Pediatric Trauma Society

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Increased Risk of Bicycle Accident in Pediatric Patients with Attention Deficit Hyperactivity Disorder (ADHD)
Areg Grigorian, MD; Jeffry Nahmias, MD; Brian Sheehan, MD; Matthew Dolich, MD; Sebastian Schubl, MD; Cristobal Barrios, MD; Michael Lekawa, MD
University of California, Irvine, Department of Surgery, Orange, CA

Background: The prevalence of attention-deficit hyperactivity disorder (ADHD) in the general pediatric population is 7% whereas the prevalence in trauma and their propensity towards specific mechanisms of injury (MOI) are unknown. We hypothesized pediatric patients with ADHD would have a higher risk of involvement in MOI requiring need for constant attention to surroundings, such as a bicycle collision.

Methods: The pediatric TQIP (2014-2016) was queried for patients with ADHD. Patients<16 years with ADHD were compared to those without ADHD. Those in a motor vehicle accident (MVA) were compared to other MOI. The reference group of MVA served as a baseline for the general prevalence of ADHD in our study population (patients would be passengers).

Results: The prevalence of ADHD was 2.5% (2,866). ADHD-patients were older (mean, 12 vs. 7 years, p<0.001) with more males (80.9% vs. 62.5%, p<0.001). ADHD-patients had higher risk for bicycle accident (OR=1.63, CI=1.35-1.95, p<0.001), lower risk for fall (OR=0.49, CI=0.43-0.56, p<0.001) and no difference in penetrating MOI (p>0.05). ADHD-bicyclists were less likely to wear a helmet (9.4% vs. 18.2%, p=0.003) and had a higher rate of traumatic brain injury (TBI) (55.6% vs. 39.7%), compared to non-ADHD-bicyclists.

Conclusions: Pediatric ADHD-patients have a 60% higher risk to be involved in a bicycle accident. ADHD-patients that are involved in a bicycle accident are less likely to wear a helmet and have a higher rate of TBI. Increased public awareness, education and supervision of this at-risk population may help reduce the risk of pediatric bicycle accidents leading to TBI.

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