Traumatic Brain Injury and Driver Safety: A Systematic Review

Traumatic brain injuries (TBI) can lead to impairments in cognitive, physical, and psychosocial functions, which may ultimately affect an individual’s ability to drive. A systematic review was conducted to: 1) assess the impact of TBI on crash risk/driving performance; 2) determine what factors associated with TBI are predictive of increased crash risk/poor driving performance; and 3) determine if there is a likelihood of future seizure among individuals with a TBI who did not experience a seizure at the time of the injury. Results indicated that: 1) The available evidence is insufficient to determine whether crash risk is elevated for drivers with TBI compared to uninjured controls (Summary RR=1.32; 95% CI=0.77-2.25). However, driving performance was significantly impaired among individuals with TBI compared to uninjured controls (Strength of Evidence: Moderate); 2) Cognitive function measured by certain neuropsychological tests may predict the outcome of driving performance measured by a road test for patients with TBI. (Strength of Evidence: Moderate); and 3) Individuals with TBI who have not experienced a seizure within the first week post-injury still have a significant likelihood of experiencing late seizure(s). Frequencies of late seizures ranged from 1% to 25% during follow-up periods ranging from 1 to 11 years (Strength of Evidence: Moderate). The highest rate of late seizures (25%) was associated primarily with penetrating missile TBIs (Strength of Evidence: Minimally Acceptable [32% vs. 5%]). These findings have potential implications for regulatory agencies with responsibility for road safety

Seizure and the Risk for Seizure Recurrence Among Individuals Who Have Undergone Surgery for Epilepsy

Epilepsy is a central nervous system disorder for which recurrent seizures are the main symptom. Seizures resulting from epilepsy may culminate in unpredictable and sudden incapacitation, and thus are of significant concern to those interested in driver safety. Surgical therapy is one of the main treatment options for patients who do not respond to pharmacotherapy. Although approximately two thirds of individuals who undergo the most common types of surgery for epilepsy become seizure free, a significant proportion of these individuals will experience seizure recurrence. A systematic review and metaanalysis was conducted to examine the likelihood of seizure recurrence among individuals who have undergone surgery for epilepsy. Specifically, we were interested in quantifying the relationship between time since last seizure and the likelihood that a seizure will occur within the following year. Our results indicate that the longer the time that has elapsed since the occurrence of the last seizure, the lower the risk for seizure recurrence in the following year. The average annual risk for experiencing seizure recurrence among individuals who have remained seizure free for ≥8 years is less than 2% and less than 1% for those who have remained seizure free for ≥10 years. These findings have important implications for regulatory agencies with responsibility for road safety; particularly those agencies that regulate safety sensitive industries

Psychiatric Disorders and Driver Safety: A Systematic Review

Driving is a complicated psychomotor performance that depends on the driver’s ability to maintain effective and reliable control of his or her vehicle; respond to the road, traffic, and other external clues; and follow the “rules of the road”. Psychiatric disorders may interfere with any of the aforementioned driving skills to a significant degree, resulting in impaired driving ability. A systematic review and meta-analysis was conducted to examine the relationship between psychiatric disorders and driver safety. The relationship between driver safety and four subgroups of psychiatric disorders was examined, as well as the relationship between crash risk and personality disorder traits. Our results indicate that, while the possibility of an increased crash risk among drivers with psychiatric disorders cannot be ruled out, the evidence concerning crash risk for drivers with psychiatric disorders is inconclusive. Current evidence concerning crash risk among drivers with psychotic, mood, anxiety or personality disorders is inconclusive, although some evidence suggests that individuals with mood disorders are at increased risk for crash. The evidence also suggests an association between certain traits of patients with personality disorders (including aggression, hostility, impulsivity, disregard for law, and various psychological symptoms) and increased crash risk. These results underscore the necessity of more research in the area of psychiatric disorders and driver safety

