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.

中文翻译：

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芬兰的小儿创伤性脑损伤和注意力缺陷/多动障碍药物治疗：一项全国性的基于登记的队列研究。


背景 小儿创伤性脑损伤 (pTBI) 与创伤后注意力缺陷/多动障碍 (ADHD) 药物使用之间的关联仍待研究。目的 我们旨在评估 pTBI 与随后的 ADHD 药物治疗之间的关联。方法 1998 年至 2018 年在芬兰进行的一项全国性回顾性队列研究，纳入了 66 594 名 pTBI 患者和 61 412 名四肢远端骨折患者。 ADHD 药物数据来自芬兰社会保险机构。主要结局是创伤后儿童多动症药物治疗。采用 1 年清除期，并在 pTBI 后 1 年后开始随访。结果 Kaplan-Meier 分析显示，pTBI 患者的 ADHD 药物使用量较高，尤其是术后。与参考组相比，两个性别组的比率均升高。 10 年来，累计发病率为 3.89% (pTBI) vs 1.90%（参考）。 4 年后，pTBI 的 HR 为 1.89（95% CI 1.70 至 2.10），初次随访一年后手术组的 HR 为 6.31（95% CI 2.80 至 14.20）。 10 年后，女性累积发病率增加至 2.14% (pTBI) vs 1.07%（参考），男性累积发病率增加至 5.02% (pTBI) vs 2.35%（参考）。 1-20 岁期间，女性 pTBI 的 HR 为 2.01（95% CI 1.72 至 2.35），男性为 2.23（95% CI 2.04 至 2.45）。结论 经过 20 年的随访，pTBI 与创伤后 ADHD 药物之间存在显着关联。临床意义 这些结果强调了针对 pTBI 采取预防措施的必要性，并强调了长期创伤后监测和心理教育的潜在影响。