1
|
Sorotzky M, Raphael A, Breuer A, Odeh M, Gillis R, Gillis M, Shibli R, Fiszlinski J, Algur N, Magen S, Megged O, Schlesinger Y, Mendelovich J, Weiser G, Berliner E, Barak-Corren Y, Heiman E. Jerusalem's CoVID-19 Experience-The Effect of Ethnicity on Disease Prevalence and Adherence to Testing. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-01965-7. [PMID: 38457104 DOI: 10.1007/s40615-024-01965-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 02/22/2024] [Accepted: 03/01/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND The management of the SARS-CoV-2 pandemic depends amongst other factors on disease prevalence in the general population. The gap between the true rate of infection and the detected rate of infection may vary, especially between sub-groups of the population. Identifying subpopulations with high rates of undetected infection can guide authorities to direct resource distribution in order to improve health equity. METHODS A cross-sectional epidemiological survey was conducted between April and July 2021 in the Pediatric Emergency Department of the Shaare Zedek Medical Center, Jerusalem, Israel. We compared three categories: unconfirmed disease (UD), positive serology test result with no history of positive PCR; confirmed disease (CD), history of a positive PCR test result, regardless of serology test result; and no disease (ND), negative serology and no history of PCR. These categories were applied to local prevailing subpopulations: ultra-orthodox Jews (UO), National Religious Jews (NRJ), secular Jews (SJ), and Muslim Arabs (MA). RESULTS Comparing the different subpopulations groups, MAs and UOs had the greatest rate of confirmed or unconfirmed disease. MA had the highest rate of UD and UO had the highest rate of CD. UD significantly correlated with ethnicity, with a low prevalence in NRJ and SJ. UD was also associated with larger family size and housing density defined as family size per number of rooms. CONCLUSION This study highlights the effect of ethnicity on disease burden. These findings should serve to heighten awareness to disease burden in weaker populations and direct a suitable prevention program to each subpopulation's needs. Early awareness and possible intervention may lower morbidity and mortality.
Collapse
Affiliation(s)
- Michael Sorotzky
- Department of Pediatrics, Shaare Zedek Medical Center, 12 Shmuel Bait St, PO Box 3235, 9103102, Jerusalem, Israel.
| | - Allon Raphael
- Department of Pediatrics, Shaare Zedek Medical Center, 12 Shmuel Bait St, PO Box 3235, 9103102, Jerusalem, Israel
| | - Adin Breuer
- Department of Pediatrics, Shaare Zedek Medical Center, 12 Shmuel Bait St, PO Box 3235, 9103102, Jerusalem, Israel
| | - Ma'aran Odeh
- Department of Pediatrics, Shaare Zedek Medical Center, 12 Shmuel Bait St, PO Box 3235, 9103102, Jerusalem, Israel
| | - Roni Gillis
- Department of Pediatrics, Shaare Zedek Medical Center, 12 Shmuel Bait St, PO Box 3235, 9103102, Jerusalem, Israel
| | - Michal Gillis
- Department of Pediatrics, Shaare Zedek Medical Center, 12 Shmuel Bait St, PO Box 3235, 9103102, Jerusalem, Israel
| | - Roaia Shibli
- Department of Pediatrics, Shaare Zedek Medical Center, 12 Shmuel Bait St, PO Box 3235, 9103102, Jerusalem, Israel
| | - Judith Fiszlinski
- Department of Pediatrics, Shaare Zedek Medical Center, 12 Shmuel Bait St, PO Box 3235, 9103102, Jerusalem, Israel
| | - Nurit Algur
- Clinical Endocrinology Laboratory, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Sophie Magen
- Clinical Endocrinology Laboratory, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Orli Megged
- Department of Pediatrics, Shaare Zedek Medical Center, 12 Shmuel Bait St, PO Box 3235, 9103102, Jerusalem, Israel
- Pediatric Infectious Diseases Unit, Shaare Zedek Medical Center, Jerusalem, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Yechiel Schlesinger
- Department of Pediatrics, Shaare Zedek Medical Center, 12 Shmuel Bait St, PO Box 3235, 9103102, Jerusalem, Israel
- Pediatric Infectious Diseases Unit, Shaare Zedek Medical Center, Jerusalem, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Joseph Mendelovich
- Department of Pediatrics, Shaare Zedek Medical Center, 12 Shmuel Bait St, PO Box 3235, 9103102, Jerusalem, Israel
- Pediatric Emergency Department, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Giora Weiser
