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Rib FracturesEPERCNCT04482582

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

A study testing Cryoneurolysis in people with Rib Fractures, run by Stanford University at 1 site in United States.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

The purpose of this study is to provide long-term pain control for elderly patients with rib fractures in order to minimize their risk of complications and return them to baseline functional capacity Read more about this study

Who is it for?
Ages 65 years and older
Conditions the study is for
Rib Fractures
What is being tested?
Cryoneurolysis
Type of treatment
Surgery or procedure
Could I receive a placebo?
No, everyone receives an active treatment
How many people
127 participants
Where
1 siteUnited States
Study dates
1 Jun 2021to 30 Apr 2025
Phase
Interventional
Are there results?
Yes, posted in the registrySummary in the doctors' view

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 65 years and older
  • All sexes
  • No healthy volunteers
  • Older adult

Who may be able to join

  • Patients greater than 65 years with any acute rib fracture
  • Pain score equal to or greater than 5 with deep inspiration.
  • Presenting and admitted to Stanford Emergency Department

Who cannot join

  • Radiographic evidence of metastasis to ribs
  • Glasgow Coma Scale (GCS) score <13
  • Patients undergoing SSRF
  • Rib fractures located < 3cm from spinous process
  • Coagulopathy (INR >1.5, Pat < 100)
  • Other factors precluding cryoablation at IR attending's discretion
  • If only ribs broken are 1,2 or 10,11, 12

Trial locations and contacts

1 site in 1 country.

United States1 site
  • Stanford Hospital and Clinics

    Palo Alto, California, 94305

Other trials in United States

About this study

The purpose of this study is to provide long-term pain control for elderly patients with rib fractures in order to minimize their risk of complications and return them to baseline functional capacity

Read the detailed description

The purpose of this study is to provide long-term pain control for elderly patients with rib fractures in order to minimize their risk of complications and return them to baseline functional capacity. In order to do this, we would offer a minimally invasive solution known as Cryoneurolysis. By directly applying cold Cryoneurolysis to the nerves, this can destroy nerve axons, resulting in Wallerian degeneration of the distal nerve without distorting epineural or perineurial tissue. The application of cryoneurolysis will help reduce the amount of narcotics the patient would need, and potentially lead to a better post-injury quality of life.

Conditions
Rib Fractures
Being tested
Cryoneurolysis, Standard of Care
Keywords
rib fractures, CT guided cryoneurolysis
Medical subject headings
Rib Fractures

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • CryoneurolysisRadiation

    Patients will be offered a minimally invasive solution known as cryoneurolysis. By directly applying a cold cryoneurolysis probe to the nerves the axon is destroyed, resulting in Wallerian degeneration of the distal nerve without distorting epineurial or perineurial tissue. Application of cryoneurolysis will help reduce the amount of narcotics the patient would need to take and instead provide them longer term pain control with minimal risk.

  • Standard of CareOther

    Patients will be provided regular standard of care at the Stanford Hospital with long-term follow-up provided at the Stanford Center for Reconstruction after Chest Wall Injury.

Study groups in NCT04482582
Study groupRoleWhat they receive
Image-guided percutaneous ICN (pICN): Group AExperimentalPatients 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.
Receives: Radiation: Cryoneurolysis
Standard-of Care : Group BActive comparatorPatients 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.
Receives: Other: Standard of Care

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Acute Pain Assessed by Numeric Pain Score

    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.

    Measured: Hospital discharge (up to 1 month)

Secondary outcomes (8)
  1. 30-day Mortality

    Will be obtained from chart review after discharge

    Measured: 1 month after hospital discharge

  2. Number of Participants Requiring ICU Admission

    Will be obtained from chart review after discharge

    Measured: 1 month after hospital discharge

  3. Length of Hospital Stay

    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.

    Measured: Up to 1 month

  4. Use of Narcotic Equivalents

    Daily oral narcotic equivalents

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

  5. Number of Participants With a Rib-specific Readmission Within 30 Days of Discharge

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

    Measured: 1 month after hospital discharge

  6. The McGill Pain Questionnaire (MPQ) and Pain Rating Index (PRI) Scale Score

    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.

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

  7. The Glasgow Outcome Scale Extended (GOS-E) Score

    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.

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

  8. Short Form (SF-12) Health Survey Scale Score

    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.

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

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted22 Jul 2020
  2. Study start1 Jun 2021
  3. Primary completion25 Apr 2024
  4. Study completion30 Apr 2025

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Model description
We are proposing a prospective, randomized trial evaluating efficacy of image-guided percutaneous intercostal cryoneurolysis (pICN) for pain control after traumatic rib fractures in persons \>=65 years. Eligible patients would be enrolled by the trauma service after consent or assent is obtained. Patients will be randomized to either pICN within 72 hours of presentation or existing standard-of-care.
Masking
None (open label)
Enrolment
127 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04482582
Sponsor's protocol ID
57099
Acronym
EPERC
Status last verified
Aug 2025
First submitted
18 Jul 2020
Last updated
27 Mar 2026
FDA-regulated drug
No
FDA-regulated device
Yes
Individual data sharing
No

Publications

  • Ziegler DW, Agarwal NN. The morbidity and mortality of rib fractures. J Trauma. 1994 Dec;37(6):975-9. doi: 10.1097/00005373-199412000-00018.

