Motor Vehicle Crash Involvement Research Articles

Impact of alcohol driving-while-impaired license suspension duration on future alcohol-related license events and motor vehicle crash involvement in North Carolina, 2007 to 2016

Background/PurposeLicense suspensions are a strategy to address alcohol-impaired driving behavior and recidivism following an alcohol driving while impaired (alcohol-DWI) conviction. Little is known about the specific impacts of conviction-related suspensions on safety outcomes and given recent fluctuations in alcohol-impaired driving behavior, crashes, and suspension trends, updated and focused assessments of this intervention are necessary. This study aimed to 1) examine the association between type of recent alcohol-DWI suspension and having a secondary alcohol-related license outcome and/or future crash event in North Carolina (NC) between 2007 and 2016; and 2) assess potential modification of these associations by race/ethnicity. MethodsWe used linked NC licensing data, NC crash data, and county-level contextual data from a variety of data sources. We compared individuals ages 21 to 64 who sustained initial (1-year) versus repeat (4-year) suspensions for alcohol-related license and crash involvement outcomes. We estimated unadjusted and adjusted hazard ratios (aHRs) using Cox proportional hazards models and produced Kaplan-Meier (KM) survival curves using a three-year follow-up period. After observing statistically significant modification by race/ethnicity, we calculated stratified aHRs for each outcome (Black and White subgroups only, as other subgroups had low numbers of outcomes). Results122,002 individuals sustained at least one alcohol-DWI conviction suspension (117,244 initial, 4,758 repeat). Adjusted KM survival curves indicated that within three years of the index suspension, the predicted risks of having a license outcome and crash outcome were about 8 % and 15 %, respectively, among individuals with an initial suspension and 5 % and 10 %, respectively, among individuals with a repeat suspension. After adjusting for potential confounding, we found that compared to those with an initial suspension, those with repeat suspensions had a lower incidence of future license (aHR: 0.49; 95 % CI: 0.42, 0.57) and crash outcomes (aHR: 0.67; 95 % CI: 0.60, 0.75). Among Black individuals, license outcome incidence was 162 % lower among repeat versus initial index suspension groups (aHR: 0.38; 95 % CI: 0.26, 0.55), while for White individuals, the incidence was 87 % lower (aHR: 0.54; 95 % CI: 0.45, 0.64). Similarly, crash incidence for repeat versus initial suspensions among Black individuals was 56 % lower (aHR: 0.64; 95 % CI: 0.50, 0.83), while only 39 % lower among White individuals (aHR: 0.72; 95 % CI: 0.63, 0.81). ConclusionsDecreased incidence of both license and crash outcomes were observed among repeat versus initial index suspensions. The magnitude of these differences varied by race/ethnicity, with larger decreases in incidence among Black compared to White individuals. Future research should examine the underlying mechanisms leading to alcohol-impaired driving behavior, convictions, recidivism, and crashes from a holistic social-ecological perspective so that interventions are designed to both improve road safety and maximize other critical public health outcomes, such as access to essential needs and services (e.g., healthcare and employment).

Associations between vision impairment and vision-related interventions on crash risk and driving cessation: systematic review and meta-analysis

ObjectivesTo systematically investigate the associations between vision impairment and risk of motor vehicle crash (MVC) involvement, and evaluate vision-related interventions to reduce MVCs.DesignMedline (Ovid), EMBASE and Global Health electronic databases...

National Analysis of Motor Vehicle Collision-Associated Mortality Among Opioid Users From 2010 to 2020: The Need for Effective Prevention Policies.

The purpose of this study is to evaluate the trends in the incidence of opioid-associated motor vehicle fatalities in the United States (US) over the past decade and identify geographic or demographic trends. We conducted a retrospective repeated cross-sectional study utilizing the CDC WONDER Multiple Cause of Death Database to gather data on opioid-associated motor vehicle fatalities from 2010 to 2020. The southern US experienced the highest percent increase in opioid-related fatalities from 2010 to 2020 (263.1%), followed by the Midwest (160.7%), the west (86.3%), and the northeast (10.0%). The use of opioids increases a driver's risk of motor vehicle crash involvement, especially amongst non-Hispanic White males between 25 and 55years of age who live in the southern states of the US. There is a need for augmented opioid-related policy concerning the potency and intake of prescription opioids to reduce motor vehicle fatalities.

