Artikel
Are children and youths with Attention-Deficit / Hyperactivity Disorder (ADHD) accident prone?
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Autoren
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E. Scharnetzky
- Centre for Social Policy Research, Bremen University
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W. Schill
- Bremen Institute for Prevention Research and Social Medicine, Bremen University
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G. Glaeske
- Centre for Social Policy Research, Bremen University
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K. Janhsen
- Centre for Social Policy Research, Bremen University
| Veröffentlicht: | 30. September 2004 |
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Gliederung
Text
Context
Injuries and poisonings are a significant health problem in children and youths causing many hospital admissions, long-lasting functional limitations and deaths. Attention-Deficit/Hyperactivity Disorder (ADHD) is generally accepted to be associated with an increased risk of injury.
Aim of the Study
To determine rate ratios of hospital admissions for injuries and poisonings for children and youths with and without ADHD. To validate the use of stimulant prescription as an indicator for ADHD.
Material and Methods
A cohort study of 334.423 persons aged 6 to 18 years using records of a German statutory health insurance, Gmuender Ersatzkasse (GEK). The diagnosis ADHD was assigned if at least one stimulant prescription was registered during the study period from 2000 to 2002. Hospital admission rates for injuries and poisonings and rate ratios were calculated using a Poisson model. Stimulant prescription, age, period and region of residence were included in the model. Interactions between stimulant prescription and the other main variables were tested for significance. Hospital admissions with ADHD as a primary or secondary diagnosis were used to determine the sensitivity of stimulant prescription with respect to ADHD. Using a positive predictive value of 90% found in the literature, the prevalence of ADHD and the specificity of stimulant prescription were calculated.
Results
Injuries and poisonings caused 21,8% of all hospital admissions for boys in this cohort. The rate ratio for boys with compared to those without stimulant prescription was 1,40 (95% confidence interval 1,23-1,59). For head injuries the rate ratio was 1,79 (95% confidence interval 1,45-2,20). A significant interaction (p<0,01) was found for stimulant prescription and region. The sensitivity of stimulant prescription with respect to the diagnosis ADHD was 66,4% in boys and 50,5% in girls. The prevalence of ADHD was calculated to be 4,3% in boys and 1,3% in girls. The specificity of stimulant prescription in boys is 99,7% and in girls 99,9%.
Conclusions
Boys with a diagnosis of ADHD as indicated by stimulant prescription are admitted more frequently to hospital due to injuries and poisonings, especially injuries of the head. Preventive strategies should be included in the routine care of these children. The interaction between region of residence and stimulant prescription indicates that different standards of diagnosis and/or treatment of ADHD are implemented in different parts of Germany. Stimulant prescription is considered a valid indicator for ADHD with moderate sensitivity and high specificity.
No conflict of interest
