Paediatric traumatic brain injury and attention-deficit/hyperactivity disorder medication in Finland: a nationwide
Juho Laaksonen1, Ville Ponkilainen2, Julius Möttönen3
1Department of Clinical Medicine, University of Tampere, Tampere, Finland juho.laaksonen@tuni.fi.
Insights
Paediatric traumatic brain injury (pTBI) significantly increases the risk of attention-deficit/hyperactivity disorder (ADHD) medication use. This association persists for up to 20 years, underscoring the need for proactive TBI prevention and long-term patient monitoring.
Area of Science:
- Neuroscience
- Pediatrics
- Public Health
Background:
- The link between paediatric traumatic brain injury (pTBI) and subsequent attention-deficit/hyperactivity disorder (ADHD) medication is not well understood.
- Existing research has not sufficiently explored the long-term implications of pTBI on ADHD diagnosis and treatment.
Purpose of the Study:
- To investigate the association between paediatric traumatic brain injury (pTBI) and the need for attention-deficit/hyperactivity disorder (ADHD) medication.
- To quantify the risk of ADHD medication use following pTBI in a large pediatric cohort.
Main Methods:
- A nationwide retrospective cohort study in Finland (1998-2018) involving 66,594 patients with pTBI and 61,412 controls with distal extremity fractures.
- Utilized data from the Finnish Social Insurance Institution for ADHD medication records, applying a 1-year washout period and initiating follow-up 1 year post-injury.
- Kaplan-Meier analyses and Cox proportional hazards models were employed to assess cumulative incidence and hazard ratios.
Main Results:
- Patients with pTBI exhibited significantly higher rates of ADHD medication use compared to the reference group, with cumulative incidence reaching 3.89% vs 1.90% over 10 years.
- The hazard ratio for pTBI was 1.89 after 4 years, increasing substantially for the operative group (HR 6.31).
- Long-term follow-up (up to 20 years) revealed sustained elevated risks, with hazard ratios of 2.01 for females and 2.23 for males with pTBI.
Conclusions:
- A significant and lasting association exists between paediatric traumatic brain injury (pTBI) and the subsequent need for attention-deficit/hyperactivity disorder (ADHD) medication.
- Findings highlight the critical importance of implementing preventive strategies for pTBI and establishing long-term monitoring and psychoeducational support for affected children.
Background:
The association between paediatric traumatic brain injury (pTBI) and post-traumatic attention-deficit/hyperactivity disorder (ADHD) medication usage remains understudied subject.
Objective:
We aimed to evaluate the association between pTBI and subsequent ADHD medication.
Methods:
A nationwide retrospective cohort study in Finland from 1998 to 2018 included 66 594 patients with pTBI and 61 412 references with distal extremity fractures. ADHD medication data were obtained from the Finnish Social Insurance Institution. The primary outcome was post-traumatic pediatric ADHD medication. A 1-year washout period was applied, and follow-up started 1 year post-pTBI.
Findings:
Kaplan-Meier analyses showed higher ADHD medication usage in patients with pTBI, especially post-operatively. Both sex groups exhibited elevated rates compared with the reference group. Over 10 years, cumulative incidence rates were 3.89% (pTBI) vs 1.90% (reference). HR for pTBI was 1.89 (95% CI 1.70 to 2.10) after 4 years and 6.31 (95% CI 2.80 to 14.20) for the operative group after the initial follow-up year. After 10 years, cumulative incidence in females increased to 2.14% (pTBI) vs 1.07% (reference), and in males, to 5.02% (pTBI) vs 2.35% (reference). HR for pTBI was 2.01 (95% CI 1.72 to 2.35) in females and 2.23 (95% CI 2.04 to 2.45) in males over 1-20 years.
Conclusions:
A substantial association between pTBI and post-traumatic ADHD medication was evidenced over a 20-year follow-up period.
Clinical Implications:
These results stress the need for preventive measures for pTBI and highlight the potential impact of long-term post-traumatic monitoring and psychoeducation.
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