Trends in Passenger Seat Belt Use Among High School Students—United States, 1991–2019

PurposeDespite having the highest risk per miles driven for motor vehicle crash involvement, only 57% of US high school students reported always using a seat belt when riding in a car with another driver in 2019. MethodsData from the national Youth Risk Behavior Surveys conducted biennially from 1991 to 2019 were used to assess trends in seat belt use. Modified Poisson regression with robust variance estimates and linear splines was used to examine seat belt use trend changes overall and by gender, race/ethnicity, and grade. ResultsFrom 1991 to 2015, seat belt use was about 3.3% higher each survey cycle compared with the previous survey cycle, adjusting for gender, race/ethnicity, and age. After 2015, seat belt use was about 1.8% lower each survey cycle than the previous survey cycle, adjusting for the same covariates. DiscussionNew and effective strategies should be considered for promoting consistent seat belt use among US high school students.

Incidence and Risk of Fatal Vehicle Crashes Among Professional Drivers: A Population-Based Study in Taiwan.

Fatal vehicle crashes (FVCs) are among the leading causes of death worldwide. Professional drivers often drive under dangerous conditions; however, knowledge of the risk factors for FVCs among professional drivers remain scant. We investigated whether professional drivers have a higher risk of FVCs than non-professional drivers and sought to clarify potential risk factors for FVCs among professional drivers. We analyzed nationwide incidence rates of FVCs as preliminary data. Furthermore, by using these data, we created a 1:4 professionals/non-professionals preliminary study to compare with the risk factors between professional and non-professional drivers. In Taiwan, the average crude incidence rate of FVCs for 2003–2016 among professional drivers was 1.09 per 1,000 person-years; professional drivers had a higher percentage of FVCs than non-professional drivers among all motor vehicle crashes. In the 14-year preliminary study with frequency-matched non-professional drivers, the risk of FVCs among professional drivers was significantly associated with a previous history of involvement in motor vehicle crashes (adjustment odds ratio [OR] = 2.157; 95% confidence interval [CI], 1.896–2.453), previous history of benzodiazepine use (adjustment OR = 1.385; 95% CI, 1.215–1.579), and speeding (adjustment OR = 1.009; 95% CI, 1.006–1.013). The findings have value to policymakers seeking to curtail FVCs.

Older Driver Safety: A Renewed Perspective in a Survey Study in Illinois, U.S.

Older adults (aged 65 or older) are at higher risk of involvement in motor vehicle crashes. Many studies have been conducted on older road users’ safety, but how older people’s driving behavior and demographic characteristics, and warnings of side effects of prescription medication, are associated with their crash risk has not been fully investigated. Aimed to address this knowledge gap, a mail survey of older drivers in Illinois, U.S. was conducted. Information on respondents’ driving behaviors, demographic characteristics, physical conditions, medication use, crash experience, etc. was gathered. Response distributions, odds ratios, and logistic regression models were employed to analyze the survey data. The results showed that most respondents kept a high level of mobility despite driving difficulty and medication use. Older drivers’ crash risk is mainly affected by external factors (driving exposure, alcohol consumption, and medication use) rather than their demographic characteristics and driving difficulty. Warnings from physicians on the side effects of prescription drugs had no significant effects on older drivers’ crash risk. Given the importance of mobility to older adults, the focus needs to be placed on providing a safe roadway system and safe driving advice for older drivers, particularly those who are on medication.

A bee colony optimization (BCO) and type-2 fuzzy approach to measuring the impact of speed perception on motor vehicle crash involvement

The major challenge of this paper is to examine how various forms of speed perception affect motor vehicle crash (MVC) involvement. To model this relationship, we use a type-2 fuzzy inference system (T2FIS). Another general challenge is to improve the performance of seven created T2FISs in a sense of compliance with the empirical data. This is achieved by a proposal of an algorithm based on the bee colony optimization (BCO) metaheuristic. The main novelty of this algorithm is the way how the testing points are selected in a type-2 fuzzy environment, which influences the execution efficiency. Data collection was carried out in twelve experiments. A total of 178 young drivers assessed the speed level from four positions; three of them relate to the speed perception of other vehicles on the road, while the remaining one represents the assessment of their own speed. At each position, three speed levels were assessed: 30, 50, and 70 km/h. As a result of the implemented methodology, a relationship between the various forms of speed perception and participation in MVCs can be quantified. The BCO-based algorithm achieved an average improvement of 21.17% in the performance of the initial T2FIS structures. The final results indicate that the drivers whose speed perception of the vehicle they are looking at from the rear side, as well as of the own vehicle, is poor have an elevated risk toward participation in MVCs compared to other forms of speed perception. This can be useful in various educational and recruitment procedures.

