A systematic review of the risk of motor vehicle collision after stroke or transient ischemic attack

ABSTRACT

Background: Returning to driving after stroke is one of the key goals in stroke rehabilitation, and fitness to drive guidelines must be informed by evidence pertaining to risk of motor vehicle collision (MVC) in this population.

Objectives: The purpose of the present study was to determine whether stroke and/or transient ischemic attack (TIA) are associated with an increased MVC risk.

Methods: We searched MEDLINE, CINAHL, EMBASE, PsycINFO, and TRID through December 2016. Pairs of reviewers came to consensus on inclusion, based on an iterative review of abstracts and full-text manuscripts, on data extraction, and on the quality of evidence.

Results: Reviewers identified 5,605 citations, and 12 articles met inclusion criteria. Only one of three case-control studies showed an association between stroke and MVC (OR 1.9, 95% CI 1.0–3.9). Of five cohort reports, only one study, limited to self-report, found an increased risk of MVC associated with stroke or TIA (RR 2.71, 95% CI 1.11–6.61). Two of four cross-sectional studies using computerized driving simulators identified a more than two-fold risk of MVCs among participants with stroke compared with controls. The difference in one of the studies was restricted to those with middle cerebral artery stroke.

Conclusions: The evidence does not support a robust increase in risk of MVCs. While stroke clearly prevents some patients from driving at all and impairs driving performance in others, individualized assessment and clinical judgment must continue to be used in assessing and advising those stroke patients who return to driving about their MVC risk.

KEYWORDS:

• Accidents
• traffic
• automobile driving
• stroke
• ischemic attack
• transient

Acknowledgments

Megan A. Hird; Dr. Anne-Kristine Schanke; Yoassry Elzohairy; and Tracey Ma.

Disclosures

Dr. Bhangu received funding from Sunnybrook Research Foundation. Dr. Vrkljan, Dr. Charlton, Dr. Koppel, and Dr. O’Neill have been appraisers of international guidelines on medical fitness to drive. Dr. O’Neill is the developer of the Sláinte agus Tiomáint guidelines on medical fitness to drive and is employed by the RCPI/RSA as the director of the National Office for Traffic Medicine. Dr. Finestone is involved in the development of the CMA driving guide. Dr. Marshall is a consultant for the Ministry of Transportation of Ontario. Dr. Bayley is the scientific co-director for the Ontario neurotrauma Foundation and sits on the Heart and Stroke Society’s Canadian Stroke Best Practice and Quality Advisory. Dr. Dow is the Editor-in-Chief for the CMA drivers guide.

Previous presentation

This work was presented in abstract format at the American Psychiatric Association on 8 May 2018, at the Canadian Association of Occupational Therapy Conference on 21 June 2018, at the World Stroke Congress on 18 October 2018, and at the Gerontological Society of American Annual Scientific Meeting on 16 November 2018.

Additional information

Funding

The Ministry of Transportation of Ontario provided financial support under the Road Safety Research Partnership Program [MTO RSRPP 16-17]; and partially funded by Joule Inc., A Canadian Medical Association Company [CMA-DS-001]. Dr. Saposnik is supported by the Heart and Stroke Foundation Career. Dr. Swartz is supported by a Heart and Stroke Foundation of Canada New Investigator Award. Dr. Dow receives funding from the Société de l’assurance automobile du Québec (SAAQ); The Ministry of Transportation of Ontario provided financial support under the Road Safety Research Partnership Program [MTO RSRPP 16-17].