    PubMed 7996614
  • Flagel BT, Luchette FA, Reed RL, Esposito TJ, Davis KA, Santaniello JM, Gamelli RL. Half-a-dozen ribs: the breakpoint for mortality. Surgery. 2005 Oct;138(4):717-23; discussion 723-5. doi: 10.1016/j.surg.2005.07.022.

    PubMed 16269301
  • Sharma OP, Oswanski MF, Jolly S, Lauer SK, Dressel R, Stombaugh HA. Perils of rib fractures. Am Surg. 2008 Apr;74(4):310-4. doi: 10.1177/000313480807400406.

    PubMed 18453294
  • Marasco S, Lee G, Summerhayes R, Fitzgerald M, Bailey M. Quality of life after major trauma with multiple rib fractures. Injury. 2015 Jan;46(1):61-5. doi: 10.1016/j.injury.2014.06.014. Epub 2014 Jun 21.

    PubMed 25069400
  • Fabricant L, Ham B, Mullins R, Mayberry J. Prolonged pain and disability are common after rib fractures. Am J Surg. 2013 May;205(5):511-5; discusssion 515-6. doi: 10.1016/j.amjsurg.2012.12.007.

    PubMed 23592156
  • Gordy S, Fabricant L, Ham B, Mullins R, Mayberry J. The contribution of rib fractures to chronic pain and disability. Am J Surg. 2014 May;207(5):659-62; discussion 662-3. doi: 10.1016/j.amjsurg.2013.12.012. Epub 2014 Jan 31.

    PubMed 24612969
  • Holcomb JB, McMullin NR, Kozar RA, Lygas MH, Moore FA. Morbidity from rib fractures increases after age 45. J Am Coll Surg. 2003 Apr;196(4):549-55. doi: 10.1016/S1072-7515(02)01894-X.

    PubMed 12691929
  • Stawicki SP, Grossman MD, Hoey BA, Miller DL, Reed JF 3rd. Rib fractures in the elderly: a marker of injury severity. J Am Geriatr Soc. 2004 May;52(5):805-8. doi: 10.1111/j.1532-5415.2004.52223.x.

    PubMed 15086666
  • Bulger EM, Arneson MA, Mock CN, Jurkovich GJ. Rib fractures in the elderly. J Trauma. 2000 Jun;48(6):1040-6; discussion 1046-7. doi: 10.1097/00005373-200006000-00007.

    PubMed 10866248
  • Liman ST, Kuzucu A, Tastepe AI, Ulasan GN, Topcu S. Chest injury due to blunt trauma. Eur J Cardiothorac Surg. 2003 Mar;23(3):374-8. doi: 10.1016/s1010-7940(02)00813-8.

    PubMed 12614809
  • Van Vledder MG, Kwakernaak V, Hagenaars T, Van Lieshout EMM, Verhofstad MHJ; South West Netherlands Trauma Region Study Group. Patterns of injury and outcomes in the elderly patient with rib fractures: a multicenter observational study. Eur J Trauma Emerg Surg. 2019 Aug;45(4):575-583. doi: 10.1007/s00068-018-0969-9. Epub 2018 Jun 15.

    PubMed 29905897
  • Witt CE, Bulger EM. Comprehensive approach to the management of the patient with multiple rib fractures: a review and introduction of a bundled rib fracture management protocol. Trauma Surg Acute Care Open. 2017 Jan 5;2(1):e000064. doi: 10.1136/tsaco-2016-000064. eCollection 2017.

    PubMed 29766081
  • Todd SR, McNally MM, Holcomb JB, Kozar RA, Kao LS, Gonzalez EA, Cocanour CS, Vercruysse GA, Lygas MH, Brasseaux BK, Moore FA. A multidisciplinary clinical pathway decreases rib fracture-associated infectious morbidity and mortality in high-risk trauma patients. Am J Surg. 2006 Dec;192(6):806-11. doi: 10.1016/j.amjsurg.2006.08.048.

    PubMed 17161098
  • de Jong MB, Kokke MC, Hietbrink F, Leenen LP. Surgical Management of Rib Fractures: Strategies and Literature Review. Scand J Surg. 2014 Jun;103(2):120-125. doi: 10.1177/1457496914531928. Epub 2014 Apr 29.

    PubMed 24782038
  • Shi HH, Esquivel M, Staudenmayer KL, Spain DA. Effects of mechanism of injury and patient age on outcomes in geriatric rib fracture patients. Trauma Surg Acute Care Open. 2017 Mar 16;2(1):e000074. doi: 10.1136/tsaco-2016-000074. eCollection 2017.

    PubMed 29766084

Questions about this trial

What is this clinical trial studying?

A study testing Cryoneurolysis in people with Rib Fractures, run by Stanford University at 1 site in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 3 inclusion and 7 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 27 Mar 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

Yes. Results are posted in the registry (first posted 27 Mar 2026). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Acute Pain Assessed by Numeric Pain Score (time frame: Hospital discharge (up to 1 month)). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT04482582, which also lists 38 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 27 Mar 2026.

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