Advancing our understanding of cognitive development and motor vehicle crash risk: A multiverse representation analysis

Neurobiological and cognitive maturational models are the dominant theoretical account of adolescents' risk-taking behavior. Both the protracted development of working memory (WM) through adolescence, as well as individual differences in WM capacity have been theorized to be related to risk-taking behavior, including reckless driving. In a cohort study of 84 adolescent drivers Walshe et al. (2019) found adolescents who crashed had an attenuated trajectory of WM growth compared to adolescent drivers who never reported being in a crash, but observed no difference in WM capacity at baseline. The objectives of this report were to attempt to replicate these associations and to evaluate their robustness using a hybrid multiverse – specification curve analysis approach, henceforth called multiverse representation analysis (MRA). The authors of the original report provided their data: 84 adolescent drivers with annual evaluations of WM and other risk factors from 2005 to 2013, and of driving experiences in 2015. The original analysis was implemented as described in the original report. An MRA approach was used to evaluate the robustness of the association between developmental trajectories of WM and adolescents’ risk-taking (indexed by motor vehicle crash involvement) to different reasonable methodological choices. We enumerated 6 reasonable choice points in data processing-analysis configurations: (1) model type: latent growth or multi-level regression, (2) treatment of WM data; (3) which waves are included; (4) covariate treatment; (5) how time is coded; and (6) link function/estimation method: weighted least squares means and variance estimation (WLSMV) with a linear link versus logistic regression with maximum likelihood estimation. This multiverse consists of 96 latent growth models and 18 multi-level regression models.

Associations between vision impairment and driving and the effectiveness of vision-related interventions: protocol for a systematic review and meta-analysis

IntroductionDriving is one of the main modes of transport with safe driving requiring a combination of visual, cognitive and physical skills. With population ageing, the number of people living with...

The impact of cognitive functioning on driving performance of older persons in comparison to younger age groups: A systematic review

Older drivers are at a severely higher risk for motor vehicle crash involvement. Due to the global aging of the population, this increased crash risk has a significant impact on society, as well as on an older individual’s quality of life. For this reason, there is a need for understanding how normal age-related changes in cognition and underlying brain dynamics impact driving performance to identify the functional and neurophysiological biomarkers that could be used to design strategies to preserve or improve safe driving behavior in older persons. This review provides an overview of the literature on age-related changes in cognitive functioning and brain dynamics that impact driving simulator performance of healthy persons. A systematic literature search spanning the last ten years was conducted, resulting in 22 eligible studies. Results indicated that various aspects of cognition, most importantly executive function, complex attention, and dual tasking, were associated with driving performance, irrespective of age. However, there was a distinct age-related decline in cognitive and driving performance. Older persons had a more variable, less consistent driving simulator performance, such as more variable speed adaptation or less consistent lane keeping behavior. Only a limited number of studies evaluated the underlying brain dynamics in driving performance. Therefore, future studies should focus on implementing neuroimaging techniques to further unravel the neural correlates of driving performance.

Association of Photopic and Mesopic Contrast Sensitivity in older drivers with risk of motor vehicle collision using naturalistic driving data

