The Assessment of Driving Fitness Using an On-Road Evaluation in Patients With Cirrhosis
Copyright © 2022 by The American College of Gastroenterology..
INTRODUCTION: The association between cirrhosis and driving performance is of particular clinical relevance because of the life-threatening safety issues both for the driver with cirrhosis and the general public. Study aims were to assess (i) driving competency through the use of an in-office computerized battery and on-road driving assessment (DriveABLE) and (ii) the association between minimal hepatic encephalopathy (MHE), in-office paper-pencil tools, and additional measures (e.g., frailty, depression, cognitive testing) with unsafe driving.
METHODS: Patients were prospectively recruited from 2 tertiary care liver clinics. In-office tests and in-office and on-road assessments of driving competence were completed. The χ 2 test and 1-way analysis of variance were used to analyze differences among those with and without MHE. Logistic regression was used to evaluate predictors of an indeterminate/fail result on the in-office computerized driving assessment battery (DriveABLE Cognitive Assessment Tool [DCAT]).
RESULTS: Eighty patients participated with a mean age of 57 years, 70% male, 75% Child-Pugh B/C, and 36% with a history of overt hepatic encephalopathy. Thirty percent met MHE criteria on both the psychometric hepatic encephalopathy score and the Stroop app tests. Only 2 patients (3%) were categorized as "unfit to drive" in the on-road driving test, one with MHE and the other without. Fifty-eight percent of the patients were scored as indeterminate/fail on the DCAT. This corresponded to a higher mean number of on-road driving errors (5.3 [SD 2.1] vs 4.2 [SD 1.6] in those who passed the DCAT, P = 0.01). Older age (odds ratio 1.3; confidence interval 1.1, 1.5; P = 0.001) and MHE by Stroop/psychometric hepatic encephalopathy score (odds ratio 11.0; confidence interval 2.3, 51.8; P = 0.002) were independently predictive of worse performance on the DCAT.
DISCUSSION: Worse performance in in-office testing was associated with worse scores on a computerized driving assessment battery and more on-road driving errors, but in-office tools were insufficient to predict on-road driving failures. A diagnosis of MHE should not be used alone to restrict driving in patients with cirrhosis. At-risk patients require on-road driving tests under the supervision of driving regulatory agencies. Future studies should continue to refine and evaluate in-office or at-home testing to predict driving performance.
| Medienart: |
E-Artikel |
|---|
| Erscheinungsjahr: |
2022 |
|---|---|
| Erschienen: |
2022 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:117 |
|---|---|
| Enthalten in: |
The American journal of gastroenterology - 117(2022), 12 vom: 01. Dez., Seite 2017-2024 |
| Sprache: |
Englisch |
|---|
| Beteiligte Personen: |
Tandon, Puneeta [VerfasserIn] |
|---|
| Links: |
|---|
| Themen: |
|---|
| Anmerkungen: |
Date Completed 05.12.2022 Date Revised 29.01.2023 published: Print-Electronic Citation Status MEDLINE |
|---|
| doi: |
10.14309/ajg.0000000000001927 |
|---|
| funding: |
|
|---|---|
| Förderinstitution / Projekttitel: |
|
| PPN (Katalog-ID): |
NLM346040965 |
|---|
| LEADER | 01000naa a22002652 4500 | ||
|---|---|---|---|
| 001 | NLM346040965 | ||
| 003 | DE-627 | ||
| 005 | 20231226030500.0 | ||
| 007 | cr uuu---uuuuu | ||
| 008 | 231226s2022 xx |||||o 00| ||eng c | ||
| 024 | 7 | |a 10.14309/ajg.0000000000001927 |2 doi | |
| 028 | 5 | 2 | |a pubmed24n1153.xml |
| 035 | |a (DE-627)NLM346040965 | ||
| 035 | |a (NLM)36087105 | ||
| 040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
| 041 | |a eng | ||
| 100 | 1 | |a Tandon, Puneeta |e verfasserin |4 aut | |
| 245 | 1 | 4 | |a The Assessment of Driving Fitness Using an On-Road Evaluation in Patients With Cirrhosis |
