Comparative Analysis of Unsafe Driving Risk in Medical Conditions

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Submitted on 1 Mar 2018

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Comparative Analysis of Unsafe Driving Risk in Medical Conditions

Sanghee Moon, Maud Ranchet, Mark Tant, Abiodun E. Akinwuntan, Hannes Devos

To cite this version:

Sanghee Moon, Maud Ranchet, Mark Tant, Abiodun E. Akinwuntan, Hannes Devos. Comparative Analysis of Unsafe Driving Risk in Medical Conditions. American Congress of Rehabilitation Medicine, Oct 2017, Atlanta, GA, United States. �hal-01721056�

Background

Knowledge Gap

Discussion

Acknowledgement

References

Objectives

 Which medical conditions are at higher risk

of unsafe driving?

 Which medical conditions do physicians

struggle most with when appraising

fitness-to-drive?

 Primary objective

- To compare different driving safety

measures across medical conditions

 Secondary objective

- To compare agreements between

fitness-to-drive recommendation made by referring

physician and comprehensive

fitness-to-drive decision by driving evaluation center

 Classification of medical conditions[3]

 Outcome measures

(1) Physician’s fitness-to-drive recommendation

(2) Comprehensive fitness-to-drive recommendation (3) MVC records

(4) Traffic violation records

Methods

 Participants

- 6,584 drivers with medical conditions referred to an official driving evaluation center (CARA) in Belgium

 Fitness-to-drive evaluation procedure

- 1st-tier referring physician’s fitness-to-drive recommendation

→ Final-tier comprehensive fitness-to-drive decision by CARA

→ ‘Fit-to-drive’ or ‘Unfit-to-drive’

Neurological Psychiatric Musculoskeletal Visual Vestibular-hearing Cardiovascular-pulmonary

Liver-renal Sleep Diabetes mellitus Substance abuse

Comparative Analysis of Unsafe Driving Risk in Medical Conditions

Sanghee Moon, BS

, Maud Ranchet, PhD

, Mark Tant, PhD

, Abiodun E Akinwuntan, PhD, MPH, MBA

, Hannes Devos, PhD

1_{Laboratory for Advanced Rehabilitation Research in Simulation (LARRS), Department of Physical Therapy and Rehabilitation Science,}

University of Kansas Medical Center, Kansas City, KS, USA, 2_{Univ Lyon, IFSTTAR, Lyon, France,} 3_{Belgian Road Safety Institute, Brussels, Belgium}

Contact: smoon@kumc.edu

1. Carr (2010) Physicians guide to assessing and counseling older drivers. NHTSA.

Washington, DC.

2. Rizzo (2011) Impaired driving from medical conditions. JAMA. 305:1018-1026.

3. Dobbs (2005) Medical conditions and driving.

NHTSA. Washington, DC.

4. Moon (2017) Comparison of unsafe driving across medical conditions. Mayo Clin

Proceed. 92:1341-1350.

 This study was supported by the

VIAS Institute

 Most of 6,584 patients → Safe drivers  Neurological conditions

- Most were safe drivers

 Musculoskeletal conditions - Low risk of unsafe driving

Compared to musculoskeletal conditions:  Substance abuse

 Psychiatric conditions

 Cardiovascular-pulmonary conditions - Higher risks of unsafe driving

 Physicians struggled with appraising

fitness-to-drive in substance abuse and

psychiatric conditions

 Limitations

- Self-reported MVC and traffic violations - No consideration on comorbidities

- No analysis of the effect of age on driving safety

Conclusion

 Risks of unsafe driving varied greatly across medical conditions

 Increase awareness especially for

substance abuse, psychiatric conditions, and cardiovascular conditions

 Driving is a complex activity requiring intact visual, cognitive, and motor skills to

accurately and timely respond to a constantly changing environment

 Fitness-to-drive

- Determining fitness-to-drive is a medical

decision-making process to identify drivers

who may be at risk of unsafe driving[1]

 Medical conditions can negatively affect

visual, cognitive, and motor prerequisites for safe driving[2]

→ (1) ↑ chance of receiving unfavorable

fitness-to-drive recommendation by

referring physicians

→ (2) ↑ chance of receiving negative

comprehensive fitness-to-drive

decision by driving evaluation center

→ (3) ↑ risk of motor vehicle crashes (MVC) → (4) ↑ risk of traffic violations

© Shutterstock

Results

 The majority of drivers (74%) were

diagnosed with neurological conditions, followed by musculoskeletal (12%) and

psychiatric conditions (6%)

 Overall agreement was strong (> 0.80),

while substantial agreement (0.60 - 0.80) in

psychiatric conditions and substance abuse 2 2 1 0 0 1 5 0 1 10 0 5 10 15 20 U n fi t-to -d ri ve ( %) Physician’s recommendation * * * 98 2 Physician’s recommendation Fit Unfit 90 10 Comprehensive decision Fit Unfit 81 19 MVC No Yes 75 25 Traffic violation No Yes 10 25 5 12 7 7 4 4 8 22 0 10 20 30 40 U n fi t-to -d ri ve ( %) Comprehensive decision 17 25 22 22 24 37 22 31 ₃₀ 47 0 20 40 60 80 M V C (% ) MVC 24 29 30 ₂₉ 14 25 11 13 27 53 0 20 40 60 80 T raf fi c v iol at ion (% ) Traffic violation  Driving characteristics (%)

 Outcomes of unsafe driving across medical conditions

* * * * * * * * * * * * * * * *p < 0.001 *p < 0.001 *p < 0.001 *p < 0.001