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Risk of unintentional injuries in children and adolescents with ADHD and the impact of ADHD medications: a systematic review and meta-analysis

Risk of unintentional injuries in children and adolescents with ADHD and the impact of ADHD medications: a systematic review and meta-analysis
Risk of unintentional injuries in children and adolescents with ADHD and the impact of ADHD medications: a systematic review and meta-analysis

A systematic review with meta-analyses was performed to: 1) quantify the association between ADHD and risk of unintentional physical injuries in children/adolescents (“risk analysis”); 2) assess the effect of ADHD medications on this risk (“medication analysis”). We searched 114 databases through June 2017. For the risk analysis, studies reporting sex-controlled odds ratios (ORs) or hazard ratios (HRs) estimating the association between ADHD and injuries were combined. Pooled ORs (28 studies, 4,055,620 individuals without and 350,938 with ADHD) and HRs (4 studies, 901,891 individuals without and 20,363 with ADHD) were 1.53 (95% CI = 1.40,1.67) and 1.39 (95% CI = 1.06,1.83), respectively. For the medication analysis, we meta-analysed studies that avoided the confounding-by-indication bias [four studies with a self-controlled methodology and another comparing risk over time and groups (a “difference in differences” methodology)]. The pooled effect size was 0.879 (95% CI = 0.838,0.922) (13,254 individuals with ADHD). ADHD is significantly associated with an increased risk of unintentional injuries and ADHD medications have a protective effect, at least in the short term, as indicated by self-controlled studies.

ADHD, Child psychiatry, Epidemiology, Pediatrics, Public health, Robust variance estimation, Stimulants, Unintentional physical injuries
0149-7634
63-71
Ruiz-Goikoetxea, Maite
e751449f-8f23-4c6c-8a91-48383398f7de
Cortese, Samuele
53d4bf2c-4e0e-4c77-9385-218350560fdb
Aznarez-Sanado, Maite
84eca809-fc6e-4733-9731-1b34190bfbcd
Magallón, Sara
ada1177a-75d3-4ceb-8d2b-48fa0703033b
Alvarez Zallo, Noelia
d2cc6fb2-b241-4af1-bebb-0bef573548a9
Luis, Elkin O.
aa0b559d-ff4d-4d30-97b6-c2af3eb6485a
de Castro-Manglano, Pilar
e5b77ce0-eb03-4cd3-af49-066b31145abd
Soutullo, Cesar
427da6c4-a6b9-4349-9de4-517c59750270
Arrondo, Gonzalo
5b9c1446-74f9-4dc7-aa73-6c67f3eaddbc
Ruiz-Goikoetxea, Maite
e751449f-8f23-4c6c-8a91-48383398f7de
Cortese, Samuele
53d4bf2c-4e0e-4c77-9385-218350560fdb
Aznarez-Sanado, Maite
84eca809-fc6e-4733-9731-1b34190bfbcd
Magallón, Sara
ada1177a-75d3-4ceb-8d2b-48fa0703033b
Alvarez Zallo, Noelia
d2cc6fb2-b241-4af1-bebb-0bef573548a9
Luis, Elkin O.
aa0b559d-ff4d-4d30-97b6-c2af3eb6485a
de Castro-Manglano, Pilar
e5b77ce0-eb03-4cd3-af49-066b31145abd
Soutullo, Cesar
427da6c4-a6b9-4349-9de4-517c59750270
Arrondo, Gonzalo
5b9c1446-74f9-4dc7-aa73-6c67f3eaddbc

Ruiz-Goikoetxea, Maite, Cortese, Samuele, Aznarez-Sanado, Maite, Magallón, Sara, Alvarez Zallo, Noelia, Luis, Elkin O., de Castro-Manglano, Pilar, Soutullo, Cesar and Arrondo, Gonzalo (2018) Risk of unintentional injuries in children and adolescents with ADHD and the impact of ADHD medications: a systematic review and meta-analysis. Neuroscience & Biobehavioral Reviews, 84, 63-71. (doi:10.1016/j.neubiorev.2017.11.007).

Record type: Review

Abstract

A systematic review with meta-analyses was performed to: 1) quantify the association between ADHD and risk of unintentional physical injuries in children/adolescents (“risk analysis”); 2) assess the effect of ADHD medications on this risk (“medication analysis”). We searched 114 databases through June 2017. For the risk analysis, studies reporting sex-controlled odds ratios (ORs) or hazard ratios (HRs) estimating the association between ADHD and injuries were combined. Pooled ORs (28 studies, 4,055,620 individuals without and 350,938 with ADHD) and HRs (4 studies, 901,891 individuals without and 20,363 with ADHD) were 1.53 (95% CI = 1.40,1.67) and 1.39 (95% CI = 1.06,1.83), respectively. For the medication analysis, we meta-analysed studies that avoided the confounding-by-indication bias [four studies with a self-controlled methodology and another comparing risk over time and groups (a “difference in differences” methodology)]. The pooled effect size was 0.879 (95% CI = 0.838,0.922) (13,254 individuals with ADHD). ADHD is significantly associated with an increased risk of unintentional injuries and ADHD medications have a protective effect, at least in the short term, as indicated by self-controlled studies.

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Accepted/In Press date: 14 November 2017
e-pub ahead of print date: 21 November 2017
Published date: 1 January 2018
Keywords: ADHD, Child psychiatry, Epidemiology, Pediatrics, Public health, Robust variance estimation, Stimulants, Unintentional physical injuries

Identifiers

Local EPrints ID: 417430
URI: https://eprints.soton.ac.uk/id/eprint/417430
ISSN: 0149-7634
PURE UUID: c2272718-3e6e-45da-b0c9-8c5ba42a80e8
ORCID for Samuele Cortese: ORCID iD orcid.org/0000-0001-5877-8075

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Date deposited: 31 Jan 2018 17:30
Last modified: 31 Jan 2018 17:30

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Contributors

Author: Maite Ruiz-Goikoetxea
Author: Samuele Cortese ORCID iD
Author: Maite Aznarez-Sanado
Author: Sara Magallón
Author: Noelia Alvarez Zallo
Author: Elkin O. Luis
Author: Pilar de Castro-Manglano
Author: Cesar Soutullo
Author: Gonzalo Arrondo

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