Background Computed Tomographic (CT) scanning of the head can detect acute intracranial injury and help to identify patients requiring neurosurgical intervention. The inappropriate utilization of CT scan strains meagre imaging resources especially in resource-constrained settings and risks the patients to unnecessary radiation. The Canadian CT head rule (CCHR) is a validated clinical tool used to predict mild head injury patients that will have a clinically significant intracranial injury on head CT scan. This reduces the number of requested CT scans while at the same time ensuring that those who would benefit from it are easily identified. However, this tool has not been previously applied in many low income settings where it would be very useful. Objective To determine the appropriateness of head CT scans performed among patients with mild traumatic head injury based on the Canadian CT head rule (CCHR). Methods This was a cross sectional study conducted at the emergency department of Mulago Hospital involving 259 adults clinically diagnosed with mild head injury with a head CT scan performed. They were assessed using the CCHR for a prediction of whether a head CT scan was appropriate or inappropriate. The proportion of appropriate head CT scans was obtained. The participants were followed up to assess their health status. Results The common abnormal CT scan findings were comminuted and depressed skull fractures. The proportion of appropriate head CT scans performed based on the CCHR was 70.7%. Most participants with positive CT scan findings were classified as appropriate when the CCHR was applied. 81.6% (n = 62) of the participants whose CT scans were classified as inappropriate had normal findings. There was a statistically significant association between categories of CCHR classification (appropriate vs inappropriate) and CT scan findings (normal vs neurologically insignificant). Conclusion About one-third of head CT scans performed in this study were inappropriate by applying the CCHR. Avoidance of CT scan in such patients is unlikely to miss any important injuries. Findings from the study can guide the adoption and adaptation of CCHR use in emergency departments.

Background Carotid Atherosclerotic Disease (CAD) Doppler findings including carotid artery stenosis, thickened intima media thickness, and high-risk atherosclerotic plaques are associated with increased risk of stroke and symptomatic cerebrovascular disease. However, few studies have explored these Doppler characteristics among stroke patients in Africa. This study, therefore, investigates these carotid artery Doppler characteristics among stroke patients in Uganda.Methods A hospital-based cross-sectional study of 95 stroke patients attending two national referral hospitals in Uganda between March and July 2022. Following the caption of their sociodemographic and clinical characteristics, they underwent Doppler sonography of the extracranial carotid arteries using a standard carotid Doppler protocol. Multivariate logistic regression was used to determine factors associated with abnormal carotid Doppler parameters (i.e., carotid intima-media thickness, carotid stenosis).Results The mean age of the study participants was 61 ± 13 years with 60% (57/95) of the participants being male. Most participants had an ischemic stroke (67%), hypertension (76.4%), and used alcohol (58.9%). The prevalence of significant carotid stenosis in participants with ischemic stroke was 12.5% (8/64) (i.e., 7.8% had severe carotid stenosis and 4.7% had moderate stenosis). The prevalence of high carotid intima media thickness (CIMT) and atherosclerotic plaques were 31.6% (30/95) and 26.3% (25/95), respectively. Most atherosclerotic plaques were echogenic. Age above 60 years (adjusted odds ratio [aOR] = 5.2, 95% Confidence Interval [CI]:1.97-14; p < 0.010), high low-density lipoprotein cholesterol (aOR = 4.2, 95% CI: 1.29–8.79; p = 0.013) increased the likelihood of having abnormal CIMT.Conclusion The burden of carotid atherosclerotic disease is increasing among stroke patients in Uganda. Large-scale epidemiological studies are needed to further profile the disease in high risk populations.

Background The advances in diagnostic technology such as the Helical Multi-Detector Computed Tomography (MDCT) have improved the outcome of several diseases, especially in emergencies and children. However, the upsurge in utilization is associated with global unjustified CT procedures, 10-30% of which are performed among children. MDCT imparts relatively high radiation doses with increased risk of radiation induced cancers and wastage of imaging resources. This is a radiation and public health concern in low resource setting especially sub-Saharan Africa, which has a youthful population. Quality improvement in medical imaging requires measuring compliance of imaging-referrers’ ordering practice behavior against an evidence-based tool such as clinical imaging guidelines. To the best of our knowledge, there is paucity of such studies in the sub-Saharan Africa. This study therefore aimed at determining the frequency and proportion of inappropriate requisitions for commonly performed CT examinations among children and young adults. Methods This was a retrospective review for CT requisition forms (CTRFs) for patients aged 35 years and below from 6 hospital-based CT units performed from 1st July 2018 to 31st December 2018. The level of appropriateness for each request was determined using the online Appropriate Use Criteria (AUC)” ESR iGuide Results A total of 931 CTRFs were assessed, 80% of which were head CT scans. Overall, 34.5% CTRFS were inappropriate. Inappropriate Ct requisition was significant associated with the category of hospital, age, non-trauma indication, the anatomical scan region, and the non- use of contrast media agent. A total of 40(4.3%) CTRFs were not categorized because of insufficient clinical information Conclusions The findings show significant levels of performed CT procedures, especially for head region, non-traumatic and non-contrasted among adult patients could be avoided or replaced by procedures that use less or non-ionizing radiation. What is now needed is a pilot study (ies) to investigate causes of inappropriate use of diagnostic imaging and evaluate the effects of some strategies such as education, training and the use of CIGs on such clinical practices in low resource setting