77 score on a scale
Interval 47.94 to 55.5
51.46 score on a scale
Interval 44.83 to 55.48
Short Form (SF-12) Health Survey Scale Score
SF-12 MCS at 12-month follow-up
57.83 score on a scale
Interval 53.2 to 60.7
59.65 score on a scale
Interval 55.87 to 61.6

Adverse Events

Image-guided Percutaneous ICN (pICN): Group A

Serious events: 13 serious events
Other events: 9 other events
Deaths: 3 deaths

Standard-of Care : Group B

Serious events: 11 serious events
Other events: 24 other events
Deaths: 3 deaths

Serious adverse events

Serious adverse events
Measure
Image-guided Percutaneous ICN (pICN): Group A
n=56 participants at risk
Patients who were admitted after a traumatic injury, with rib fractures identified, who are \>= 65 years of age will be randomized to percutaneous image-guided cryoneurolysis (pICN) group within 72 hours of presentation.
Standard-of Care : Group B
n=54 participants at risk
Patients who were admitted after a traumatic injury, with rib fractures identified, who are \>= 65 years of age will be randomized to standard-of-care group within 72 hours of presentation.
Musculoskeletal and connective tissue disorders
Rib specific readmission
0.00%
0/56 • From enrollment to one year post-discharge from hospital
Prospective and retrospective analysis
1.9%
1/54 • Number of events 1 • From enrollment to one year post-discharge from hospital
Prospective and retrospective analysis
General disorders
Non chest wall related readmission
23.2%
13/56 • From enrollment to one year post-discharge from hospital
Prospective and retrospective analysis
18.5%
10/54 • From enrollment to one year post-discharge from hospital
Prospective and retrospective analysis

Other adverse events

Other adverse events
Measure
Image-guided Percutaneous ICN (pICN): Group A
n=56 participants at risk
Patients who were admitted after a traumatic injury, with rib fractures identified, who are \>= 65 years of age will be randomized to percutaneous image-guided cryoneurolysis (pICN) group within 72 hours of presentation.
Standard-of Care : Group B
n=54 participants at risk
Patients who were admitted after a traumatic injury, with rib fractures identified, who are \>= 65 years of age will be randomized to standard-of-care group within 72 hours of presentation.
Nervous system disorders
Composite mild neurological events
1.8%
1/56 • From enrollment to one year post-discharge from hospital
Prospective and retrospective analysis
3.7%
2/54 • From enrollment to one year post-discharge from hospital
Prospective and retrospective analysis
Respiratory, thoracic and mediastinal disorders
Hematoma
1.8%
1/56 • From enrollment to one year post-discharge from hospital
Prospective and retrospective analysis
0.00%
0/54 • From enrollment to one year post-discharge from hospital
Prospective and retrospective analysis
Respiratory, thoracic and mediastinal disorders
hemopneumothorax
3.6%
2/56 • From enrollment to one year post-discharge from hospital
Prospective and retrospective analysis
1.9%
1/54 • From enrollment to one year post-discharge from hospital
Prospective and retrospective analysis
Respiratory, thoracic and mediastinal disorders
Pulmonary contusion
1.8%
1/56 • From enrollment to one year post-discharge from hospital
Prospective and retrospective analysis
0.00%
0/54 • From enrollment to one year post-discharge from hospital
Prospective and retrospective analysis
Cardiac disorders
bradycardia/tachycardia/atrial fibrillation/hypotension/code blue/aortic stenosis
7.1%
4/56 • From enrollment to one year post-discharge from hospital
Prospective and retrospective analysis
18.5%
10/54 • From enrollment to one year post-discharge from hospital
Prospective and retrospective analysis
Infections and infestations
Infection
0.00%
0/56 • From enrollment to one year post-discharge from hospital
Prospective and retrospective analysis
3.7%
2/54 • From enrollment to one year post-discharge from hospital
Prospective and retrospective analysis
Gastrointestinal disorders
Constipation/vomiting
0.00%
0/56 • From enrollment to one year post-discharge from hospital
Prospective and retrospective analysis
16.7%
9/54 • From enrollment to one year post-discharge from hospital
Prospective and retrospective analysis

Additional Information

Dr. Joseph Forrester

Stanford University

Phone: 720-284-2317

Results disclosure agreements

  • Principal investigator is a sponsor employee
  • Publication restrictions are in place