Pediatric Critical Care Medicine, Stanford University School of Medicine, Stanford, CA, United States.
Center for Health Policy, Center for Primary Care Research Outcomes Research, Stanford, University, Stanford, CA, United States.
Injury. 2021 Aug;52(8):2244-2250. doi: 10.1016/j.injury.2021.05.017. Epub 2021 May 16.
The objective is to determine how outcomes from unintentional falls differ for children with and without developmental disabilities, with a sensitivity analysis specifically examining those with ADHD.
This is a retrospective observational cohort study of 2010-2015 data from the Nationwide Emergency Department Sample (NEDS). The NEDS is a sampling of ED visits across 953 hospitals in 36 states. Unintentional falls for children with and without developmental disabilities were compared, adjusting for age, sex, payment source, income, mechanism, injury severity score (ISS). A sensitivity analysis was then performed for children with ADHD (n=139,642) and those without any developmental disabilities. A priori chosen outcomes included hospital admission, length of stay, intubation, and surgery. Logistic regression analysis estimated adjusted odds ratios for outcomes.
Among children who presented to the ED with unintentional falls (n=13,217,237), there were 223,445 (1.7%) with developmental disabilities. The majority of those with developmental disabilities were male, ages 10-14 years. Compared to children without developmental disabilities, those with developmental disabilities were more likely to have an inpatient admission (aOR=2.27, 95% CI=2.10-2.44), length of stay more than 2 days (aOR=1.73, 95% CI=1.51-1.98), intubation (aOR=4.77, 95% CI=3.62-6.27) and surgery (aOR=2.11, 95% CI=1.93-2.32). A sensitivity analysis showed that 139,642 (1%) of children ages 5-17 years had ADHD. Of those with ADHD, the majority was also male, ages 10-14 years. Compared to children without ADHD, those with ADHD had a higher odds of inpatient admission (aOR=1.74, 95% CI=1.58-1.91), length of stay greater than 2 days (aOR=1.59, 95% CI=1.37-1.85), intubation (aOR=3.96, 95% CI=2.73-5.73), and surgery (aOR=1.82, 95% CI=1.60-2.06).
Children with developmental disabilities, in particular those with ADHD, who experience falls are often older and male. They had greater odds of poor outcomes. These children need additional anticipatory guidance and attention to adequate treatment to prevent injuries from unintentional falls.
本研究旨在探讨有无发育障碍的儿童在非故意跌倒方面的结局差异，敏感性分析特别关注患有注意缺陷多动障碍（ADHD）的儿童。
这是一项回顾性观察队列研究，分析了 2010 年至 2015 年全国急诊部样本（NEDS）的数据。NEDS 是对 36 个州 953 家医院的急诊就诊情况进行抽样调查。比较了有和无发育障碍的儿童的非故意跌倒情况，并对年龄、性别、支付来源、收入、机制、损伤严重程度评分（ISS）进行了调整。然后对患有 ADHD（n=139642）的儿童和无任何发育障碍的儿童进行了敏感性分析。预先选择的结局包括住院、住院时间、插管和手术。逻辑回归分析估计了结局的调整比值比。
在因非故意跌倒就诊于急诊科的儿童（n=13217237）中，有 223445 人（1.7%）患有发育障碍。大多数有发育障碍的儿童为男性，年龄在 10-14 岁。与无发育障碍的儿童相比，有发育障碍的儿童更有可能住院（调整比值比[aOR]=2.27，95%置信区间[CI]=2.10-2.44）、住院时间超过 2 天（aOR=1.73，95% CI=1.51-1.98）、插管（aOR=4.77，95% CI=3.62-6.27）和手术（aOR=2.11，95% CI=1.93-2.32）。敏感性分析显示，139642 名（1%）5-17 岁的儿童患有 ADHD。在这些患有 ADHD 的儿童中，大多数也是男性，年龄在 10-14 岁。与无 ADHD 的儿童相比，患有 ADHD 的儿童更有可能住院（aOR=1.74，95% CI=1.58-1.91）、住院时间超过 2 天（aOR=1.59，95% CI=1.37-1.85）、插管（aOR=3.96，95% CI=2.73-5.73）和手术（aOR=1.82，95% CI=1.60-2.06）。
患有发育障碍的儿童，尤其是患有 ADHD 的儿童，跌倒时往往年龄更大、为男性。他们的不良结局风险更高。这些儿童需要额外的预期指导和充分的治疗，以预防非故意跌倒造成的伤害。
