Return to driving after head injury

Abstract

Objectives: To determine whether patients who return to driving after head injury can be considered safe to do so and to compare the patient characteristics of those who return to driving with those who do not. Methods: In a multicentre qualitative study ten rehabilitation units collectively registered 563 adults with traumatic brain injury during a 2.5 year period. Recruitment to the study varied from immediately after hospital admission to several years post injury. Patients and their families were interviewed around three to six months following recruitment. 383 (67.5%) subjects were interviewed within one year of injury, of whom 270 (47.6%) were interviewed within 6 months of injury. Main outcome measures were the presence or absence of driving related problems reported by drivers and ex-drivers, and scores on driving related items of the Functional Independence/Functional Assessment Measure (FIM+FAM). Results: Of the 563 patients 381 were drivers before the injury and 139 had returned to driving at interview. Many current drivers reported problems with behaviour (anger, aggression, irritability) (67 (48.2%)), memory ( 89 (64%)), concentration and attention (39 (28.1%)), and vision (39 (28.1%)). Drivers reported most driving-related problems as frequently as ex-drivers, main exceptions were epilepsy and community mobility. Current drivers scored significantly higher on the FIM+FAM (i.e. more independent), than ex-drivers. The driving group had sustained less severe head injuries than ex-drivers, nevertheless 78 (56.2%) of current drivers had received a severe head injury. Few (61, 16%) previous drivers reported receiving formal advice about driving following injury. Conclusions: The existence of problems which could significantly affect driving do not prevent patients returning to driving after TBI. Patients should be assessed for both mental and physical status before returning to driving after a head injury, and systems put in place to enable clear and consistent advice to be given to patients regarding driving