BackgroundOlder drivers have a crash rate nearly equal to that of young drivers whose crash rate is the highest among all age groups. Contrast sensitivity impairment is common in older adults. The purpose of this study is to examine whether parameters from the photopic and mesopic contrast sensitivity functions (CSF) are associated with incident motor vehicle crash involvement by older drivers.MethodsThis study utilized data from older drivers (ages ≥60 years) who participated in the Strategic Highway Research Program Naturalistic Driving Study, a prospective, population-based study. At baseline participants underwent photopic and mesopic contrast sensitivity testing for targets from 1.5–18 cycles per degree. Model fitting generated area under the log CSF (AULCSF) and peak log sensitivity. Participant vehicles were instrumented with sensors that captured continuous driving data when the vehicle was operating (accelerometers, global positioning system, forward radar, 4-channel video). They participated for 1–2 years. Crashes were coded from the video and other data streams by trained analysts.ResultsThe photopic analysis was based on 844 drivers, and the mesopic on 854 drivers. Photopic AULCSF and peak log contrast sensitivity were not associated with crash rate, whether defined as all crashes or at-fault crashes only (all p > 0.05). Mesopic AULCSF and peak log sensitivity were associated with an increased crash rate when considered for all crashes (rate ratio (RR): 1.36, 95% CI: 1.06–1.72; RR: 1.28, 95% CI: 1.01–1.63, respectively) and at-fault crashes only (RR: 1.50, 95% CI: 1.16–1.93; RR: 1.38, 95% CI: 1.07–1.78, respectively).ConclusionsResults suggest that photopic contrast sensitivity testing may not help us understand future crash risk at the older-driver population level. Results highlight a previously unappreciated association between older adults’ mesopic contrast sensitivity deficits and crash involvement regardless of the time of day. Given the wide variability of light levels encountered in both day and night driving, mesopic vision tests, with their reliance on both cone and rod vision, may be a more comprehensive assessment of the visual system’s ability to process the roadway environment.

Frailty phenotype and self-reported crashes and driving space: Baseline AAA LongROAD

IntroductionThe present study uses data from the American Automobile Association (AAA) Longitudinal Research on Aging Drivers (LongROAD) study to assess the association of the frailty phenotype with reduced driving space and involvement in motor vehicle crashes. MethodsThe LongROAD study is a multisite prospective cohort study of participants aged 65–79 years. Fried's frailty phenotype status at baseline and self-reported restricted driving space in the past three months and at least one self-reported crash in the recent year are examined. Multivariable logistic regression was used to obtain odds ratios, adjusting for covariates and clustering by site. ResultsPre-frail (i.e. only 1–2 indicators of frailty) participants had 30% higher odds (adjusted OR = 1.3, 95% CI:1.0–1.8) of reporting involvement in a crash in the prior year than non-frail participants after adjusting for sex, age, depression, word recall, average miles driven per week, and site. No association for reduced driving space for frail older drivers was found. ConclusionsThe frailty phenotype is associated with motor vehicle crashes, but not reduced driving space. Our findings suggest that future research should be focused on the identification of pre-frail older adult drivers to improve the health and quality of life of older adult drivers.

Acute sleep deprivation and culpable motor vehicle crash involvement

To quantify the relationship between acute sleep deprivation and culpable involvement in motor vehicle crashes. Participants were 6845 drivers involved in a representative sample of crashes investigated by the US Department of Transportation in years 2005-2007. A modified case-control study design was used to compare self-reported hours of sleep in the 24 hr before crashing between drivers deemed culpable versus nonculpable. Analyses controlled for fatigue-related, driver-related, and environmental factors. Specific errors that led to crashes were also examined. Drivers who reported having slept for 6, 5, 4, and less than 4 hr in the 24 hr before crashing had 1.3 (95% confidence interval [CI] = 1.04 to 1.7), 1.9 (1.1 to 3.2), 2.9 (1.4 to 6.2), and 15.1 (4.2 to 54.4) times the odds, respectively, of having been culpable for their crashes, compared with drivers who reported 7-9 hr of sleep. Drivers who had slept less than 4 hr had 3.4 (95% CI = 2.1 to 5.6) times the increase in odds of culpable involvement in single-vehicle crashes compared with multiple-vehicle crashes. Recent change in sleep schedule, typically feeling drowsy upon waking, and driving for 3+ hr were also associated with culpability (all p ≤ 0.013). Assuming nonculpable drivers comprised a representative sample of all drivers present where crashes occurred, these odds ratios approximate incidence rate ratios for culpable crash involvement per unit of time driving. Driving after having slept less than 7 hr in a 24 hr period is associated with elevated risk of culpable crash involvement. Risk is greatest for drivers who have slept less than 4 hr and is manifested disproportionately in single-vehicle crashes.

