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segunda-feira, 08 janeiro 2018 11:14

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

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Ruiz-Goikoetxea M1, Cortese S2 Aznarez-Sanado M3  Magallón S4Alvarez Zallo N5Luis EO6de Castro-Manglano P 7 Soutullo C8Arrondo G9

1
Servicio de Urgencias Extrahospitalarias, Servicio Navarro de Salud-Osasunbidea, Pamplona, Spain. Electronic address: mruizgoikoetxea@yahoo.es.
2
Center for Innovation in Mental Health, Academic Unit of Psychology, University of Southampton, Southampton, UK; Faculty of Medicine, Clinical and Experimental Sciences (CNS and Psychiatry), University of Southampton, Southampton, UK; Department of Child and Adolescent Psychiatry, NYU Langone Medical Center, New York, NY, USA. Electronic address: samuele.cortese@gmail.com.
3
Facultad de Educación y Psicología, Universidad de Navarra, Pamplona, Spain. Electronic address: masanado@unav.es.
4
Facultad de Educación y Psicología, Universidad de Navarra, Pamplona, Spain. Electronic address: smagallon@unav.es.
5
Servicio de Urgencias Extrahospitalarias, Servicio Navarro de Salud-Osasunbidea, Pamplona, Spain. Electronic address: noealza@gmail.com.
6
Facultad de Educación y Psicología, Universidad de Navarra, Pamplona, Spain. Electronic address: eluis.1@alumni.unav.es.
7
Departamento de Psiquiatría y Psicología Médica, Unidad de Psiquiatría Infantil y Adolescente, Clínica Universidad de Navarra, Pamplona, Spain. Electronic address: pcastro@unav.es.
8
Departamento de Psiquiatría y Psicología Médica, Unidad de Psiquiatría Infantil y Adolescente, Clínica Universidad de Navarra, Pamplona, Spain. Electronic address: csoutullo@unav.es.
9
Instituto Cultura y Sociedad (ICS), Grupo Mente-Cerebro, Universidad de Navarra, Pamplona, Spain. Electronic address: garrondo@yahoo.es.

Elsevier Neuroscience & Biobehavioral Reviews 

2018 Jan 8


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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