| 264 | 1 | |c 2022 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
| 338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
| 500 | |a Date Completed 05.12.2022 | ||
| 500 | |a Date Revised 29.01.2023 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2022 by The American College of Gastroenterology. | ||
| 520 | |a INTRODUCTION: The association between cirrhosis and driving performance is of particular clinical relevance because of the life-threatening safety issues both for the driver with cirrhosis and the general public. Study aims were to assess (i) driving competency through the use of an in-office computerized battery and on-road driving assessment (DriveABLE) and (ii) the association between minimal hepatic encephalopathy (MHE), in-office paper-pencil tools, and additional measures (e.g., frailty, depression, cognitive testing) with unsafe driving | ||
| 520 | |a METHODS: Patients were prospectively recruited from 2 tertiary care liver clinics. In-office tests and in-office and on-road assessments of driving competence were completed. The χ 2 test and 1-way analysis of variance were used to analyze differences among those with and without MHE. Logistic regression was used to evaluate predictors of an indeterminate/fail result on the in-office computerized driving assessment battery (DriveABLE Cognitive Assessment Tool [DCAT]) | ||
| 520 | |a RESULTS: Eighty patients participated with a mean age of 57 years, 70% male, 75% Child-Pugh B/C, and 36% with a history of overt hepatic encephalopathy. Thirty percent met MHE criteria on both the psychometric hepatic encephalopathy score and the Stroop app tests. Only 2 patients (3%) were categorized as "unfit to drive" in the on-road driving test, one with MHE and the other without. Fifty-eight percent of the patients were scored as indeterminate/fail on the DCAT. This corresponded to a higher mean number of on-road driving errors (5.3 [SD 2.1] vs 4.2 [SD 1.6] in those who passed the DCAT, P = 0.01). Older age (odds ratio 1.3; confidence interval 1.1, 1.5; P = 0.001) and MHE by Stroop/psychometric hepatic encephalopathy score (odds ratio 11.0; confidence interval 2.3, 51.8; P = 0.002) were independently predictive of worse performance on the DCAT | ||
| 520 | |a DISCUSSION: Worse performance in in-office testing was associated with worse scores on a computerized driving assessment battery and more on-road driving errors, but in-office tools were insufficient to predict on-road driving failures. A diagnosis of MHE should not be used alone to restrict driving in patients with cirrhosis. At-risk patients require on-road driving tests under the supervision of driving regulatory agencies. Future studies should continue to refine and evaluate in-office or at-home testing to predict driving performance | ||
| 650 | 4 | |a Journal Article | |
| 700 | 1 | |a Pidborochynski, Tara |e verfasserin |4 aut | |
| 700 | 1 | |a Abraldes, Juan G |e verfasserin |4 aut | |
| 700 | 1 | |a Carbonneau, Michelle |e verfasserin |4 aut | |
| 700 | 1 | |a Newnham, Kimberly |e verfasserin |4 aut | |
| 700 | 1 | |a Bailey, Robert |e verfasserin |4 aut | |
| 700 | 1 | |a Ismond, Kathleen P |e verfasserin |4 aut | |
| 700 | 1 | |a Bajaj, Jasmohan S |e verfasserin |4 aut | |
| 700 | 1 | |a Dobbs, Bonnie |e verfasserin |4 aut | |
| 773 | 0 | 8 | |i Enthalten in |t The American journal of gastroenterology |d 1953 |g 117(2022), 12 vom: 01. Dez., Seite 2017-2024 |w (DE-627)NLM000025445 |x 1572-0241 |7 nnns |
| 773 | 1 | 8 | |g volume:117 |g year:2022 |g number:12 |g day:01 |g month:12 |g pages:2017-2024 |
| 856 | 4 | 0 | |u http://dx.doi.org/10.14309/ajg.0000000000001927 |3 Volltext |
| 912 | |a GBV_USEFLAG_A | ||
| 912 | |a GBV_NLM | ||
| 951 | |a AR | ||
| 952 | |d 117 |j 2022 |e 12 |b 01 |c 12 |h 2017-2024 | ||