2384 - Risk Factors for Pedestrian Injury on Tribal Lands

Background American Indians have the highest rate of pedestrian death per capita among ethnic groups in the United States. In North Dakota, the incidence rate for pedestrian involvement in crashes 3.9% on tribal lands compared to less than 0.1% among other rural populations in the state. The cultural foundation of the American Indians includes a proclivity toward walking and community-based solutions. Nationally, contributing factors such as limited sight zone, alcohol involvement, no sidewalk facility, and uncontrolled intersections are attributed in these crashes. Methods Descriptive Statistics and Case Study. Information regarding pedestrian motor vehicle crash (MVC) involvement is available nationally for fatal crashes. The fatal crash data will be coupled with all injury-level crashes in North Dakota to look at these crashes from a local perspective as well as the national view. This state database is a census of police-reported traffic crashes in the state. Both data sets include data on incident, vehicle, and occupant crash elements. While these data do not provide a means for predicting pedestrian crash involvement, it can be used to gain a better understanding of the crash events. Results Quantitative Problem Scope and Trend Discussions and Tribal Community Case Study Solutions/Interventions. This analysis will use crash records from the years 2012 to 2016. Descriptive statistical analysis of crash records is used in a diagnostic process to distinguish crash elements associated with tribal lands MVC where pedestrian involvement. The pedestrian-involved MVC crashes on other roads will be compared for statistical similarity. Significant differences in driver, vehicle, environment, and roadway elements will be examined using the chi-square test. Gaining a better understanding of these tribal pedestrian-involved crashes will help decision makers to more effectively select the most appropriate evidence based solutions. Conclusions Investigation into crashes the occurred locally on tribal lands and other rural locations provides insight to aid tribal communities as they prevent future traffic injuries.

Use of prescription opioids and motor vehicle crashes: A meta analysis

ObjectivesOpioid analgesics are a major driver of the ongoing opioid epidemic in the United Sates, accounting for about two thirds of drug overdose fatalities. There are conflicting reports regarding the effects of prescription opioids on driving safety. A meta-analysis was performed to assess the epidemiologic evidence for the association between use of prescription opioids and the risk of motor vehicle crashes. MethodsStudies examining the association between driver prescription opioid use and motor vehicle crash involvement or crash culpability and published in English were identified through a comprehensive search of 15 bibliographic databases. Eligible articles were fully reviewed and summarized. Study quality was assessed using the Newcastle-Ottawa Scale. Overall summary odds ratios (ORs) and 95% confidence intervals (CIs) were estimated through random effects models. ResultsOverall, 15 studies were included in the meta-analysis; of them, 10 assessed the association of prescription opioid use with the risk of crash involvement and 5 assessed the association of prescription opioid use with the risk of crash culpability. Reported crude ORs associated with prescription opioid use ranged from 1.15 to 8.19 for the risk of crash involvement and from 0.75 to 2.78 for the risk of crash culpability. Summary ORs based on pooled data were 2.29 (95% CI: 1.51, 3.48) for crash risk and 1.47 (95% CI: 1.01, 2.13) for crash culpability. ConclusionsThe existent epidemiologic evidence indicates that use of prescription opioids by drivers is associated with significantly increased risks of crash involvement and crash culpability. Further research is needed to understand the epidemiologic patterns of prescription opioid use in the driver population and the interaction effects between opioids and alcohol on driving safety.

Examining motor vehicle crash involvement and readiness to change on drinking and driving behaviors among injured emergency department patients

