Efficacy of Percutaneous Vertebroplasty in the Treatment of Malignant and Benign Vertebral Fractures: Single-Center Experiences

Vas Score ◽

Transpedicular Approach ◽

Significant Difference ◽

Before And After ◽

The Mean

AbstractPercutaneous vertebroplasty (PVP) is a method used for vertebral stabilization and pain treatment. This study was performed to demonstrate the efficacy of PVP in treatment of malignant and benign vertebral compression fractures (VCFs). The study was conducted on 45 cases with a total of 106 VCFs. The mean age of the patients was 62.4 years (37–86 years). The vertebral fractures were classified according to Genant’s Classification. Pain was rated using the visual analog scale (VAS). VAS scores were recorded before and after PVP operations. A total of 58 vertebrae (54.8%) were treated via a bipedicular approach, and 48 vertebrae (45.2%) were treated via a unilateral transpedicular approach with the help of biplane imaging and under anesthesia. L1 vertebra (19.8%) fractures and Grade III fractures (46.3%) were more common. Vertebral collapse was the most common cause of malignancy (53.8%). The mean VAS score was measured to be 8.39 before the VP operations and 2.05 after the VP operations. The VAS score dropped to 2.3 through the unipedicular approach and to 1.84 through the bipedicular approach. The decrease in pain due to VP was statistically significant (p < 0.001). There was no statistically significant difference between the unipedicular and bipedicular approaches in terms of pain relief (p> 0.05). Some patients (18.8%) had complications. PVP is a highly therapeutic method for pain relief in case of pain secondary to malignant or benign vertebral fractures.

Comparison of the Effects of Diltiazem Gel with Lidocaine Gel on reducing pain and discomfort in Patients Undergoing Rectosigmoidoscopy: A Randomized double-blinded Clinical Trial

Current Drug Therapy ◽

10.2174/1574885516666210125112637 ◽

2021 ◽

Vol 16 ◽

Author(s):

Ahmad Hormati ◽

Mohammad Reza Ghadir ◽

Faezeh Alemi ◽

Seyyed Saeed Sarkeshikian ◽

Abolfazl Mohammadbeigi ◽

...

Keyword(s):

Clinical Trial ◽

Pain Relief ◽

T Test ◽

Analysis Of Covariance ◽

Lidocaine Group ◽

Vas Score ◽

Significant Difference ◽

Lidocaine Gel ◽

The Mean ◽

Double Blinded

Background: Flexible rectosigmoidoscopy is an easy and accessible exam to diagnose distal colon diseases, although many patients refuse undergoing it due to pain and discomfort during the procedure. Studies show that the application of local lidocaine, as an analgesic, has no effect on pain relief in patients undergoing rectosigmoidoscopy. The current study aimed at comparing the effects of diltiazem gel, an antispasmoic drug with local pain-reducing effects, with lidocaine gel in patients undergoing flexible rectosigmoidoscopy. Materials and Methods: The current double-blinded, randomized, clinical trial was performed to compare the effect of two topical drugs, lidocaine and diltiazem, on pain relief in patients undergoing rectosigmoidoscopy. A total of 80 patients who were potential candidates for rectosigmoidoscopy were enrolled in the study after obtaining the informed consent, and then randomly assigned to one of the lidocaine gel (2 mL) or diltiazem gel (2 mL) group, 10 minutes prior to rectosigmoidoscopy. The level of pain in the patients during the procedure was measured using the visual analogue scale (VAS) and the results were recorded. The data were analyzed using paired samples t-test and independent t-test as well as analysis of covariance (ANOVA) with SPSS version 18. P-value <0.05 was considered the level of significance. Results: Of 80 patients, 35 (43.75%) were male and 45 (56.25%) female. The mean age and body mass index (BMI) of the patients were 51.45 ± 15.21 years and 25.95 ± 7.47 kg/m2 , respectively, and there was no significant difference between the groups. The most frequent indications for rectosigmoidoscopy were abdominal pain (46.3%) and rectorrhagia (31.3%). The mean VAS score for pain reported by the patients in the lidocaine and diltiazem groups were 3.97 ± 2.89 and 2.60 ± 2.36, respectively. The VAS score for pain in the diltiazem group was significantly lower than of the lidocaine group (P = 0.023). Conclusion: The application of local diltiazem gel around the anus, in spite of no side effects, can effectively reduce the pain and discomfort in patients during rectosigmoidoscopy.

