Injury among children and young people with and without attention deficit-hyperactivity disorder in the community: the risk of fractures, thermal injuries and poisonings

Background: Injuries commonly cause morbidity and mortality in children and young people (CYP). Attention deficit-hyperactivity disorder (ADHD) is the commonest neurobehavioural disorder in CYP and is associated with increased injury risk. However, large, population-based estimates of the risk of specific injuries are lacking. We aimed to provide estimates of the risk of fractures, thermal injuries and poisonings in CYP with and without ADHD.Methods: In this population-based cohort study we used primary and secondary care medical records from England from the Clinical Practice Research Datalink (CPRD). There were 15,126 CYP with ADHD frequency-matched to 263,724 without, aged 3-17 years at diagnosis. The risk of: (i) fractures (ii) thermal injuries, and (iii) poisonings in CYP with ADHD was compared to those without.Results: The absolute rate of injury per thousand person years at risk in CYP with vs. without ADHD was: fracture 28.9 (95%CI 27.5 to 30.3) vs. 18.7 (95%CI 18.5 to 19.0); long bone fracture 17.7 (95%CI 16.7 to 18.8) vs. 11.8 (95%CI 11.6 to 12.0); thermal injuries 4.4 (95%CI 3.9 to 4.9) vs. 2.2 (95%CI 2.1 to 2.3); poisonings 6.3 (95%CI 5.7 to 6.9) vs. 1.9 (95%CI 1.9 to 2.0). Adjusting for age, sex, geographical region, deprivation and calendar year, CYP with ADHD had: 25% increase in risk of fracture, (hazard ratio, HR=1.25 (95% CI 1.19 to 1.31)); 21% increase in risk of long bone fracture, (HR=1.21 (95% CI 1.13 to 1.28)); double the risk of thermal injury (HR=2.00 (95% CI 1.76 to 2.27) and almost four times the risk of poisoning (HR=3.72 (95% CI 3.32 to 4.17).Conclusions: CYP with ADHD are at greater risk of fracture, thermal injury and poisoning compared to those without. Paediatricians and healthcare professionals should provide injury prevention advice at diagnosis and reviews