ABSTRACTObjective: To measure the effect of motor vehicle crash (MVC) involvement and readiness to change drinking and driving behaviors on subsequent driving and drinking behaviors among injured emergency department (ED) patients who use alcohol at harmful levels.Methods: This was a secondary analysis of a randomized controlled trial of injured ED patients who screened positive for harmful alcohol use, who at recruitment reported driving in the past 12 months and received at least one of the intended intervention sessions (brief behavioral intervention versus attention placebo control; N = 407). Outcome variables were as follows: (1) change in 6 impaired driving behaviors and (2) report of MVCs and traffic violations in the 12 months following recruitment; predictor variables were as follows: (1) treatment assignment, (2) MVC involvement at recruitment, and (3) baseline readiness to change alcohol use and drinking and driving.Results: Modeling of change in the 6 impaired driving variables indicated that neither the recruitment visits being MVC related nor baseline readiness to change alcohol use and drinking and driving behaviors predicted greater changes in impaired driving over time. Baseline reports of past moving traffic violations and the ED visit being MVC related predicted a greater likelihood of each behavior at 12 months following study recruitment.Conclusions: This study and others have demonstrated that ED patients with harmful alcohol use are willing to engage in behavioral interventions directed at changing risky behaviors. However, this study did not demonstrate that patients considered having the potential to be more engaged with the intervention because their ED visit was MVC related and/or they had expressed intent to change their risky alcohol use and drinking and driving behaviors were more likely to change these risky behaviors.

Age-related differences in fatal intersection crashes in the United States

ObjectiveGiven the aging U.S. population and resulting number of older drivers in the coming years, it is important to understand the factors leading to their involvement in vehicle crashes and develop counter-measures to reduce their frequency and severity. This is also useful for helping older adults “age in place” in terms of accessibility, mobility, quality of life and safety. Thus, the objective of this study was to provide up-to-date data on differences in age-related risks and rates for involvement in fatal intersection motor-vehicle crashes in the US. MethodsPooled data for the years 2011–2014 from the FARS, a census of fatal traffic crashes within the 50 States, the District of Columbia, and Puerto Rico, created by the US National Highway Traffic Safety Administration (NHTSA) were used to calculate summary statistics including annualized crash rates. Multivariate logistic regression models were used to evaluate age and gender-related differences in fatal intersection crash risk, controlling for covariates. An induced exposure analysis was conducted to calculate crash involvement ratios (CIRs) for all two-vehicle fatal intersection crashes. Older and younger drivers were compared with respect to the presence of factors related to intersection crashes using a multivariate Poisson regression model. ResultsDuring the period of 2011–2014, among the reported 120,809 fatal accidents in the US involving 178,489 drivers of vehicles, 48,733 (28%) were drivers involved in fatal intersection crashes. Age-adjusted annualized fatal intersection crash rates per 100,000 licensed drivers were highest for drivers aged 85 or older (9.89/100,000), followed by 20 years of age (8.93/100,000). Teen and older drivers (55+ years of age) were over-involved in fatal intersection crashes, drivers from 20 to 54 years old were under-involved. Male and female drivers, 70–74 years of age, were 20% and 21%, respectively, more likely to be involved in a fatal intersection crash than 20–24year olds (of same gender). By age 85, fatal intersection crash risk for all drivers was almost doubled. Significant differences in factors related to crashes involving younger (<65) and older (65+ years) drivers were time of day, lighting and weather conditions, day of week, roadway type and number of lanes, presence of visible traffic controls, speed limit and estimated driving speed, and whether the driver was deemed at fault for the crash ConclusionThe results provide the most up-to-date analysis of aging and fatal intersection crash risk in the US, and underscore several trends worthy of further investigation. Older adults face a number of challenges associated with natural aging, including sensory, perceptual, cognitive and motor declines that may impact their driving. As with younger drivers, expanded or renewed approaches to driver training at licensing renewals, as well as safety-based technological advances are viable avenues toward improving the safety outlook for older adults.

The use and safety of medications known to affect driving in Jordan: A cross-sectional study

ABSTRACTObjectives: The aim of this study was to estimate the main driving-impairing medications used by drivers in Jordan, the reported frequency of medication side effects, the frequency of motor vehicle crashes (MVCs) while using driving-impairing medicines, as well as factors associated with MVCs.Methods: A cross-sectional study involving 1,049 individuals (age 18–75 years) who are actively driving vehicles and taking at least one medication known to affect driving (anxiolytics, antidepressants, hypnotics, antiepileptics, opioids, sedating antihistamines, hypoglycemic agents, antihypertensives, central nervous system [CNS] stimulants, and herbals with CNS-related effects) was conducted in Amman, Jordan, over a period of 8 months (September 2013–May 2014) using a structured validated questionnaire.Results: Sixty-three percent of participants noticed a link between a medicine taken and feeling sleepy and 57% stated that they experience at least one adverse effect other than sleepiness from their medication. About 22% of the participants reported having a MVC while on medication. Multiple logistic regression analysis showed that among the participants who reported having a crash while taking a driving-impairing medication, the odds ratios were significantly higher for the use of inhalant substance (odds ratio [OR] = 2.787, P = .014), having chronic conditions (OR = 1.869, P = .001), and use of antiepileptic medications (OR = 2.348, P = .008) and significantly lower for the use of antihypertensives (OR = 0.533, P = .008).Conclusion: The study results show high prevalence of adverse effects of medications with potential for driving impairment, including involvement in MVCs. Our findings highlight the types of patient-related and medication-related factors associated with MVCs in Jordan, such as inhalant use, presence of chronic conditions, and use of antiepileptics.

