Use of a Driving Simulator in Medical Fitness to Drive Evaluations: Lessons Learned

Abstract

<h3>Research Objectives</h3> Current gold standard for medical fitness to drive is on-road driving test conducted by a certified driving rehabilitation specialist (CDRS). Due to scarcity of CDRS, we evaluated whether driving simulator yields objective data that can inform decisions on medical fitness to drive. <h3>Design</h3> Prospective observational design. A single CDRS evaluated on-road driving and videos of simulated driving. The CDRS was "blinded" to participant status on videos of simulated driving. <h3>Setting</h3> Brain Injury Rehabilitation Service at Brooke Army Medical Center, Fort Sam Houston, San Antonio, TX. <h3>Participants</h3> 12 brain injury patients (5 with on-road driving test), 30 controls. <h3>Interventions</h3> None. <h3>Main Outcome Measures</h3> On-road driving safety. Safety based on simulated driving. Team decision based on sensory, cognitive, motor, and medical evaluations. <h3>Results</h3> The correspondence between safety from on-road driving and simulated driving was only 60%. It was more difficult to pass simulated driving than on-road driving. The correspondence between safety from on-road driving and team decision (based on sensory, cognitive, motor, medical evaluations) was only 60%. The correspondence between simulated driving and team decision (controls were presumed to be safe) was a dismal 40%. <h3>Conclusions</h3> Logistic and technical barriers precluded usefulness of objective simulator data. Nevertheless, important clinical lessons learned include: Simulated driving that includes opportunities to demonstrate handling of hazards appeared to be more difficult to pass than on-road driving tests. Controls enjoy a privilege of presumed driving safety while brain injury patients under medical scrutiny do not have this privilege. Each of three components considered (on-road driving; simulated driving; and team input of sensory, cognitive, motor and medical findings) contribute unique data that are valuable to determination of medical fitness to drive. <h3>Author(s) Disclosures</h3> Disclaimer: The views expressed in this abstract are those of the authors and do not necessarily represent the official policy or position of the Defense Health Agency, Department of Defense, or any other U.S. government agency. For more information, please contact dha.TBICOEinfo@mail.mil. UNCLASSIFIED.