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Overuse of head CT scans in non-traumatic paediatric cases in the West Bank, Palestine: a cross-sectional study

Por: Hamad · S. · Ahmad · Y. · Saymeh · A. A. A. · Ghanayim · M. · Taha · S. · Alawneh · M. · Alawneh · M. · Damiri · B.
Background

Overuse of CT scans is associated with multiple harms, such as an increased risk of cancer development, particularly in children. However, the rate of CT scan use is high and unwarranted worldwide.

Objectives

This study aimed to identify the patterns and reported indications for head CT scans ordered for non-traumatic paediatric cases in Palestine.

Design

This was a retrospective, cross-sectional study based on a desk review.

Setting

The study was carried out from June 2024 to September 2024 in five hospitals located in five major Palestinian governorates in the West Bank.

Participants

The study included records of children aged 14 or younger, presenting with non-traumatic complaints and having undergone head CT between January 2020 and September 2024. A total of 3715 patient records were explored, of which 2977 were included in the final analysis; 1764 (59.3%) males and 1213 (40.7%) females.

Primary and secondary outcome measures

A pilot review of 100 records was conducted, and the data collection spreadsheet included demographic and clinical characteristics, presentations, reported reasons for CT requests, CT results, and information on lumbar puncture (LP) performance.

Results

The mean age of patients was 4.3 years (SD±3.3), with 59.3% aged 3 to 11 years, and 47.7% presenting to hospitals in northern governorates. The most commonly reported presentation was fever and convulsion (8.2%), followed by convulsions (7.7%), and a combination of fever, headache and vomiting (6.5%). Only 12.9% of the CT scans yielded positive findings, including dilated ventricles (19.3%), sinusitis (18.8%), brain oedema (12.9%), and brain mass (11.1%). Most CT scans were requested to check for contraindications to LP, with only 4.1% having a positive CT finding indicating a contraindication. At the multivariate level, a positive CT result was associated with being a neonate, having a past medical condition, ordering CT to check for contraindication to LP and presenting with convulsions.

Conclusions

CT scans were found to be overused without justification, particularly for ruling out contraindications to LP. The development of clear and specific national guidelines is recommended. This process can be supported through training, decision support tools, alternative management pathways and specialist consultations to ensure compliance. Additionally, enhancing reporting quality and using health information systems are vital for monitoring and improving radiological safety.

Association between waterpipe smoking, polycythaemia and cardiac risk factors among Palestinian university students: a cross-sectional study

Por: Younis · T. · Hodali · H. · Saifi · M. · Gharabeh · S. · Damiri · B.
Objective

This study aims to investigate the relationship between waterpipe smoking, polycythaemia and cardiac risk factors, including blood pressure and obesity.

Design

Cross-sectional Study conducted in 2022.

Setting

An-Najah National University (ANNU) in the West Bank, Palestine.

Participants

A total of 954 university students participated in the study.

Primary and secondary outcome measures

A questionnaire used to assess smoking behaviours and other substance practices and patterns. Anthropometric and clinical measurements were measured and recorded, and complete blood counts (CBC) were obtained using an automated haematology analyser. Descriptive statistics were used to characterise the sample. Logistic regression models were applied to assess associations between smoking and polycythaemia. Also, there is a link between polycythaemia and high systolic and diastolic blood pressure.

Results

Out of 954 participants, 60% were females, 18.5% smoked cigarettes (57.1% daily), 31.1% smoked waterpipes (20.5% daily), 6.5% smoked e-cigarettes (18.2% daily), 18.8% had polycythaemia and 17.6% were obese. After adjusting for gender, obesity and other confounders, waterpipe smoking was associated with polycythaemia (OR=1.70, p=0.023), male gender (OR=87.89, p

Conclusion

The study findings indicated significant associations between high blood pressure and polycythaemia, tobacco smoking, obesity and male gender. These findings underscore the importance of addressing tobacco hazards and their potential impact on cardiometabolic health, particularly among young adults.

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