- Department of Pediatrics, Shaare Zedek Medical Center, 12 Shmuel Bait St, PO Box 3235, 9103102, Jerusalem, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- Pediatric Emergency Department, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Elihay Berliner
- Department of Pediatrics, Shaare Zedek Medical Center, 12 Shmuel Bait St, PO Box 3235, 9103102, Jerusalem, Israel
- Pediatric Emergency Department, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Yuval Barak-Corren
- Department of Pediatrics, Shaare Zedek Medical Center, 12 Shmuel Bait St, PO Box 3235, 9103102, Jerusalem, Israel
- Predictive Medicine Group, Boston Children's Hospital, Boston, USA
| | - Eyal Heiman
- Department of Pediatrics, Shaare Zedek Medical Center, 12 Shmuel Bait St, PO Box 3235, 9103102, Jerusalem, Israel
- Pediatric Emergency Department, Shaare Zedek Medical Center, Jerusalem, Israel
| |
Collapse
|
2
|
Sorotzky M, Shahar-Nissan K, Shack AR, Berant R, Weiser G, Berliner E, Heiman E. Management of intraorbital infections in the pediatric emergency department. Eur J Pediatr 2022; 181:2741-2746. [PMID: 35476291 DOI: 10.1007/s00431-022-04468-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 03/04/2022] [Accepted: 04/05/2022] [Indexed: 11/28/2022]
Abstract
UNLABELLED Intraorbital infections may lead to severe complications, necessitating rapid diagnosis and intervention. The decision process regarding the need for emergent imaging and possible surgical intervention is unclear in the literature. This retrospective cohort study included two major pediatric emergency departments in Israel between 2010 and 2020. Patients arriving at the emergency department with an admission diagnosis of intraorbital infection and at least one high-risk symptom for orbital involvement were included in the study. The main outcome measures were the computerized tomography (CT) timing and results, whether the case was managed surgically or conservatively and whether the patient returned to the same hospital with significant complications. Ninety-five patients were included; 70 underwent a CT scan in the first 24 h, and of those 21 were managed surgically; 16 were treated based on clinical findings alone, with no imaging performed. When comparing groups based on management, we found no significant differences based on presenting symptoms, duration of complaints, or severity of CT findings. However, having three or more high-risk presenting symptoms was associated with a greater likelihood of surgical intervention (multivariate logistic regression p = 0.069, odds ratio 1.73, 95% confidence interval 0.96-3.11; one-way ANOVA and Fisher's exact test p < 0.05). CONCLUSION The decision to treat intraorbital infections at our institutions appears to be based on clinical impression of disease severity rather than radiologic findings. This suggests a need for further interdisciplinary studies to clarify optimal management. WHAT IS KNOWN • Orbital c ellulitis is associated with significant potential complications, necessitating rapid diagnosis and treatment. • Present literature provides insufficiently clear guidance on emergency department management. WHAT IS NEW • Consideration of all relevant factors (clinical features, laboratory findings, timing of imaging, and conservative vs. surgical management) in a single retrospective cohort. • Our findings suggest that decision-making in practice may be guided by clinical impression rather than imaging.
Collapse
Affiliation(s)
- Michael Sorotzky
- Department of Pediatrics, Wilf Children's Hospital, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Keren Shahar-Nissan
- Pediatric Emergency Department, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Avram R Shack
- Department of Pediatrics, Wilf Children's Hospital, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Ron Berant
- Pediatric Emergency Department, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Giora Weiser
- Pediatric Emergency Department, Wilf Children's Hospital, Shaare Zedek Medical Center, 12 Shmuel Bait Street, 9103102, Jerusalem, Israel.,Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Elihay Berliner
- Pediatric Emergency Department, Wilf Children's Hospital, Shaare Zedek Medical Center, 12 Shmuel Bait Street, 9103102, Jerusalem, Israel.,Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Eyal Heiman
- Pediatric Emergency Department, Wilf Children's Hospital, Shaare Zedek Medical Center, 12 Shmuel Bait Street, 9103102, Jerusalem, Israel. .,Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
| |
Collapse
|