A system for rating the stability and strength of medical evidence

BACKGROUND: Methods for describing one's confidence in the available evidence are useful for end-users of evidence reviews. Analysts inevitably make judgments about the quality, quantity consistency, robustness, and magnitude of effects observed in the studies identified. The subjectivity of these judgments in several areas underscores the need for transparency in judgments. DISCUSSION: This paper introduces a new system for rating medical evidence. The system requires explicit judgments and provides explicit rules for balancing these judgments. Unlike other systems for rating the strength of evidence, our system draws a distinction between two types of conclusions: quantitative and qualitative. A quantitative conclusion addresses the question, "How well does it work?", whereas a qualitative conclusion addresses the question, "Does it work?" In our system, quantitative conclusions are tied to stability ratings, and qualitative conclusions are tied to strength ratings. Our system emphasizes extensive a priori criteria for judgments to reduce the potential for bias. Further, the system makes explicit the impact of heterogeneity testing, meta-analysis, and sensitivity analyses on evidence ratings. This article provides details of our system, including graphical depictions of how the numerous judgments that an analyst makes can be combined. We also describe two worked examples of how the system can be applied to both interventional and diagnostic technologies. SUMMARY: Although explicit judgments and formal combination rules are two important steps on the path to a comprehensive system for rating medical evidence, many additional steps must also be taken. Foremost among these are the distinction between quantitative and qualitative conclusions, an extensive set of a priori criteria for making judgments, and the direct impact of analytic results on evidence ratings. These attributes form the basis for a logically consistent system that can improve the usefulness of evidence reviews

Diabetes and Motor Vehicle Crashes: A Systematic Evidence-Based Review and Meta-Analysis

The primary objective of this systematic review was to address the question, “Are drivers with diabetes mellitus at greater risk for a motor vehicle crash than comparable drivers without the disease?” and secondarily, to address the question, “Are insulin-treated diabetics at higher risk for crash?” Our searches identified 16 articles that addressed these questions. An assessment of study quality of the included studies found them to be in the low-to-moderate range. While attempts were made to control for differences in the characteristics of individuals that may confound the relationship between diabetes and crash risk in all included studies, most failed to control for exposure. A random-effects metaanalysis found that individuals with diabetes have a 19% increased risk for a motor vehicle crash when compared to similar individuals without diabetes. We found no compelling evidence to suggest that insulin-treated individuals are at higher risk for motor vehicle crash than individuals with diabetes not being treated with insulin. We discuss the implications of these findings

Hair coat properties of donkeys, mules and horses in a temperate climate

Background There are clear differences between donkeys and horses in their evolutionary history, physiology, behaviour and husbandry needs. Donkeys are often kept in climates they are not adapted to and as such may suffer impaired welfare unless protection from the elements is provided. Objectives We provide the first direct comparison of the hair coat properties of donkeys, mules and horses living outside, throughout the year, in the temperate climate of the UK. Study Design The weight, length and width of hair were measured, across the four seasons, as indicators of the hair coat insulation properties. Methods Hair samples were taken from 42 animals: 18 donkeys (4 females, 14 males), 16 horses (6 females, 10 males), and eight mules (5 females, 3 males), in March, June, September and December. Results Donkeys’ hair coats do not significantly differ across the seasons. All three measurements of the insulation properties of the hair samples indicate that donkeys do not grow a winter coat and that their hair coat was significantly lighter, shorter and thinner than that of horses and mules in winter. In contrast the hair coats of horses changed significantly between seasons, growing thicker in winter. Main Limitations The measurements cover only a limited range of features that contribute to the thermo-regulation of an animal. Further research is needed to assess shelter preferences by behavioural measures, and absolute heat loss via thermoimaging. Conclusions Donkeys, and to a lesser extent mules, appear not to be as adapted to colder, wet climates as horses, and may therefore require additional protection from the elements, such as access to a wind and waterproof shelter, in order for their welfare needs to be met

Systematic Review Evidence Methodology: Providing Quality Family Planning Services

From 2010 to 2014, CDC and the Office of Population Affairs at the USDHHS collaborated on the development of clinical recommendations for providing quality family planning services. A high priority was placed on the use of existing scientific evidence in developing the recommendations, in accordance with IOM guidelines for how to develop "trustworthy" clinical practice guidelines. Consequently, a series of systematic reviews were developed using a transparent and reproducible methodology aimed at ensuring that the clinical practice guidelines would be based on evidence collected in the most unbiased manner possible. This article describes the methodology used in conducting these systematic reviews, which occurred from mid-2011 through 2012