Intensive Cryotherapy in the Emergency Department for Acute Musculoskeletal Injuries
Condition: Pain; Opiate; Emergency
MeSH terms: Emergencies
Study type: Interventional

Summary: 
      Acute musculoskeletal (MSK) injuries, including strains, sprains or contusions, are a common
      reason patients seek emergency care. Pain control is an essential component of treatment.
      Within the orthopedic literature, there is robust body of research supporting the use of
      cryotherapy for post-operative patients and injured athletes. However, within the emergency
      department (ED), studies have been focused on pharmacologic analgesia. The absence of
      evidence on optimal method or impact of ice therapy for acute MSK injuries contributes to
      inconsistent practice patterns that may impede symptom control or increase narcotic usage.

      The specific aim of the ICED investigation is to evaluate the effectiveness of intensive
      cryotherapy for the treatment of pain due to acute MSK injuries treated in the ED. Secondary
      outcomes include length-of-stay (LOS), patient satisfaction, and narcotic usage.
    

Detailed description: 
      Background Acute musculoskeletal (MSK) injuries, including strains, sprains or contusions,
      are a common reason patients seek emergency care. Pain control is an essential component of
      treatment. Within the orthopedic literature, there is robust body of research supporting the
      use of cryotherapy for post-operative patients and injured athletes. However, within the
      emergency department (ED), studies have been focused on pharmacologic analgesia. The absence
      of evidence on optimal method or impact of ice therapy for acute MSK injuries contributes to
      inconsistent practice patterns that may impede symptom control or increase narcotic usage.

      Objectives The specific aim of the ICED investigation is to evaluate the effectiveness of
      intensive cryotherapy for the treatment of pain due to acute MSK injuries treated in the ED.
      Secondary outcomes include length-of-stay (LOS), and narcotic usage.

      Methods Adults younger than sixty-six years-old presenting to the ED with acute MSK pain are
      enrolled through a process of informed consent, unless one or more of the exclusion criteria
      are met. Crushed ice is double-bagged and applied at the site of injury, where it is wrapped
      in place for twenty minutes. Pain scores are measured using a visual analog scale (VAS) when
      the ice is applied, at 20 minutes and at 60 minutes. Treating physicians do not alter their
      management. Data on LOS and use of pharmacologic analgesics are obtained through chart
      review.

      Results Change in VAS will be analyzed with regression analysis and analysis of variance.
      Patients are grouped into categories of pharmacologic analgesic usage. Patient satisfaction
      scores and narcotic usage will be analyzed using a Chi Square test, while LOS data compared
      with an unpaired two-tailed t-test.
    

Intervention name(s): Intensive cryotherapy
Intervention type(s): Procedure
Intervention description(s): Application of ice inside a plastic bag wrapped to the patient's site of pain, and held in place for 20min.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Treatment