Comparison of Percutaneous Vertebroplasty and Percutaneous Curved Vertebroplasty for Osteoporotic Vertebral Compression Fractures: Distribution of Bone Cement and Complication

10.21203/rs.3.rs-136112/v1 ◽

2020 ◽

Author(s):

Li Fan Jie ◽

Li Yang ◽

Wang Yan Jie ◽

Du YiBin

Keyword(s):

Bone Cement ◽

Vertebral Fractures ◽

Osteoporotic Vertebral Compression Fractures ◽

Compression Fractures ◽

Anterior Edge ◽

Significant Difference ◽

Medical University

Abstract Purpose: To evaluate the clinical efficacy and complications of percutaneous curved vertebroplasty in treatment of osteoporotic vertebral compression fractures.Methods: Patients with single vertebral osteoporotic vertebral compression fractures were selected. The patients were divided into Percutaneous curved vertebroplasty group and Percutaneous vertebroplasty group.Distribution and leakage of bone cement and recovery of the height of the anterior edge of the injured vertebra were observed. VAS and ODI were assessed preoperatively 1 day and 1 year postoperatively. Postoperative follow-up was conducted for 1 year to observe the occurrence of adjacent vertebral fractures. The trial was approved by the Ethics Committee of the Third Affiliated Hospital of Anhui Medical University. Results: Compared with the percutaneous vertebroplasty group, distribution of bone cement was more uniform and satisfactory, the leakage rate of bone cement was lower in the percutaneous curved vertebroplasty group. Both the visual analogue scale score and Oswestry disability index of the two groups at 1 day and I year after surgery were significantly improved compared with those before surgery (P < 0.05). There was no significant difference in VAS and ODI. The height of the anterior edge of the injured vertebral body of the two groups improved significantly(P < 0.05), and there was no significant difference between the two groups . There was no significant difference in the incidence of adjacent vertebral fractures between the two groups..Conclusion: The results show that PCVP has beneficial to the uniform distribution of bone cement in the fracture vertebrae and reduce the leakage of bone cement.

Does Percutaneous Vertebroplasty or Balloon Kyphoplasty for Osteoporotic Vertebral Compression Fractures Increase the Incidence of New Vertebral Fractures? A Meta-Analysis

January 2018 - Pain Physician ◽

10.36076/ppj.2017.1.e13 ◽

2017 ◽

Vol 1 (21;1) ◽

pp. E13-E28 ◽

Cited By ~ 40

Author(s):

Tao Zhang

Keyword(s):

Vertebral Fractures ◽

Meta Analysis ◽

Balloon Kyphoplasty ◽

Osteoporotic Vertebral Compression Fractures ◽

Inclusion Criteria ◽

Compression Fractures ◽

Osteoporotic Vertebral Fractures ◽

Significant Difference

Background: Because of an aging population,osteoporotic vertebral fractures are becoming more frequent. Conservative therapy was considered the gold standard for treating osteoporotic vertebral compression fractures (OVCFs) in the past. Percutaneous vertebroplasty (PVP) or balloon kyphoplasty (BKP) as minimally invasive techniques are new treatments that arewidely used for painful OVCFs. However, an increase in new vertebral compression fractures at non-treated levels following augmentation is of concern. There is no convincing evidence that new fractures are inevitable after augmentation compared to after conservative treatment, and it is still unclear whether further fractures are the consequence of augmentation ora result of the natural progression of osteoporosis. Objective: The objective of this study was to evaluate the new-level fracture risk after PVP or BKP compared with conservative (non-operative) treatment and to determine the dominant risk factor associated with new OVCFs. Study Design: A meta-analysis of comparative studies was performed to evaluate the incidence of new vertebral fractures between vertebral augmentation, such as vertebroplasty and kyphoplasty, and no operation. Setting: The PubMed,ISI Web of Science, ELSEVIER ScienceDirect, and Cochrane Library databases and abstracts published in annual proceedings were systematically searched.In addition, we also retrieved data from references when titles met our inclusion criteria. Methods: Detailed searches of a number of online databases comparing operative and non-operative groups were performed. We included randomized controlled trials,clinical controlled trials,and prospective clinical studies to provide available data. All studies were reviewed by 2 reviewers independently, and all the references that met our inclusion criteria were searched for additional trials, using the guidelines set by the QUOROM (Quality of Reporting of Meta-analysis) statement. Results: We evaluated 12 studies encompassing 1,328 patients in total,including 768 who underwent operation with polymethylmethacrylateand 560 who received non-operative treatments. For new-level vertebral fractures, our meta-analysis found no significant difference between the 2 methods, including total new fractures (P = 0.55) and adjacent fractures (P = 0.5).For pre-existing vertebral fractures, there was no significant difference between the 2 groups (operative and non-operative groups) (P = 0.24). Additionally,there was no significant difference in bone mineral density, both in the lumbar (P = 0 .13) and femoral neck regions (P = 0.37), between the 2 interventions. Limitation: All studies we screened were published online except for unpublished articles. Moreover, only a few data sources could be extracted from the published studies. There were only 5 randomized clinical trials and 7 prospective studies that met our inclusion criteria. Conclusion: Vertebral augmentation techniques, such as vertebroplasty and kyphoplasty, have been widely used to treat osteoporotic vertebral fractures in order to alleviate back pain and correct the deformity, and it has been frequently reported that many new vertebral fractures occurred after this operation. Our analysis did not reveal evidence of an increased risk of fracture of vertebral bodies, especially those adjacent to the treated vertebrae, following augmentation with either method compared with conservative treatment. Key words: Vertebroplasty, kyphoplasty, new osteoporotic compression vertebral fracture, meta-analysis

