Paediatric traumatic brain injury and attention-deficit/hyperactivity disorder medication in Finland: a nationwide register-based cohort study

There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

Abstract

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.

Related collections

Most cited references 30

Record: found
Abstract: found
Article: not found

Quality of the Finnish Hospital Discharge Register: a systematic review.

Reijo Sund (2012)

The Finnish Hospital Discharge Register (FHDR) is one of the oldest individual level hospital discharge registers and has been intensively used for research purposes. The aim of this study was to gather information concerning the quality of FHDR into one place in terms of a systematic review of validation studies that compare data to external information. Several reference databases were searched for validity articles published until January 2012. For each included study, focus of validation, register years examined, number of compared observations, external source(s) of data, summary of validation results, and conclusions concerning the validity of FHDR were extracted. In total, 32 different studies comparing FHDR data to external information were identified. Most of the studies examined validity in the case of vascular disease, mental disorders or injuries. More than 95% of discharges could be identified from the register. Positive predictive value (PPV) for common diagnoses was between 75 and 99%. Completeness and accuracy in the register seem to vary from satisfactory to very good in the register as long as the recognised limitations are taking into account. Poor recording of subsidiary diagnoses and secondary operations and other rarely used items are the most obvious limitations in validity, but do not compromise the value of data in FHDR in being used in studies that are not feasible to conduct otherwise.

0 comments Cited 317 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Attention-deficit/hyperactivity disorder.

Stephen Faraone, Philip Asherson, Tobias Banaschewski … (2015)

Attention-deficit/hyperactivity disorder (ADHD) is a persistent neurodevelopmental disorder that affects 5% of children and adolescents and 2.5% of adults worldwide. Throughout an individual's lifetime, ADHD can increase the risk of other psychiatric disorders, educational and occupational failure, accidents, criminality, social disability and addictions. No single risk factor is necessary or sufficient to cause ADHD. In most cases ADHD arises from several genetic and environmental risk factors that each have a small individual effect and act together to increase susceptibility. The multifactorial causation of ADHD is consistent with the heterogeneity of the disorder, which is shown by its extensive psychiatric co-morbidity, its multiple domains of neurocognitive impairment and the wide range of structural and functional brain anomalies associated with it. The diagnosis of ADHD is reliable and valid when evaluated with standard criteria for psychiatric disorders. Rating scales and clinical interviews facilitate diagnosis and aid screening. The expression of symptoms varies as a function of patient developmental stage and social and academic contexts. Although there are no curative treatments for ADHD, evidenced-based treatments can markedly reduce its symptoms and associated impairments. For example, medications are efficacious and normally well tolerated, and various non-pharmacological approaches are also valuable. Ongoing clinical and neurobiological research holds the promise of advancing diagnostic and therapeutic approaches to ADHD. For an illustrated summary of this Primer, visit: http://go.nature.com/J6jiwl.

0 comments Cited 293 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: found

Is Open Access

Reducing bias through directed acyclic graphs

Ian Shrier, Robert Platt (2008)

Background The objective of most biomedical research is to determine an unbiased estimate of effect for an exposure on an outcome, i.e. to make causal inferences about the exposure. Recent developments in epidemiology have shown that traditional methods of identifying confounding and adjusting for confounding may be inadequate. Discussion The traditional methods of adjusting for "potential confounders" may introduce conditional associations and bias rather than minimize it. Although previous published articles have discussed the role of the causal directed acyclic graph approach (DAGs) with respect to confounding, many clinical problems require complicated DAGs and therefore investigators may continue to use traditional practices because they do not have the tools necessary to properly use the DAG approach. The purpose of this manuscript is to demonstrate a simple 6-step approach to the use of DAGs, and also to explain why the method works from a conceptual point of view. Summary Using the simple 6-step DAG approach to confounding and selection bias discussed is likely to reduce the degree of bias for the effect estimate in the chosen statistical model.

0 comments Cited 273 times – based on 0 reviews      Review now

Bookmark

All references

Author and article information

Journal

Journal ID (nlm-ta): BMJ Ment Health

Journal ID (iso-abbrev): BMJ Ment Health

Journal ID (hwp): bmjment

Journal ID (publisher-id): ebmh

Title: BMJ Mental Health

Publisher: BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )

ISSN (Electronic): 2755-9734

Publication date Collection: 2024

Publication date (Electronic): 30 May 2024

Volume: 27

Issue: 1

Electronic Location Identifier: e301083

Affiliations

[1 ] departmentDepartment of Clinical Medicine , Ringgold_7840University of Tampere , Tampere, Finland

[2 ] departmentDepartment of Orthopedics and Traumatology , Ringgold_60670Tampere University Hospital , Tampere, Finland

[3 ] departmentDepartment of Pediatrics , Ringgold_163043University of Eastern Finland , Joensuu, Finland

[4 ] departmentDepartment of Pediatrics , Ringgold_60650Kuopio University Hospital , Kuopio, Finland

Author notes

[Correspondence to ] Dr Juho Laaksonen, Department of Clinical Medicine, University of Tampere, Tampere, Finland; juho.laaksonen@ 123456tuni.fi

Author information

Juho Laaksonen http://orcid.org/0000-0002-9328-4721

Article

Publisher ID: bmjment-2024-301083

DOI: 10.1136/bmjment-2024-301083

PMC ID: 11141179

SO-VID: e6f051ff-ddb9-4027-a265-6c6ce523ae55

License:

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

History

Date received : 19 March 2024

Date accepted : 18 May 2024

Funding

Funded by: FundRef http://dx.doi.org/10.13039/100010114, Yrjö Jahnssonin Säätiö;

Funded by: Maire Taponen;

Funded by: FundRef http://dx.doi.org/10.13039/501100004212, Päivikki ja Sakari Sohlbergin Säätiö;

Custom metadata

special-feature unlocked

Keywords: child & adolescent psychiatry

Data availability:

Keywords: child & adolescent psychiatry

Paediatric traumatic brain injury and attention-deficit/hyperactivity disorder medication in Finland: a nationwide register-based cohort study

Read this article at

Abstract

Background

Objective

Methods

Findings

Conclusions

Clinical implications

Related collections

Recursive Rule based Visual Categorization

Most cited references 30

Quality of the Finnish Hospital Discharge Register: a systematic review.

Attention-deficit/hyperactivity disorder.

Reducing bias through directed acyclic graphs

Author and article information

Journal

Affiliations

Author notes

Author information

Article

History

Funding

Categories

Custom metadata

Comments

Comment on this article

Similar content 142

Most referenced authors 429