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Developmental Risk Factors for Pediatric Hand Trauma: The Impact of ADHD
Meeti Mehta, BS
1; Shayan M Sarrami, MD
1; Alexander J Davit III, MD
21University of Pittsburgh, Pittsburgh, PA; 2Department of Plastic Surgery, University of Pittsburgh Medical Center / Children's Hospital of Pittsburgh, Pittsburgh, PA
Introduction One in ten children have been diagnosed with ADHD before the age of 18. Several studies demonstrate the association between ADHD and increased risk of child injury. This study aims to evaluate demographic and injury characteristics to identify risk factors associated with hand trauma in patients diagnosed with ADHD. Methods We conducted a retrospective cohort study of pediatric hand trauma patients from 2010-2020. Demographic and clinical data were collected. Psychiatric history was abstracted from patient charts. Geographic/socioeconomic data were obtained from the US Census Bureau. Univariate and multivariate logistic regression was performed to calculate odds ratios (OR) using R Software, alpha = 0.05. Results 1311 patients sustained hand trauma, with 16% of patients having a diagnosis of ADHD. Patients with ADHD were more likely to be male (OR 1.966, p<0.001), African American (OR 1.178, p=0.007), age > 12 years (OR 2.301, p=0.003), with median household incomes below the federal poverty line (OR 1.569, p=0.031). These patients were also more likely to have concomitant diagnoses of ODD (OR 23.724, p<0.001), PTSD (OR 6.373, p=0.002), anxiety (OR 5.337, p<0.001), depression (OR 4.739, p<0.001), and autism (OR 4.385, p=0.001). Their most common mechanisms of injury included sports (28%), falls (14%), door slams (13%), violence (10%), and self-inflicted (9%). Children with ADHD were more likely to sustain injury from self-inflicted mechanisms (OR 6.220, p=0.001) or violence (OR 2.975, p=0.040) than children without ADHD. These patients also had greater odds of trauma from gunshot wounds (OR 3.172, p=0.027), or from punching a person (OR 4.549, p=0.019), or object (OR 3.899, p=0.009). Given this association with punching, patients were more likely to sustain injuries to the metacarpophalangeal joint (OR 1.981, p=0.002) and volar plate (OR 3.375, p=0.041) compared to those without ADHD. These patients were also more likely to sustain vascular injury (OR 3.294, p=0.022), and therefore, were more likely to require arterial repair (OR 9,811.325, p<0.001) than patients without ADHD. Conclusion Children with ADHD are at high risk for hand trauma, especially due to violence, assault, or punching. The significant relationship between this patient population and other marginalized and underrepresented groups highlights the vulnerability of these children and emphasizes the need for social and medical interventions to address these disparities. To this end, hand surgeons have a unique opportunity to inquire about patients' psychiatric history as part of their comprehensive assessment and communicate with family to help avoid repeat injuries.
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