UNILATERAL PERCUTANEOUS VERTEBROPLASTY FOR SYMPTOMATIC OSTEOPOROTIC VERTEBRAL COMPRESSION FRACTURES -EVALUATION OF RADIOLOGICAL AND CLINICAL OUTCOMES

10.36106/ijsr/1033481 ◽

2021 ◽

pp. 1-2

Author(s):

Sandeep Kumar ◽

Kumari Rashmi ◽

Kumar Anshuman ◽

Debarshi Jana

Keyword(s):

Vertebral Fractures ◽

Local Anaesthesia ◽

Compression Fracture ◽

Osteoporotic Fractures ◽

Early Mobilization ◽

Vas Score ◽

Osteoporotic Vertebral Fractures

Background: Vertebral fractures are the most common type of osteoporotic fractures. These are developing into a significant health problem worldwide as about 30% of the patients above 50 years suffer from a fracture secondary to osteoporosis. Osteoporotic vertebral fractures may be treated with rest and analgesics. Some fractures may also require surgery. Percutaneous procedure like vertebroplasty and kyphoplasty done under local anaesthesia can reduce the pain and restore height of vertebral body without need for an open surgery. The aim of the study was to assess the clinical and radiological outcomes following unilateral percutaneous vertebroplasty under local anaesthesia. Methods: 21 patients who underwent unilateral vertebroplasty for symptomatic osteoporotic compression fracture between August 2019 and July 2020 were included in the study. Unilateral vertebroplasty using an 11-gauge trocar through transpedicular technique was performed under c-arm guidance. Patient was mobilized as soon as tolerated. Oswestry disability index and visual analogue scale were assessed pre-operatively, in the immediate post-op and at 1-year follow up. Results: There were 15 females and 6 males. The mean age was 70.04±6.07 years. The pre-op ODI score was 76.8±7.6. The pre-op VAS score was 7.66±0.71. The average time period from fracture to vertebroplasty is 4.19±3.19 days. The immediate post-operative VAS score was 5.76±0.8 and the ODI score was 62.85±7.17. The VAS at final follow up was 1.23±1.19. ODI at final follow up was 9.04±3.19. There was a showed a significant improvement when preoperative, immediate post-operative ODI and VAS scores and final follow up (p<0.001). Conclusions: In our study unilateral percutaneous vertebroplasty has provided pain relief, early mobilization of the patient with less complication without the requirement of general anaesthesia.

