Driving after Concussion: Is It Safe To Drive after Symptoms Resolve?

Schmidt, Julianne D.; Hoffman, Nicole L.; Ranchet, Maud; Miller, L. Stephen; Tomporowski, Phillip D.; Akinwuntan, Abiodun Emmanuel; Devos, Hannes

doi:10.1089/neu.2016.4668

Cited by 35 publications

(30 citation statements)

References 39 publications

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“…Surveys must always balance between brevity and comprehensiveness in gathering information. A recent investigation [46] showed that concussed athletes had worse driving performance–poor enough to recommend they not drive. Participants then indicated that this recommendation would make them less likely to disclose a concussion.…”

Section: Discussionmentioning

confidence: 99%

Pilots and athletes: Different concerns, similar concussion non-disclosure

2019

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Objectives Concussion non-disclosure research has focused almost exclusively on athletes. The focus on athletic populations has been sensible considering athletes’ demonstrated susceptibility to sustaining and concealing concussions. Nevertheless, the habitual use of athletic populations has allowed researchers and practitioners to omit the development of generalized perceived costs and perceived rewards as critical determinants of concussion self-disclosure. We hypothesized that perceiving concussion disclosure as generally more costly than rewarding would predict negative attitudes towards disclosure and decreased intent to disclose. We also hypothesized that generalized perceived costs and rewards could explain concussion non-disclosure in different populations, athletes and future pilots specifically, even when those populations perceive concussion self-disclosure as costly for different specific reasons. Methods We examined concussion disclosure using 2,504 cadets at the United States Air Force Academy. Cadets completed anonymous surveys assessing their intention to self-disclose undiagnosed concussions ( Anticipated Concussion Disclosure ) as well as several variables potentially related to concussion self-disclosure: perceived cost, perceived reward, personal identity, attitudes, normative behavior, social support, and self-efficacy. Results The results demonstrate that concussion non-disclosure develops when a population perceives disclosure as more costly (i.e. directly or emotionally) and less rewarding. Perceived Cost and Perceived Reward variables alone accounted for 50% of the variance in Anticipated Conclusion Disclosure ( Adjusted R 2 = 0.50, F (2,2312) = 1,145.31, p < 0.001). As expected, Anticipated Conclusion Disclosure developed for different reasons within different sub-populations. Consistent with existing research, cadet intercollegiate athletes reported being primarily concerned that concussion self-disclosure would cause them to miss practice or game time ( t (736.7) = 14.20, p < .001, Cohen’s d = 0.96). In contrast, cadet future pilots reported being primarily concerned that concussion self-disclosure would have negative United States Air Force career repercussions ( t (1828) = 10.25, p < .001, Cohen’s d = 0.50). Conclusions These results suggest that cultures of concussion non-disclosure can develop in any population where disclosure is perceived as having undesirable consequences, not just athletic populations. Concussion researchers and practitioners should devote more attention...

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Section: Discussionmentioning

confidence: 99%

Pilots and athletes: Different concerns, similar concussion non-disclosure

2019

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“…performance on processing speed, visual memory, and motor speed measures (Schmidt et al, 2017). Patients with a history of mild TBI also self-report more traffic violations and vehicle collisions (Bernstein & Calamia, 2018) and using more strategies to compensate for driving difficulties (Bottari, Lamothe, Gosselin, Gélinas, & Ptito, 2012) relative to those with no history of concussion.…”

Section: Discussionmentioning

confidence: 99%

A Systematic Review and Meta-Analysis on the Association Between Driving Ability and Neuropsychological Test Performances after Moderate to Severe Traumatic Brain Injury

Egeto

Badovinac

Hutchison

et al. 2019

J Int Neuropsychol Soc

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Objectives: Guidelines on return-to-driving after traumatic brain injury (TBI) are scarce. Since driving requires the coordination of multiple cognitive, perceptual, and psychomotor functions, neuropsychological testing may offer an estimate of driving ability. To examine this, a meta-analysis of the relationship between neuropsychological testing and driving ability after TBI was performed. Methods: Hedge’s g and 95% confidence intervals were calculated using a random effects model. Analyses were performed on cognitive domains and individual tests. Meta-regressions examined the influence of study design, demographic, and clinical factors on effect sizes. Results: Eleven studies were included in the meta-analysis. Executive functions had the largest effect size (g = 0.60 [0.39–0.80]), followed by verbal memory (g = 0.49 [0.27–0.71]), processing speed/attention (g = 0.48 [0.29–0.67]), and visual memory (g = 0.43 [0.14–0.71]). Of the individual tests, Useful Field of Vision (UFOV) divided attention (g = 1.12 [0.52–1.72]), Trail Making Test B (g = 0.75 [0.42–1.08]), and UFOV selective attention (g = 0.67 [0.22–1.12]) had the largest effects. The effect sizes for Choice Reaction Time test and Trail Making Test A were g = 0.63 (0.09–1.16) and g = 0.58 (0.10–1.06), respectively. Years post injury (β = 0.11 [0.02–0.21] and age (β = 0.05 [0.009–0.09]) emerged as significant predictors of effect sizes (both p < .05). Conclusions: These results provide preliminary evidence of associations between neuropsychological test performance and driving ability after moderate to severe TBI and highlight moderating effects of demographic and clinical factors.

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“…Driving is a complex process involving coordination of cognitive, visual and motor skills, as well as concentration, attention, visual perception, insight and memory, which can all be affected by SRC 90. Little is known about the risk of driving after SRC, but preliminary data suggest some impairment exists when patients with concussion report they are asymptomatic 91. Currently, no widely accepted return to driving protocols exist; however, in athletes who drive, discussing the potential risks and harms is appropriate.…”

Section: Management Of Concussionmentioning

confidence: 99%

American Medical Society for Sports Medicine position statement on concussion in sport

et al. 2019

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Sport-related concussion (SRC) is a common injury in recreational and organised sport. Over the past 30 years, there has been significant progress in our scientific understanding of SRC, which in turn has driven the development of clinical guidelines for diagnosis, assessment and management of SRC. In addition to a growing need for knowledgeable healthcare professionals to provide evidence-based care for athletes with SRC, media attention and legislation have created awareness and, in some cases, fear about many issues and unknowns surrounding SRC. The American Medical Society for Sports Medicine (AMSSM) formed a writing group to review the existing literature on SRC, update its previous position statement, and to address current evidence and knowledge gaps regarding SRC. The absence of definitive outcomes-based data is challenging and requires relying on the best available evidence integrated with clinical experience and patient values. This statement reviews the definition, pathophysiology and epidemiology of SRC, the diagnosis and management of both acute and persistent concussion symptoms, the short-term and long-term risks of SRC and repetitive head impact exposure, SRC prevention strategies, and potential future directions for SRC research. The AMSSM is committed to best clinical practices, evidence-based research and educational initiatives that positively impact the health and safety of athletes.

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Driving after Concussion: Is It Safe To Drive after Symptoms Resolve?

Cited by 35 publications

References 39 publications

Pilots and athletes: Different concerns, similar concussion non-disclosure

Pilots and athletes: Different concerns, similar concussion non-disclosure

A Systematic Review and Meta-Analysis on the Association Between Driving Ability and Neuropsychological Test Performances after Moderate to Severe Traumatic Brain Injury

American Medical Society for Sports Medicine position statement on concussion in sport

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