A Portable Platform for Evaluation of Visual Performance in Glaucoma Patients.

PurposeTo propose a new tablet-enabled test for evaluation of visual performance in glaucoma, the PERformance CEntered Portable Test (PERCEPT), and to evaluate its ability to predict history of falls and motor vehicle crashes.DesignCross-sectional study.MethodsThe study involved 71 patients with glaucomatous visual field defects on standard automated perimetry (SAP) and 59 control subjects. The PERCEPT was based on the concept of increasing visual task difficulty to improve detection of central visual field losses in glaucoma patients. Subjects had to perform a foveal 8-alternative-forced-choice orientation discrimination task, while detecting a simultaneously presented peripheral stimulus within a limited presentation time. Subjects also underwent testing with the Useful Field of View (UFOV) divided attention test. The ability to predict history of motor vehicle crashes and falls was investigated by odds ratios and incident-rate ratios, respectively.ResultsWhen adjusted for age, only the PERCEPT processing speed parameter showed significantly larger values in glaucoma compared to controls (difference: 243ms; P<0.001). PERCEPT results had a stronger association with history of motor vehicle crashes and falls than UFOV. Each 1 standard deviation increase in PERCEPT processing speed was associated with an odds ratio of 2.69 (P = 0.003) for predicting history of motor vehicle crashes and with an incident-rate ratio of 1.95 (P = 0.003) for predicting history of falls.ConclusionA portable platform for testing visual function was able to detect functional deficits in glaucoma, and its results were significantly associated with history of involvement in motor vehicle crashes and history of falls.

Driver license renewal policies and fatal crash involvement rates of older drivers, United States, 1986-2011.

BackgroundOlder drivers experience elevated risk of motor vehicle crash involvement, injury, and death. Several states attempt to address these risks through driver license renewal policies; however, little is known about their effects.MethodsData from 46 U.S. states from years 1986–2011 were examined. Associations between driver licensing policies and population-based fatal crash involvement rates of drivers aged 55 years and older, in 5-year age groups, were estimated using population-averaged negative binomial regression. Estimates were adjusted for seasonality, time trends, other traffic safety laws, and economic factors. Ratios of relative risks (RRR), which compared changes in fatal crash involvement rates of older drivers associated with changes in licensing policies to corresponding changes in fatal crashes of drivers ages 40–54, were computed to account for other possible sources of confounding.ResultsMandatory in-person renewal was associated with a 31% reduction in the fatal crash involvement rates of drivers ages 85 and older (RRR: 0.69, 95% Confidence Interval [CI]: 0.48–0.97). When in-person renewal was not required, requiring drivers to pass a vision test was associated with a similar reduction for drivers ages 85+ (RRR: 0.64, 95% CI: 0.49–0.85). When in-person renewal was required, however, requiring a vision test was not associated with any additional reduction, nor was requiring a knowledge test or an on-road driving test. Requiring more frequent license renewal and requiring healthcare providers to report concerns about patients’ driving ability to licensing authorities were not associated with statistically significant reductions in fatal crash involvement rates of older drivers. No policy examined was found to have a significant impact on fatal crash involvement of drivers younger than 85.ConclusionsRequiring drivers to renew their license in person, or to pass a vision test if not renewing in person, was associated with significant reductions in population-based fatal crash involvement rates for drivers ages 85 and older. The study could not determine how these effects were achieved, for example by specifically removing unsafe older drivers from the driving population or by fostering premature driving cessation. Other policies examined were not found to reduce fatal crash involvement rates of older drivers.