Unilateral percutaneous vertebroplasty for symptomatic osteoporotic vertebral compression fractures -evaluation of radiological and clinical outcomes

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20185328 ◽

2018 ◽

Vol 5 (1) ◽

pp. 19

Author(s):

Shanmuga Sundaram Pooswamy ◽

Niranjanan Raghavn Muralidharagopalan

Keyword(s):

Vertebral Fractures ◽

Local Anaesthesia ◽

Compression Fracture ◽

Osteoporotic Fractures ◽

Early Mobilization ◽

Vas Score ◽

Osteoporotic Vertebral Fractures

Background: Vertebral fractures are the most common type of osteoporotic fractures. These are developing into a significant health problem worldwide as about 30% of the patients above 50 years suffer from a fracture secondary to osteoporosis. Osteoporotic vertebral fractures may be treated with rest and analgesics. Some fractures may also require surgery. Percutaneous procedure like vertebroplasty and kyphoplasty done under local anaesthesia can reduce the pain and restore height of vertebral body without need for an open surgery. The aim of the study was to assess the clinical and radiological outcomes following unilateral percutaneous vertebroplasty under local anaesthesia.Methods: 21 patients who underwent unilateral vertebroplasty for symptomatic osteoporotic compression fracture between 2012 and 2015 were included in the study. Unilateral vertebroplasty using an 11-gauge trocar through transpedicular technique was performed under c-arm guidance. Patient was mobilized as soon as tolerated. Oswestry disability index and visual analogue scale were assessed pre-operatively, in the immediate post-op and at 1-year follow up.Results: There were 15 females and 6 males. The mean age was 70.04±6.07 years. The pre-op ODI score was 76.8±7.6. The pre-op VAS score was 7.66±0.71. The average time period from fracture to vertebroplasty is 4.19±3.19 days. The immediate post-operative VAS score was 5.76±0.8 and the ODI score was 62.85±7.17. The VAS at final follow up was 1.23±1.19. ODI at final follow up was 9.04±3.19. There was a showed a significant improvement when preoperative, immediate post-operative ODI and VAS scores and final follow up (p<0.001).Conclusions: In our study unilateral percutaneous vertebroplasty has provided pain relief, early mobilization of the patient with less complication without the requirement of general anaesthesia.

Surgery to relieve nasal obstruction: outcome for 366 patients operated on by one senior surgeon

European Archives of Oto-Rhino-Laryngology ◽

10.1007/s00405-021-06696-7 ◽

2021 ◽

Author(s):

Lars Aksel Pedersen ◽

S. Dölvik ◽

K. Holmberg ◽

C. Ahlström Emanuelsson ◽

H. Johansson ◽

...

Keyword(s):

Beneficial Effect ◽

Nasal Obstruction ◽

General Health ◽

Surgical Skills ◽

Nasal Endoscopy ◽

Experienced Surgeon ◽

Senior Surgeon ◽

Significant Difference ◽

Before And After ◽

The Mean

Abstract Background Studies of patient-rated outcome in septoplasty and turbinoplasty most frequently involve several surgeons with varying surgical skills, techniques and experience. The aim of the present study was to evaluate outcome based on one experienced surgeon. Methods Three hundred and sixty-six consecutive patients referred for nasal obstruction were included. All the patients were examined with nasal endoscopy before and after decongestion, they filled out a nose VAS and rated their overall general health before and three to six months after surgery. The patients underwent septoplasty, septoplasty plus turbinoplasty or turbinoplasty. Results The mean nose VAS for nasal obstruction (0–100) preoperatively was 64.7 for all patients. Patients undergoing septoplasty (n = 159) were younger than patients undergoing septoplasty + turbinoplasty (n = 79) or patients undergoing turbinoplasty alone (n = 128). The nose VAS for nasal obstruction improved significantly in all three groups and 25% had a normal nose VAS after surgery in the septoplasty and septoplasty + turbinoplasty groups compared to only 8% in the turbinoplasty alone group. There was no significant difference in the improvement in nasal obstruction between septoplasty and septoplasty + turbinoplasty, but the septoplasty + turbinoplasty group experienced a significantly greater improvement in general health. Conclusions In 366 patients operated on by one experienced surgeon, septoplasty and septoplasty + turbinoplasty were more effective at relieving nasal obstruction than turbinoplasty alone. Septoplasty + turbinoplasty resulted in a greater improvement in general health than septoplasty alone, despite the same improvement in nasal obstruction, indicating a beneficial effect of additional turbinoplasty in septoplasty.

