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Using Serial Trichotomization With Common Cognitive Tests to Screen for Fitness to Drive
Carrie Gibbons1, Nathan Smith2, Randy Middleton3
1Carrie Gibbons, MPH, is Research Coordinator, Centre for Applied Health Research, St. Joseph's Care Group, Thunder Bay, ON, Canada.
Objective:
The aim of this study was to illustrate the use of serial trichotomization with five common tests of cognition to achieve greater precision in screening for fitness to drive.
Method:
We collected data (using the Montreal Cognitive Assessment, Motor-Free Visual Perception Test, Clock-Drawing Test, Trail Making Test Part A and B [Trails B], and an on-road driving test) from 83 people referred for a driving evaluation. We identified cutpoints for 100% sensitivity and specificity for each test; the driving test was the gold standard. Using serial trichotomization, we classified drivers as either "Pass," "Fail," or "Indeterminate."
Results:
Trails B had the best sensitivity and specificity (66.3% of participants correctly classified). After applying serial trichotomization, we correctly identified the driving test outcome for 78.3% of participants.
Conclusion:
A screening strategy using serial trichotomization of multiple test results may reduce uncertainty about fitness to drive.
