There is a need to improve the reporting quality of RCTs published in dermatology journals.

WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT• Some commonly prescribed medications can be a hazardous to traffic safety.• Fifteen categorization systems are currently available in Europe. However, none of these systems clearly reports the methodology that was followed in order to categorize medications that impair driving.• None of the existing categorization systems are currently implemented at European level. WHAT THIS STUDY ADDS• This study describes standardized and harmonized criteria to categorize medications according to their potential to impair fitness to drive. • This study proposes a European categorization system of medications that impair driving that covers all the most frequently prescribed medications.• The proposed categorization system can be seen as a tool to improve prescribing and dispensing procedures of medications that impair driving as well as an instrument to make patients aware of the role medications play in traffic safety. AIMSTo illustrate (i) the criteria and the development of the DRUID categorization system, (ii) the number of medicines that have currently been categorized, (iii) the added value of the DRUID categorization system and (iv) the next steps in the implementation of the DRUID system. METHODSThe development of the DRUID categorization system was based on several criteria. The following steps were considered: (i) conditions of use of the medicine, (ii) pharmacodynamic and pharmacokinetic data, (iii) pharmacovigilance data, including prevalence of undesirable effects, (iv) experimental and epidemiological data, (v) additional data derived from the patient information leaflet, existing categorization systems and (vi) final categorization. DRUID proposed four tiered categories for medicines and driving. RESULTSIn total, 3054 medicines were reviewed and over 1541 medicines were categorized (the rest were no longer on the EU market). Nearly half of the 1541 medicines were categorized 0 (no or negligible influence on fitness to drive), about 26% were placed in category I (minor influence on fitness to drive) and 17% were categorized as II or III (moderate or severe influence on fitness to drive). CONCLUSIONSThe current DRUID categorization system established and defined standardized and harmonized criteria to categorize commonly used medications, based on their influence on fitness to drive. Further efforts are needed to implement the DRUID categorization system at a European level and further activities should be undertaken in order to reinforce the awareness of health care professionals and patients on the effects of medicines on fitness to drive.

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ObjectiveTo assess the use of driving-impairing medicines (DIM) in the general population with special reference to length of use and concomitant use.DesignPopulation-based registry study.SettingThe year 2015 granted medicines consumption data recorded in the Castile and León (Spain) medicine dispensation registry was consulted.ParticipantsMedicines and DIM consumers from a Spanish population (Castile and León: 2.4 million inhabitants).ExposureMedicines and DIM consumption. Patterns of use by age and gender based on the length of use (acute: 1–7 days, subacute: 8–29 days and chronic use: ≥30 days) were of interest. Estimations regarding the distribution of licensed drivers by age and gender were employed to determine the patterns of use of DIM.ResultsDIM were consumed by 34.4% (95% CI 34.3% to 34.5%) of the general population in 2015, more commonly with regularity (chronic use: 22.5% vs acute use: 5.3%) and more frequently by the elderly. On average, 2.3 DIM per person were dispensed, particularly to chronic users (2.8 DIM per person). Age and gender distribution differences were observed between the Castile and León medicine dispensation registry data and the drivers’ license census data. Of all DIM dispensed, 83.8% were in the Anatomical Therapeutic Chemical code group nervous system medicines (N), which were prescribed to 29.2% of the population.ConclusionsThe use of DIM was frequent in the general population. Chronic use was common, but acute and subacute use should also be considered. This finding highlights the need to make patients, health professionals, health providers, medicine regulatory agencies and policy-makers at large aware of the role DIM play in traffic safety.

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New evidence has appeared to support the fact that the over-involvement of older drivers in traffic accidents disappears when the low mileage bias is taken into account. As a group, older drivers are as safe as or safer than other age groups, and only low mileage older drivers have a high crash rate. Furthermore, the role of the medical condition of older drivers in traffic accidents, as well as the fitness to drive evaluation, are objects of controversy. We examined all this with a cohort of 4316 drivers attending Medical Driving Test Centres for a mandatory fitness to drive evaluation. Our data shows that older drivers (≥75) have a lower crash rate. Medical conditions that impair fitness to drive, as a tendency, increased with advanced age and with lower mileage group. The multivariate analysis of variance showed that there is an effect (p < 0.0001) of age-range and mileage on the annual crash rate per million kilometres driven, while a medical restriction ("fit to drive with restriction") has no effect (p > 0.05). Our data suggests that health status is not associated with increased crash risk for the low mileage group, although further studies are needed.

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