Preschool ADHD Diagnosis and Stimulant Use Before and After the 2011 AAP Practice Guideline
Preschool ADHD Diagnosis and Stimulant Use Before and After the 2011 AAP Practice Guideline
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DOI：
10.1542/peds.2016-2025
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发表时间：
2016-12-01
期刊：
影响因子：
8
通讯作者：
Wasserman, Richard
中科院分区：
文献类型：
--
作者：
Fiks, Alexander G.;Ross, Michelle E.;Wasserman, Richard
目的：评价2011年美国儿科学会指南发布后，4~5岁儿童注意缺陷多动障碍(ADHD)诊断和兴奋剂处方的变化。方法：从63个初级保健实践中提取电子病历数据。我们包括2008年1月至2014年7月期间接受护理的48至72个月大儿童的预防性访问。我们比较了指南发布前后ADHD的诊断率和兴奋剂处方的发生率，使用样条法进行了Logistic回归，并通过实践进行了分组。结果：在指南发布前的87 067名儿童118 957人次和指南发布后的56 814人次92 601人次中，儿童在指南发布前和指南发布后的ADHD诊断率分别为0.7%(95%可信区间，0.7%~0.8%)和0.9%(95%可信区间，0.8%~0.9%)，使用兴奋剂处方的比例均为0.4%(95%可信区间，0.4%~0.4%)。在指南发布后，ADHD诊断指南前的显著增加趋势结束。刺激性药物的使用率在指南发布前后保持不变。指南前后的变化模式在不同的实践中有很大的不同。结论：2011年针对学龄前儿童ADHD的指南的发布与不断增加的诊断率的结束有关，而处方兴奋剂的比率保持不变。这些都是令人放心的结果，因为建议采用标准化的诊断方法，并且刺激性治疗不是这个年龄段的一线治疗方法。
OBJECTIVE: To evaluate the change in the diagnosis of attention-deficit/hyperactivity disorder abstract (ADHD) and prescribing of stimulants to children 4 to 5 years old after release of the 2011 American Academy of Pediatrics guideline.METHODS: Electronic health record data were extracted from 63 primary care practices. We included preventive visits from children 48 to 72 months old receiving care from January 2008 to July 2014. We compared rates of ADHD diagnosis and stimulant prescribing before and after guideline release using logistic regression with a spline and clustering by practice. Patterns of change (increase, decrease, no change) were described for each practice.RESULTS: Among 87 067 children with 118 957 visits before the guideline and 56 814 with 92 601 visits after the guideline, children had an ADHD diagnosis at 0.7% (95% confidence interval [CI], 0.7% to 0.8%) of visits before and 0.9% (95% CI, 0.8% to 0.9%) after guideline release and had stimulant prescriptions at 0.4% (95% CI, 0.4% to 0.4%) of visits in both periods. A significantly increasing preguideline trend in ADHD diagnosis ended after guideline release. The rate of stimulant medication use remained constant before and after guideline release. Patterns of change from before to after the guideline varied significantly across practices.CONCLUSIONS: Release of the 2011 guideline that addressed ADHD in preschoolers was associated with the end of an increasing rate of diagnosis, and the rate of prescribing stimulants remained constant. These are reassuring results given that a standardized approach to diagnosis was recommended and stimulant treatment is not first-line therapy for this age group.