Quality of life of obstetrics fistula patients before and after surgical repair in the Jimma University Medical Center, Southwest Ethiopia

BMC Women s Health ◽

10.1186/s12905-021-01360-y ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Tilahun Fufa Debela ◽

Zerihun Asefa Hordofa ◽

Aster Berhe Aregawi ◽

Demisew Amenu Sori

Keyword(s):

Quality Of Life ◽

Surgical Repair ◽

Obstetric Fistula ◽

Medical Center ◽

Mean Value ◽

Significant Difference ◽

Before And After ◽

The Mean ◽

Jimma University

Abstract Background The consequences of obstetric fistula on affected women are more than the medical condition. It has extensive physical, psychological, social, and economic consequences on them. Obstetric fistula affects the entire health and entire life of women. Women suffering from obstetric fistula are often abandoned by her partner, relatives, and the community. This study aimed to determine the quality of life of obstetrics fistula patients before and after surgical repair. Methods Institutional-based prospective, before and after study design was conducted in the Jimma University Medical Center from November 1, 2019–October 30, 2020. A face-to-face interview was conducted with fistula patients who visited Jimma University Medical center, fistula clinic during the study period. All fistula patients were included in the study. Accordingly, 78 women who underwent surgical repair were interviewed. The means and the standard deviation were computed using conventional statistics formulas. The unpaired t-test was used to compare two independent means, and one-way analysis of variance (ANOVA) was used to compare the quality of life before repair and after a successful repair. Linear regression analysis was done for identifying determinants of quality of life. A P value of 0.05 will be considered statistical significance. Result The overall quality of life of women was 58.17 ± 7.2 before the surgical repair and 71.20 ± 10.79 after surgical repair. The result indicates there is a significant difference in the mean value of pre and post-operative (P < 0.001). The overall satisfaction of women with their health status before the surgical repair was 22.5 ± 1.30and it has increased to 53.0 ± .90after surgical repair. The physical health dimension score was 16.51 ± 5.27 before the surgical repair while it has increased to 21.77 ± 5.38 after the surgical repair. The score of the social domain before the surgical repair was 5.19 ± 1.34 and it has increased to 7.13 ± 3.67 after the surgical repair. The score of the environmental health domain was 17.41 ± 2.89 before the surgery while it also increased to 21.65 ± 4.04 after the surgical repair. The results have shown there was a significant difference in the mean values of pre and post-operatives in both social and environmental scores (P < 0.001). The score of the psychological health domain before the surgery was 19.06 ± 1.46 and it was increased to 19.84 ± 3.21 after the surgical repair. The result showed there is a significant difference in mean value pre and post-operative (P = 0.048), though it is a slight improvement compared to other domains. Conclusion The overall quality of life of the patient with fistula was improved after successful surgical repair. Although all domains of quality of life had shown significant improvement after successful surgical repair, the psychological domain showed slight improvement.

SECRETION OF DIHYDROTESTOSTERONE BY HUMAN PROSTATE IN BENIGN PROSTATIC HYPERTROPHY

Acta Endocrinologica ◽

10.1530/acta.0.0770401 ◽

1974 ◽

Vol 77 (2) ◽

pp. 401-407 ◽

Cited By ~ 18

Author(s):

J. A. Mahoudeau ◽

A. Delassalle ◽

H. Bricaire

Keyword(s):

Plasma Levels ◽

Benign Prostatic Hypertrophy ◽

Prostatic Hypertrophy ◽

Human Prostate ◽

Control Subjects ◽

Peripheral Plasma ◽

Significant Difference ◽

Before And After ◽

The Mean ◽

And Control

ABSTRACT Plasma levels of testosterone (T) and 5α-dihydrotestosterone (DHT) were determined by radioimmunoassay in 29 patients with benign prostatic hypertrophy (BPH) and in 56 control men of various ages. No significant difference was found in T, DHT nor DHT/T ratio between BPH and control subjects of similar age. Plasma DHT was higher in the prostatic than in the peripheral veins in 8/9 patients with BPH during laparotomy, indicating a prostatic secretion of DHT. No difference in the mean T nor the mean DHT was found in peripheral plasma before and after adenomectomy.

Influence of Apical Patency and Cleaning of the Apical Foramen on Periapical Extrusion in Retreatment

Brazilian Dental Journal ◽

10.1590/0103-6440201302016 ◽

2013 ◽

Vol 24 (5) ◽

pp. 482-486 ◽

Cited By ~ 5

Author(s):

Marili Doro Andrade Deonizio ◽

Gilson Blitzkow Sydney ◽

Antonio Batista ◽

Roberto Pontarolo ◽

Paulo Ricardo Bittencourt Guimarães ◽

...

