Two-year assessment of the activity of an evaluation unit of fitness to drive

Abstract

Driving is a complex and essential activity for patient autonomy. High Health Autority practice guidelines for the assessment of brain injury patient ability to drive are to be published in 2015 [1]. The main objective of this study is to analyze the activity of an evaluation unit of driving ability. The second one is to assess the compliance with clinical practice guidelines. Retrospective study concerning the relevance and the systematic nature of a medical assessment protocol ability to drive made by a PMR ward in tertiary university Hospital over a two year period. The protocol includes medical and ophthalmological evaluations, occupational therapy (OT) and neuropsychological assessment. Finally an on-road test with a suitable vehicle in the presence of a driving school instructor and an occupational therapist is made. A total of 77 patients were evaluated in our unit. We considered after evaluation that about half (23/52) of brain-damaged patients assessed in our unit were able to drive. Forty-two ophthalmologic assessments, 31 neuropsychological assessments and 25 reviews with OT coupled to a road test were performed. Practical analysis confirmed that the multidisciplinary assessment of visual, sensorimotor, cognitive and road test are consistent with the guidelines. However, the highlight of a neglect syndrome had not systematically dissuaded the driving capacity, that is not in line with the HAS guidelines. The assessment of ability to drive must be standardized, particularly concerning on-road test. Patient and family's information on the need to make such an assessment must be systematized and made as early as possible. It seems necessary to better estimate driving habits after evaluation of patient, whatever they were validated or not. It is also necessary to analyze post validation risk for accident [2]. Finally, these guidelines should be disseminated and shared by all stakeholders (evaluation unit, licensed physician, Committee on driving license).