Abstract
<h3>Research Objectives</h3> To determine if serial trichotomization of cognitive tests predicts passing or failing a comprehensive driving evaluation (CDE) with 100% sensitivity and 100% specificity in medically at-risk drivers. <h3>Design</h3> Retrospective cohort of CDE data. <h3>Setting</h3> CDE's assessed by occupational therapists at two driving assessment centers in Canada. <h3>Participants</h3> Participants included 143 drivers (72% male; mean age = 69.3 ± 14.1 years, range 24-94) referred by physicians for suspicion of being unfit to drive, and who had complete data on all cognitive tests and the CDE outcome. <h3>Interventions</h3> Not applicable. <h3>Main Outcome Measures</h3> Cognitive tests included the Montreal Cognitive Assessment (MoCA), Trail Making Test Part A (Trails A) and Part B (Trails B), and Useful Field of View® subtests 1-3 (UFOV1-3). The CDE outcome, based on clinical and on-road driving performance, included a pass (considered fit to continue driving), fail (considered unfit to continue driving), or indeterminate outcome (requires lessons and retesting). Serial trichotomization involved performing a receiver operating characteristics curve for each cognitive test to determine cut points with 100% sensitivity and 100% specificity in predicting pass (i.e., pass and indeterminate) or fail outcomes on the CDE. A funnel was created by arranging the cognitive tests in order from most to least predictive and using the cut points to identify pass, fail, and indeterminate outcomes. <h3>Results</h3> Approximately 33% passed, 27% failed, and 40% had indeterminate outcomes on the CDE. Through serial trichotomization, the UFOV3, UFOV2, UFOV1, Trails B, MoCA, and Trails A (from most to least predictive) predicted more pass (44.1%) and fail outcomes (34.3%) with fewer indeterminate outcomes (21.6%). <h3>Conclusions</h3> Serial trichotomization of cognitive tests is more accurate in identifying fit and unfit drivers, reducing the number of unnecessary on-road assessments by approximately twofold (indeterminate outcomes from 40% to 21.6%). Further research using larger samples and more clinical tests will identify the best combination and most accuracy in predicting fit and unfit drivers via serial trichotomization. <h3>Author(s) Disclosures</h3> This work was supported by the University of Waterloo CIHR Research Incentive Fund (PI Crizzle).
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