Keyword(s):

Material Removal ◽

Filling Material ◽

Mean Values ◽

Filtration System ◽

Root Canal Retreatment ◽

Significant Difference ◽

Before And After ◽

The Mean ◽

The Difference ◽

Removal Technique

This study evaluated the influence of apical patency, root filling removal technique and cleaning of the apical foramen, concerning the amount of debris extruded during root canal retreatment. Forty mandibular incisors were randomly assigned to 4 groups - GIM (n=10), GIIM (n=10), GIPT (n=10) and GIIPT (n=10), which were named according to leaving (I) or not (II) apical patency during canal preparation and filling removal technique (manual - M or ProTaper system - PT). After filling material removal, each specimen of each group had the apical foramen cleaned by sizes 15, 20 and 25 instruments, generating 12 subgroups: GIM15, GIM20, GIM25, GIIM15, GIIM20, GIIM25, GIPT15, GIPT20, GIPT25, GIIPT15, GIIPT20 and GIIPT25. Extruded filling debris was collected by a Milipore filtration system, an HV-durapore, 0.45 µm pore filter with a 25 mm diameter. The filters were weighed before and after the collection on an analytical scale (10–5 g), and the difference was calculated. The mean weight of extruded filling debris was analyzed statistically by Kruskal-Wallis and Friedman ANOVA tests (α=0.05). The mean values found in the groups (in mg) were: GIM (0.95±0.94), GIIM (0.47±0.62), GIPT (0.30±0.31) and GIIPT (0.32±0.44). There was no statistically significant difference among any of the groups or subgroups (p>0.05). ProTaper provided the smallest amount of extruded filling material, regardless of presence or absence of apical patency, followed by manual technique, without and with apical patency. Additional amounts of debris were collected during cleaning of the apical foramen, regardless of the instrument, presence/absence of patency or root filling removal technique.

Effect of COVID-19 outbreak on emergency department attendances in an Italian academic hospital

European Journal of Public Health ◽

10.1093/eurpub/ckaa165.207 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

M Poletto ◽

G Perri ◽

F Malacarne ◽

B Bianchet ◽

A Doimo ◽

...

Keyword(s):

Emergency Department ◽

Initial Phase ◽

Mainland China ◽

Hospital Setting ◽

Academic Hospital ◽

Significant Difference ◽

Before And After ◽

Life Threatening ◽

The Mean ◽

Critical Patients

Abstract Background Coronavirus disease 2019 (COVID-19) is a viral infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The disease was discovered during the 2019 outbreak in Mainland China and the first cases were reported in Italy on February 21, 2020. This study evaluates the emergency department (ED) attendances of an academic hospital in northern Italy before and after media reported the news of the first infected patients in Italy. Methods Adult attendances in ED in February 2020 were analysed dividing the period into 4 weeks (days 1-7, 8-14, 15-21, 22-28) compared with the same periods in 2019. The visits were analysed separately according to the Italian colour code of triage: white (non-critical), green (low-critical), yellow (medium critical), red (life-threatening). The mean weekly number of attendances was compared with t-test. Results February 2020 total ED attendances compared with February 2019 were 4865 vs 5029 (-3.3%), of which white codes were 834 vs 762 (+9.4%), green 2450 vs 2580 (-5.0%), yellow 1427 vs 1536 (-7.1%), red 154 vs 151 (+2.0%). February 2020 weekly mean ED attendances compared with February 2019 had statistically significant difference only in the fourth week (days 22-28) for green codes (75 vs 92, p = 0.007) and yellow codes (41 vs 52, p = 0.047), not for white (27 vs 26, p = 0.760) and red codes (5 vs 5, p = 0.817). The first three weeks of February 2020 compared with 2019 showed no statistically significant difference in weekly mean ED attendances. Conclusions There was a significant reduction of green and yellow codes attendances at ED in the fourth week of February 2020, corresponding to the initial phase of Italian COVID-19 outbreak. The fear of contracting SARS-CoV-2 by attending the ED probably acted as a significant deterrent in visits, especially for low and medium critical patients. Additional data are required to better understand the phenomenon, including the behaviour of non-critical attendances. Key messages A reduction of green and yellow codes attendances was reported during initial phase of COVID-19 outbreak in an Italian academic hospital. Fear of contracting COVID-19 infection in a hospital setting could impact on emergency department attendances.