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Crash Risk Following Return to Driving After Moderate-to-Severe TBI: A TBI Model Systems Study
Thomas Novack1, Yue Zhang, Richard Kennedy
1Department of Physical Medicine and Rehabilitation (Drs Novack, Dreer, and Brunner and Ms Marwitz), and Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, Integrative Center for Aging Research (Drs Zhang and Kennedy), University of Alabama at Birmingham; Department of Psychology, Wayne State University, Detroit, Michigan (Dr Rapport); Department of Physical Medicine and Rehabilitation, University of Washington, Seattle (Dr Bombardier); Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota (Dr Bergquist); Department of Physical Medicine and Rehabilitation, Moss Rehabilitation/Einstein Healthcare Network, Elkins Park, Pennsylvania (Dr Watanabe); Research Department, Craig Hospital, Englewood, Colorado (Dr Tefertiller); Department of Physical Medicine and Rehabilitation, JFK Rehabilitation Institute, Edison, New Jersey (Dr Goldin); and Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond (Dr Walker).
Objective:
To examine motor vehicle crash frequency and risk factors following moderate-to-severe traumatic brain injury (TBI).
Setting:
Eight TBI Model Systems sites. Participants: Adults ( N = 438) with TBI who required inpatient acute rehabilitation.
Design:
Cross-sectional, observational design.
Main Measures:
Driving survey completed at phone follow-up 1 to 30 years after injury.
Results:
TBI participants reported 1.5 to 2.5 times the frequency of crashes noted in the general population depending on the time frame queried, even when accounting for unreported crashes. Most reported having no crashes; for those who experienced a crash, half of them reported a single incident. Based on logistic regression, age at survey, years since injury, and perception of driving skills were significantly associated with crashes.
Conclusion:
Compared with national statistics, crash risk is higher following TBI based on self-report. Older age and less time since resuming driving were associated with lower crash risk. When driving was resumed was not associated with crash risk. These results do not justify restricting people from driving after TBI, given that the most who resumed driving did not report experiencing any crashes. However, there is a need to identify and address factors that increase crash risk after TBI.
