Background
Methods
Search strategy
Eligibility criteria
Study selection
Data extraction
Quality assessment
Data analysis
Results
Search results
Excluded studies
Article | Exclusion Criteria | Explanation | ||||
---|---|---|---|---|---|---|
Age | ADHD Diagnosis | Article Type | Study Type | Repeat Population | ||
Ayaz, 2015 [18] | x | Point-in-time data | ||||
Barkley, 2001 [8] | x | Commentary | ||||
Cairney, 2014 [19] | x | Commentary | ||||
Chen, 2017 [20] | x | Same population as Chou, 2014 | ||||
Duramaz, 2018 [21] | x | Tool used assessed impulsive behavior (not ADHD diagnosis) | ||||
Erdogan, 2014 [22] | x | All patients have fractures (case-control) | ||||
Guo, 2016 [23] | x | Same population as Chou, 2014 | ||||
Guy, 2016 [24] | x | Assessed Medicaid patients only | ||||
Hellgren, 1993 [25] | x | Mixed patient population (cannot isolate ADHD) | ||||
Hurtig, 2016 [26] | x | Assessed hyperactivity and symptoms consistent with ADHD (not ADHD diagnosis) | ||||
Lu, 2017 [27] | x | ADHD diagnosed only as a comorbid condition with Tourette Syndrome | ||||
Merrill, 2009 [28] | x | Population 0–65 years | ||||
Ozer, 2010 [29] | x | All patients have fractures (case-control) | ||||
Pastor, 2006 [30] | x | Point-in-time data | ||||
Perry, 2016 [31] | x | Population 0–40 years | ||||
Prasad, 2018 [32] | x | Point-in-time data | ||||
Rowe, 2004 [33] | x | Point-in-time data | ||||
Schermann, 2019 [34] | x | Population of military recruits | ||||
Schermann, 2018 [35] | x | Population of military recruits | ||||
Siwani, 2014 [36] | x | All patients have fractures (case-control) | ||||
Tai, 2013 [37] | x | x | All hyperkinetic disorders are included; Same population as Chou, 2014 | |||
Uslu, 2008 [38] | x | Tool used assessed impulsive behavior (not ADHD diagnosis) | ||||
Uslu, 2007 [39] | x | Tool used assessed impulsive behavior (not ADHD diagnosis) | ||||
van den Ban, 2011 [40] | x | Conference abstract (full study included in meta-analysis) | ||||
Wassenberg, 2004 [41] | x | Does not indicate fractures in ADHD patients | ||||
Yang, 2016 [42] | x | x | Excluded children previously diagnosed with ADHD; Assessed ADHD risk in those with fractures |
Characteristics of included studies
Study, Year | Country | Study Setting | Study Design | Duration | Sample Size | Age Range | Sex (of ADHD cohort) | Identification Method | Outcomes Reported | Fracture Types Reported | ||
---|---|---|---|---|---|---|---|---|---|---|---|---|
ADHD Group | Control Group | Male | ADHD | Fracture | ||||||||
Brehaut, 2003[9] | Canada | British Columbia (BC) Linked Health Dataset (BCLHD) and the BC Triplicate Prescription Program | Cohort (retro-spective) | 7 years | 16,806 | 1,010,067 | 0–19 years | 81.6 % | Methylphenidate prescription | ICD-9-CM | Fractures; Open wounds; Poisoning/toxic effect; Intracranial; Concussion; Burns | Overall |
Chou, 2014[43] | Taiwan | Longitudinal Health Insurance Database (LHID) | Cohort (retro-spective) | 11 years | 3,640 | 14,560 | 0–18 years | 79.0 % | ICD-9-CM | Fractures | Skull, neck, ribs, and spine; Upper limb; Lower limb | |
Jacob, 2017[45] | Germany | Disease Analyzer database (IMS Health) | Nested case-control | 6 years | 27,880 | 6–17 years | 76.5 % | ICD-10 | ICD-10 | Fractures | Forearm; Wrist and hand; Shoulder and upper arm; Foot and toe (except ankle); Lower leg (including ankle); Skull and face; Other | |
Raman, 2013[46] | United Kingdom | The Health Improvement Network (THIN) | Self-controlled case series | 15.5 years | 4,234 | 1–18 years | Read clinical classification system identification AND methylphenidate or dexamphetamine prescription | Read clinical classification system identification | Fractures; Intracranial; Traumatic complications; Sprains and strains; Superficial injury; Contusion; Open wound; Poisoning; Crushing injury; Foreign body in orifice; Burns; Other | Upper limb; Lower limb; Skull | ||
van den Ban, 2013[44] | Nether-lands | PHARMO record linkage system (RLS) | Cohort (retro-spective) | 11 years | 1,289 | 7,332 | 0–18 years | 79.8 % | Methylphenidate and atomextine prescription | Injuries or poisoning; Fractures; Intracranial; Open wounds | Overall |
Outcomes
Study | Fractures (among ADHD) | Sample Size (ADHD) | Prevalence | CI lower | CI upper |
---|---|---|---|---|---|
Brehaut, 2003 | 723 | 16,806 | 4.30 % | 3.99 % | 4.62 % |
Chou, 2014 | 389 | 3,640 | 10.69 % | 9.62 % | 11.75 % |
Jacob, 2017 | 1,447 | 27,880 | 5.19 % | 4.92 % | 5.46 % |
Raman, 2013 | 80 | 4,234 | 1.89 % | 1.48 % | 2.30 % |
van den Ban, 2013 | 30 | 1,289 | 2.33 % | 1.49 % | 3.16 % |
Summary | 4.83 % | 3.07 % | 6.58 % |
Study | Overall | Upper Limb | Lower Limb | Other | |||
---|---|---|---|---|---|---|---|
Number | Percent | Number | Percent | Number | Percent | ||
Brehaut, 2003 | 723a | ||||||
Chou, 2014 | 389 | 257 | 66.07 % | 95 | 24.42 % | 37 | 9.51 % |
Jacob, 2017 | 1,447 | 1,026 | 70.90 % | 320 | 22.10 % | 101 | 7.00 % |
Raman, 2013 | 80 | 51 | 63.75 % | 23 | 28.75 % | 6 | 7.50 % |
van den Ban, 2013 | 30a | ||||||
Summary | 1,916 | 1,334 | 69.62 % | 438 | 22.85 % | 144 | 7.53 % |
Study | ADHD Group | Control Group | Fold Increase | ||||
---|---|---|---|---|---|---|---|
Sample Size | Fractures | Prevalence | Sample Size | Fractures | Prevalence | ||
Brehaut, 2003 | 16,806 | 723 | 4.30 % | 1,010,067 | 20,025 | 1.98 % | 2.17 |
Chou, 2014 | 3,640 | 389 | 10.69 % | 14,560 | 1,188 | 8.16 % | 1.31 |
Jacob, 2017 | 27,880a | 1,447a | 5.19 %a | ||||
Raman, 2013 | 4,234a | 80a | 1.89 %a | ||||
van den Ban, 2013 | 1,289 | 30 | 2.33 % | 7,332 | 90 | 1.23 % | 1.90 |
Summary | 21,735 | 1,142 | 5.25 % | 1,031,959 | 21,303 | 2.06 % | 2.55 |