Kenneth K C Man1,2,3,4,5, Patrick Ip5, Esther W Chan1, Siew-Ling Law3, Miriam T Y Leung1, Evelyn X Y Ma3, Wan-Ting Quek3, Ian C K Wong6,7,8. 1. Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China. 2. Department of Social Work and Social Administration, Faculty of Social Science, The University of Hong Kong, Hong Kong, China. 3. Research Department of Practice and Policy, UCL School of Pharmacy, 29-39 Brunswick Square, London, WC1N 1AX, UK. 4. Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands. 5. Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China. 6. Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China. i.wong@ucl.ac.uk. 7. Research Department of Practice and Policy, UCL School of Pharmacy, 29-39 Brunswick Square, London, WC1N 1AX, UK. i.wong@ucl.ac.uk. 8. Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China. i.wong@ucl.ac.uk.
Abstract
BACKGROUND: Patients with attention-deficit/hyperactivity disorder (ADHD) are more prone to physical injuries, including motor vehicle accidents, fractures and brain injuries. Several observational studies have been published investigating the association between the use of pharmacological treatment for ADHD and the incidence of physical injuries among patients with ADHD; however, the findings are not concordant. OBJECTIVE: This study is a systematic review and meta-analysis of the existing literature and estimates the overall association between the use of ADHD medications and physical injury. Injury is defined as medically attended physical injuries in the form of hospitalisations, emergency department visits or general practitioners visits. METHODS: The PubMed, EMBASE, PsycINFO, CINAHL and Cochrane Review databases were searched for relevant studies published up to May 2017 relating to ADHD medication and risk of injuries. Observational studies with any study design, all age groups (children and adults) and all ADHD medications (stimulant and non-stimulants) were included. Studies relevant to the association between ADHD medication exposure and risk of injuries in ADHD patients were extracted and compiled for meta-analysis. Both within-individual and between-individual analyses were conducted. RESULTS: Overall, 2001 citations were identified and 10 observational studies were included. Three self-controlled case series and two self-controlled cohorts were eligible for meta-analysis of within-individual studies. Five cohort studies were included in the meta-analysis of between-individual studies. The adjusted rate ratio of the within-individual methods was 0.76 (95% confidence interval [CI] 0.61-0.93) and 0.88 (95% CI 0.85-0.92) for between-individual studies. CONCLUSION: The findings of this meta-analysis support a reduced risk of injuries among ADHD patients who were treated with ADHD medications.
BACKGROUND:Patients with attention-deficit/hyperactivity disorder (ADHD) are more prone to physical injuries, including motor vehicle accidents, fractures and brain injuries. Several observational studies have been published investigating the association between the use of pharmacological treatment for ADHD and the incidence of physical injuries among patients with ADHD; however, the findings are not concordant. OBJECTIVE: This study is a systematic review and meta-analysis of the existing literature and estimates the overall association between the use of ADHD medications and physical injury. Injury is defined as medically attended physical injuries in the form of hospitalisations, emergency department visits or general practitioners visits. METHODS: The PubMed, EMBASE, PsycINFO, CINAHL and Cochrane Review databases were searched for relevant studies published up to May 2017 relating to ADHD medication and risk of injuries. Observational studies with any study design, all age groups (children and adults) and all ADHD medications (stimulant and non-stimulants) were included. Studies relevant to the association between ADHD medication exposure and risk of injuries in ADHDpatients were extracted and compiled for meta-analysis. Both within-individual and between-individual analyses were conducted. RESULTS: Overall, 2001 citations were identified and 10 observational studies were included. Three self-controlled case series and two self-controlled cohorts were eligible for meta-analysis of within-individual studies. Five cohort studies were included in the meta-analysis of between-individual studies. The adjusted rate ratio of the within-individual methods was 0.76 (95% confidence interval [CI] 0.61-0.93) and 0.88 (95% CI 0.85-0.92) for between-individual studies. CONCLUSION: The findings of this meta-analysis support a reduced risk of injuries among ADHDpatients who were treated with ADHD medications.
Authors: Zheng Chang; Patrick D Quinn; Kwan Hur; Robert D Gibbons; Arvid Sjölander; Henrik Larsson; Brian M D'Onofrio Journal: JAMA Psychiatry Date: 2017-06-01 Impact factor: 21.596
Authors: Zheng Chang; Paul Lichtenstein; Brian M D'Onofrio; Arvid Sjölander; Henrik Larsson Journal: JAMA Psychiatry Date: 2014-03 Impact factor: 21.596
Authors: Els van den Ban; Patrick Souverein; Willemijn Meijer; Herman van Engeland; Hanna Swaab; Toine Egberts; Eibert Heerdink Journal: Eur Child Adolesc Psychiatry Date: 2013-06-04 Impact factor: 4.785
Authors: Kenneth K C Man; Esther W Chan; David Coghill; Ian Douglas; Patrick Ip; Ling-Pong Leung; Matthew S H Tsui; Wilfred H S Wong; Ian C K Wong Journal: Pediatrics Date: 2014-12-15 Impact factor: 7.124
Authors: K K C Man; D Coghill; E W Chan; W C Y Lau; C Hollis; E Liddle; T Banaschewski; S McCarthy; A Neubert; K Sayal; P Ip; I C K Wong Journal: Transl Psychiatry Date: 2016-11-15 Impact factor: 6.222
Authors: Zheng Chang; Laura Ghirardi; Patrick D Quinn; Philip Asherson; Brian M D'Onofrio; Henrik Larsson Journal: Biol Psychiatry Date: 2019-04-17 Impact factor: 13.382
Authors: Laura Ghirardi; Henrik Larsson; Zheng Chang; Qi Chen; Patrick D Quinn; Kwan Hur; Robert D Gibbons; Brian M D'Onofrio Journal: J Am Acad Child Adolesc Psychiatry Date: 2019-07-11 Impact factor: 8.829
Authors: Vincent Chin-Hung Chen; Hsiang-Lin Chan; Shu-I Wu; Meng Lee; Mong-Liang Lu; Hsin-Yi Liang; Michael E Dewey; Robert Stewart; Charles Tzu-Chi Lee Journal: JAMA Netw Open Date: 2019-08-02
Authors: Sarah Kittel-Schneider; Sarah Wolff; Kristin Queiser; Leonie Wessendorf; Anna Maria Meier; Moritz Verdenhalven; Nathalie Brunkhorst-Kanaan; Oliver Grimm; Rhiannon McNeill; Sascha Grabow; Christoph Reimertz; Christoph Nau; Michelle Klos; Andreas Reif Journal: J Clin Med Date: 2019-10-08 Impact factor: 4.241
Authors: Le Gao; Kenneth K C Man; Esther W Chan; Celine S L Chui; Xue Li; David Coghill; Kam Lun Hon; Man Li Tse; Terry Y S Lum; Kirstie H T W Wong; Patrick Ip; Ian C K Wong Journal: CNS Drugs Date: 2021-07-20 Impact factor: 5.749