Le score des pictogrammes pour les patients conducteurs

Abstract

IntroductionAs there is a case-law sentencing the lack of information to the patients who drive, we propose to clinically stabilized patients, sessions of therapeutic education. A driving simulator was used as therapeutic education tool and driving assessment tool. At the same time we calculated a score called pictograms’ score corresponding to the sum of risk level of each psychotropic driving-impairing medicine of the patient's prescription. Driving skill scores were then compared to the calculated pictograms’ score. Material and methods15 stabilized outpatients (depressive, bipolar or schizophrenic), (8M, 7F, 50.67±6.53 years old), having a French B driving license since 29.53±8.16 years, without somatic pathology and receiving psychotropic medications at usual dosages gave their consent and entered the study. 15 healthy control subjects (8H and 7F of 32±8.67 years and 13.07±7.94 years of license) taking no medication (with exception for hormonal contraception for women) were also tested for driving skills on the driving simulator used by the French Driving Schools ran on a desktop computer. The pictograms’ score is the weighted sum of the regulatory levels of harmonized warning pictograms for all the psychotropic prescribed. ResultsThe average simulator driving skills scores of the patient group are significantly lower than those of the healthy control group with 64.67±10.40 (32 to 82) and 79.67±6.84 (62 to 92), respectively (P=0.0018). While 20% of the patients in our sample failed (score≤50/100), 74% have comparable simulator driving skills as to the healthy subjects. In the previous 12 months before the study, their background was some road accidents among patients but only excess speed tickets for the healthy control subjects. The psychiatrists, including a doctor certified for the medical check of driving license, observed that the therapeutic education sessions are useful in moving the patient “in the right way” by overcoming his “innner conflicts”, and fears when driving. The pictograms’ score of the prescription allow us to measure the risk of multiple medications. It is analyzed taking into account the type of molecule, the dosage, the time passed since the initiation of treatment and since the last dose, the age of the patient and the diagnosis. For a psychotropic score greater than 17, we observed a worsening of the driving simulator score and potentially a risk threshold to be taken into account. ConclusionGuidelines that physicians use to assess fitness for driving are limited in their currency, and applicability. All in all, the pictograms’ score of the patient's prescription help him to understand the risk scale and act more safely. We use the pictograms’ score calculated by data mining in our health institution to refer patients with a score greater than or equal to 17 to a therapeutic education session. The pictograms’ score reflects only the treatment effect. With regards to the simulator’ driving score, the pictograms’ score differentiates the effects of the pathology from side effects of psychotropic medications on driving. Thus, it can help medication checking and reduce risk for patients who needed to drive.