Effectiveness of Pharmacological Treatment for Attention-Deficit/Hyperactivity Disorder on Physical Injuries: A Systematic Review and Meta-Analysis of Observational Studies
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.
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.
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.
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.
The findings of this meta-analysis support a reduced risk of injuries among ADHD patients who were treated with ADHD medications.
Compliance with Ethical Standards
This research did not receive any specific grant from funding agencies in the public, commercial or not-for-profit sectors
Conflict of interest
Dr. Ip reports grants from the Research Grants Council (RGC, Hong Kong) and the Health and Medical Research Fund (Food and Health Bureau, Hong Kong). Prof. Wong reports grants from The Research Grants Council (RGC, Hong Kong), Innovative Medicines Initiative (IMI), Shire, Janssen-Cilag, Eli-Lily, Pfizer, and European Union FP7 programme, outside the submitted work. Prof. Wong was a member of the National Institute for Health and Clinical Excellence (NICE) ADHD Guideline Group and the British Association for Psychopharmacology ADHD guideline group, and acted as an advisor to Shire. Mr Man, Dr Chan, Miss Law, Miss Leung, Miss Ma and Miss Quek report no competing interests. No other relationships or activities have been declared that could appear to have influenced the submitted work.
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